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Chondrocalcinosis: Advances in Diagnostic Imaging

  • Imaging (J Samuels, Section Editor)
  • Published:
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Abstract

Purpose of Review

Calcium pyrophosphate deposition disease (CPPD) arises from calcium pyrophosphate deposition throughout the body, leading to different clinical syndromes that may be diagnosed using various imaging modalities. The purpose of this review is to highlight recent updates in the imaging of CPPD.

Recent Findings

Conventional radiography remains the initial test when imaging CPPD; but musculoskeletal ultrasound and conventional computed tomography (CT) may also assist in diagnosing and characterizing CPP deposits, with increased sensitivity. Dual-energy CT is also being used to differentiate CPP crystals from other crystal deposition diseases. CPP discitis has been diagnosed with MRI, but MRI has lower sensitivity and specificity than the aforementioned imaging studies in CPPD diagnosis.

Summary

Assorted imaging modalities are increasingly used to diagnose CPPD involving atypical joints, avoiding invasive procedures. Each modality has its advantages and disadvantages. Future imaging may be able to provide more utility than what is currently available.

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References

Papers of particular interest, published recently have been highlighted as: • Of importance • • Of major importance

  1. Miksanek J, Rosenthal AK. Imaging of calcium pyrophosphate deposition disease. Curr Rheumatol Rep. 2015;17(3):20. https://doi.org/10.1007/s11926-015-0496-1.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Zhang W, Doherty M, Bardin T, Barskova V, Guerne PA, Jansen TL, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 2011;70(4):563–70. https://doi.org/10.1136/ard.2010.139105.

    Article  PubMed  CAS  Google Scholar 

  3. Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016;374(26):2575–84. https://doi.org/10.1056/NEJMra1511117.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Segal JB, Albert D. Diagnosis of crystal-induced arthritis by synovial fluid examination for crystals: lessons from an imperfect test. Arthritis Care Res. 1999;12(6):376–80. https://doi.org/10.1002/1529-0131(199912)12:6%3c376::aid-art5%3e3.0.co;2-5.

    Article  PubMed  CAS  Google Scholar 

  5. Announ N, Guerne PA. [Diagnosis and treatment of calcium pyrophosphate crystal-induced arthropathy]. Z Rheumatol. 2007;66(7):573–4, 6–8. https://doi.org/10.1007/s00393-007-0221-1.

    Article  PubMed  CAS  Google Scholar 

  6. Filippou G, Adinolfi A, Cimmino MA, Scirè CA, Carta S, Lorenzini S, et al. Diagnostic accuracy of ultrasound, conventional radiography and synovial fluid analysis in the diagnosis of calcium pyrophosphate dihydrate crystal deposition disease. Clin Exp Rheumatol. 2016;34(2):254–60.

    PubMed  Google Scholar 

  7. Forien M, Combier A, Gardette A, Palazzo E, Dieudé P, Ottaviani S. Comparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition. Joint Bone Spine. 2018;85(5):615–8. https://doi.org/10.1016/j.jbspin.2017.09.006.

    Article  PubMed  Google Scholar 

  8. O'Neill J, (ed). Essential imaging in rheumatology. Crystal-Related Disease. New York: Springer Science+Business Media; 2015.

  9. Resnick D, Niwayama G, Goergen TG, Utsinger PD, Shapiro RF, Haselwood DH, et al. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD): pseudogout. Radiology. 1977;122(1):1–15. https://doi.org/10.1148/122.1.1.

    Article  PubMed  CAS  Google Scholar 

  10. • Cho NH, Song Y, Lee S, Sung YK, Jun JB. Incidence of knee chondrocalcinosis and its risk factors in a community-based cohort. Int J Rheum Dis. 2018;21(7):1391–7. https://doi.org/10.1111/1756-185x.13317. This was a large epidemiologic study that showed the incidence of knee chondrocalcinosis.

  11. Musacchio E, Ramonda R, Perissinotto E, Sartori L, Hirsch R, Punzi L, et al. The impact of knee and hip chondrocalcinosis on disability in older people: the ProVA Study from northeastern Italy. Ann Rheum Dis. 2011;70(11):1937–43. https://doi.org/10.1136/ard.2011.150508.

    Article  PubMed  Google Scholar 

  12. Falkowski AL, Jacobson JA, Kalia V, Meyer NB, Gandikota G, Yosef M, et al. Cartilage icing and chondrocalcinosis on knee radiographs in the differentiation between gout and calcium pyrophosphate deposition. PLoS ONE. 2020;15(4):e0231508. https://doi.org/10.1371/journal.pone.0231508.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Abhishek A, Doherty S, Maciewicz R, Muir K, Zhang W, Doherty M. Chondrocalcinosis is common in the absence of knee involvement. Arthritis Res Ther. 2012;14(5):R205. https://doi.org/10.1186/ar4043.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Frediani B, Filippou G, Falsetti P, Lorenzini S, Baldi F, Acciai C, et al. Diagnosis of calcium pyrophosphate dihydrate crystal deposition disease: ultrasonographic criteria proposed. Ann Rheum Dis. 2005;64(4):638–40. https://doi.org/10.1136/ard.2004.024109.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Lee KA, Lee SH, Kim HR. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint. Osteoarthritis Cartilage. 2019;27(5):781–7. https://doi.org/10.1016/j.joca.2018.11.013.

    Article  PubMed  Google Scholar 

  16. Cipolletta E, Filippou G, Scirè CA, Di Matteo A, Di Battista J, Salaffi F, et al. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 2021. https://doi.org/10.1016/j.joca.2021.01.007.

  17. Patil P, Dasgupta B. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis. 2012;4(5):341–55. https://doi.org/10.1177/1759720x12442112.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aouba A, Vuillemin-Bodaghi V, Mutschler C, De Bandt M. Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases. Rheumatology (Oxford). 2004;43(12):1508–12. https://doi.org/10.1093/rheumatology/keh370.

    Article  CAS  Google Scholar 

  19. Haikal A, Everist BM, Jetanalin P, Maz M. Cervical CT-dependent diagnosis of crowned dens syndrome in calcium pyrophosphate dihydrate crystal deposition disease. Am J Med. 2020;133(2):e32–7. https://doi.org/10.1016/j.amjmed.2019.06.050.

    Article  PubMed  CAS  Google Scholar 

  20. • Ziegeler K, Diekhoff T, Hermann S, Hamm B, Hermann KGA. Low-dose computed tomography as diagnostic tool in calcium pyrophosphate deposition disease arthropathy: focus on ligamentous calcifications of the wrist. Clin Exp Rheumatol. 2019;37(5):826–33. This was a study that showed that low-dose CT can be effective in diagnosing CPPD arthropathy, thereby decreasing the amount of radiation exposure to patients.

  21. •• Døssing A, Müller FC, Becce F, Stamp L, Bliddal H, Boesen M. Dual-energy computed tomography for detection and characterization of monosodium urate, calcium pyrophosphate, and hydroxyapatite: a phantom study on diagnostic performance. Invest Radiol. 2021. https://doi.org/10.1097/rli.0000000000000756. This was an important recent study that showed how dual-energy CT under standard imaging settings, can be used to differentiate between different forms of crystal arthropathy, particularly monosodium urate deposition (gout), calcium pyrophosphate deposition, and hydroxyapatite deposition, thereby making it a key noninvasive imaging modality to help differentiate between common crystal arthropathies.

  22. Tedeschi SK, Solomon DH, Yoshida K, Vanni K, Suh DH, Smith SE. A prospective study of dual-energy CT scanning, US and X-ray in acute calcium pyrophosphate crystal arthritis. Rheumatology (Oxford). 2020;59(4):900–3. https://doi.org/10.1093/rheumatology/kez431.

    Article  Google Scholar 

  23. •• Budzik JF, Marzin C, Legrand J, Norberciak L, Becce F, Pascart T. Can dual-energy computed tomography be used to identify early calcium crystal deposition in the knees of patients with calcium pyrophosphate deposition? Arthritis Rheumatol. 2021;73(4):687–92. https://doi.org/10.1002/art.41569. This was another important recent study on dual-energy CT that reinforced its ability in detecting CPP deposition in the knees before it is picked up on plain radiographs, thereby allowing for earlier non-invasive diagnosis.

  24. Rougé-Labriet H, Berujon S, Mathieu H, Bohic S, Fayard B, Ravey JN, et al. X-ray Phase Contrast osteo-articular imaging: a pilot study on cadaveric human hands. Sci Rep. 2020;10(1):1911. https://doi.org/10.1038/s41598-020-58168-3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Finkenstaedt T, Biswas R, Abeydeera NA, Siriwanarangsun P, Healey R, Statum S, et al. Ultrashort time to echo magnetic resonance evaluation of calcium pyrophosphate crystal deposition in human menisci. Invest Radiol. 2019;54(6):349–55. https://doi.org/10.1097/rli.0000000000000547.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Suan JC, Chhem RK, Gati JS, Norley CJ, Holdsworth DW. 4 T MRI of chondrocalcinosis in combination with three-dimensional CT, radiography, and arthroscopy: a report of three cases. Skeletal Radiol. 2005;34(11):714–21. https://doi.org/10.1007/s00256-005-0930-y.

    Article  PubMed  CAS  Google Scholar 

  27. Moshrif A, Laredo JD, Bassiouni H, Abdelkareem M, Richette P, Rigon MR, et al. Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients. Semin Arthritis Rheum. 2019;48(6):1113–26. https://doi.org/10.1016/j.semarthrit.2018.10.009.

    Article  PubMed  CAS  Google Scholar 

  28. Li B, Singer NG, Yeni YN, Haggins DG, Barnboym E, Oravec D, et al. A Point-of-care Raman spectroscopy-based device for the diagnosis of gout and pseudogout: comparison with the clinical standard microscopy. Arthritis Rheumatol. 2016;68(7):1751–7. https://doi.org/10.1002/art.39638.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA

    Jeremy Sullivan, Michael H. Pillinger & Michael Toprover

  2. Rheumatology Section, New York Harbor Health Care System, NY Campus of the U.S. Department of Veterans Affairs, New York, NY, USA

    Michael H. Pillinger & Michael Toprover

  3. NYU Langone Orthopedic Hospital, 301 E 17th Street, Suite 1410, New York, NY, 10003, USA

    Michael Toprover

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  1. Jeremy Sullivan
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Correspondence to Michael Toprover.

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The authors declare that this article complies with ethics guidelines.

Conflict of Interest

JS reports no conflicts of interest. MHP is supported in part by grant 2UL1 TR001445-06A1 from the National Center for the Advancement of Translational Science of the National Institutes of Health, has received investigator-initiated grants from Horizon Therapeutics and Hikma Pharmaceuticals, and has served as a consultant for Horizon Therapeutics. MT has received investigator-initiated grants from Horizon Therapeutics and has served as a consultant for Horizon Therapeutics.

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Sullivan, J., Pillinger, M.H. & Toprover, M. Chondrocalcinosis: Advances in Diagnostic Imaging. Curr Rheumatol Rep 23, 77 (2021). https://doi.org/10.1007/s11926-021-01044-4

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