Ultrasound imaging in crystal arthropathies: a pictorial review

Submitted: 10 April 2023
Accepted: 8 August 2023
Published: 19 December 2023
Abstract Views: 1111
PDF: 435
SUPPLEMENTARY MATERIAL: 131
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Objective. The prevalence of crystal arthropathies in the general population is rising. The purpose of this pictorial study is to describe the sonographic elements of the most prevalent crystal arthropathies by emphasizing particular sonographic findings using illustrative images and cases while considering technical details and common pitfalls.

Methods. Using established recommendations, specialists in the fields of sonography and crystal arthropathies agreed by consensus on the unique ultrasound signs associated with each of the conditions.

Results. Gout, calcium pyrophosphate deposition arthropathy, and hydroxyapatite arthropathy are the three most prevalent crystal arthropathies. Today’s high-resolution sonography enables reliable evaluation of the underlying crystal deposits, post-inflammatory changes, and a precise description of joint inflammation.

Conclusions. High-prevalence crystal arthropathies are reliably detectable by ultrasound with current ultrasound equipment. It is necessary to have extensive ultrasound training, know specific sonographic findings, and understand all possible differential diagnoses for disorders affecting the musculoskeletal system.

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Tamborrini G, Dubs B, Krebs A, Ziswiler H-R, Bianchi S. [CME Sonography 101/Answers: Ultrasound of the Musculoskeletal System - Update 2021]. Praxis (Bern 1994). 2021; 110: 698-9. DOI: https://doi.org/10.1024/1661-8157/a003726
Filippou G, Scirè CA, Damjanov N, Adinolfi A, Carrara G, Picerno V, et al. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J Rheumatol. 2017; 44: 1744-9. DOI: https://doi.org/10.3899/jrheum.161057
Filippou G, Scirè CA, Adinolfi A, Damjanov NS, Carrara G, Bruyn GAW, et al. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. Ann Rheum Dis. 2018; 77: 1194-9. DOI: https://doi.org/10.1136/annrheumdis-2017-212542
Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis. 2021; 80: 261-7. DOI: https://doi.org/10.1136/annrheumdis-2020-217998
D’Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, et al. Scoring ultrasound synovitis in rheumatoid arthritis: A EULAR-OMERACT ultrasound taskforce - Part 1: Definition and development of a standardised, consensus-based scoring system. RMD Open 2017;3. Available at: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L617315921. DOI: https://doi.org/10.1136/rmdopen-2016-000428
Ricci V, Ricci C, Tamborrini G, Chang K-V, Mezian K, Zunica F, et al. From histology to sonography in synovitis: EURO-MUSCULUS/USPRM approach. Pathol Res Pract. 2023; 241: 154273. DOI: https://doi.org/10.1016/j.prp.2022.154273
Zufferey P, Tamborrini G, Gabay C, Krebs A, Kyburz D, Michel B, et al. Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience. Swiss Med Wkly. 2013; 143: w13861. DOI: https://doi.org/10.4414/smw.2013.13861
Naredo E, Uson J, Jiménez-Palop M, Martínez A, Vicente E, Brito E, et al. Ultrasound-detected musculoskeletal urate crystal deposition: which joints and what findings should be assessed for diagnosing gout? Ann Rheum Dis. 2014; 73: 1522-8. DOI: https://doi.org/10.1136/annrheumdis-2013-203487
Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D’Agostino MA, Iagnocco A, et al. Power and Color Doppler Ultrasound Settings for Inflammatory Flow: Impact on Scoring of Disease Activity in Patients With Rheumatoid Arthritis: Power and Color Doppler Ultrasound Comparison. Arthritis Rheumatol. 2015; 67: 386-95. DOI: https://doi.org/10.1002/art.38940
Torp-Pedersen ST, Terslev L. Settings and artefacts relevant in colour/power Doppler ultrasound in rheumatology. Ann Rheum Dis. 2008; 67: 143-9. DOI: https://doi.org/10.1136/ard.2007.078451
Costantino F, Carmona L, Boers M, Backhaus M, Balint PV, Bruyn GA, et al. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis. 2021; 80: 840-7. DOI: https://doi.org/10.1136/annrheumdis-2020-219816
Filippou G, Filippucci E, Tardella M, Bertoldi I, Di Carlo M, Adinolfi A, et al. Extent and distribution of CPP deposits in patients affected by calcium pyrophosphate dihydrate deposition disease: an ultrasonographic study. Ann Rheum Dis. 2013; 72: 1836-9. DOI: https://doi.org/10.1136/annrheumdis-2012-202748
Löffler C, Sattler H, Peters L, Tuleweit A, Löffler U, Wadsack D, et al. In arthritis the Doppler based degree of hypervascularisation shows a positive correlation with synovial leukocyte count and distinguishes joints with leukocytes greater and less than 5/nL. Joint Bone Spine. 2016; 83: 517-23. DOI: https://doi.org/10.1016/j.jbspin.2015.09.007
Cocco G, Ricci V, Villani M, Delli Pizzi A, Izzi J, Mastandrea M, et al. Ultrasound imaging of bone fractures. Insights Imaging 2022;13:189. DOI: https://doi.org/10.1186/s13244-022-01335-z
Mank VMF, Goldstein E, Babb S, Meghpara S, Breighner C, Roberts J. 20 Years of Radiographic Imaging: Crystalline Deposits Causing Severe Arthropathy and Erosions. Mil Med. 2023; 188: e432-5. DOI: https://doi.org/10.1093/milmed/usab129
Mandl P, Gessl I, Filippou G, Sirotti S, Terslev L, Pineda C, et al. OP0291 Scoring structural damage in rheumatoid arthritis by ultrasound: results from a delphi process and web-reliability exercise by the omeract us working group. Ann Rheum Dis. 2022; 81: 193-4. DOI: https://doi.org/10.1136/annrheumdis-2022-eular.3359
Wright SA, Filippucci E, McVeigh C, Grey A, McCarron M, Grassi W, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Ann Rheum Dis. 2007; 66: 859-64. DOI: https://doi.org/10.1136/ard.2006.062802
Pecherstorfer C, Simon D, Unbehend S, Ellmann H, Englbrecht M, Hartmann F, et al. A Detailed Analysis of the Association between Urate Deposition and Erosions and Osteophytes in Gout. ACR Open Rheumatol. 2020; 2: 565-72. DOI: https://doi.org/10.1002/acr2.11172
WuM,LiuFJ,ChenJ,ChenL,WeiC,HuZM, et al. Prevalence and Factors Associated With Bone Erosion in Patients With Gout. Arthritis Care Res (Hoboken). 2019; 71: 1653-9. DOI: https://doi.org/10.1002/acr.23816
Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, et al. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis. 2016; 75: 402-7. DOI: https://doi.org/10.1136/annrheumdis-2014-206289
Mathiessen A, Haugen IK, Slatkowsky-Christensen B, Bøyesen P, Kvien TK, Hammer HB. Ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis: exploring reliability and associations with MRI, radiographs and clinical joint findings. Ann Rheum Dis. 2013; 72: 51-6. DOI: https://doi.org/10.1136/annrheumdis-2011-201195
Persons B, Kissin EY. Scruples over Speckles. J Med Ultrasound. 2020; 28: 179-80. DOI: https://doi.org/10.4103/JMU.JMU_122_19
Tedeschi SK, Becce F, Pascart T, Guermazi A, Budzik J-F, Dalbeth N, et al. Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group. Arthritis Care Res (Hoboken). 2023; 75: 825-34. DOI: https://doi.org/10.1002/acr.24898
Filippou G, Sirotti S. How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification. Curr Opin Rheumatol. 2023; 35: 185-93. DOI: https://doi.org/10.1097/BOR.0000000000000939
Gamon E, Combe B, Barnetche T, Mouterde G. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease: a systematic review and meta-analysis. RMD Open. 2015; 1: e000118. DOI: https://doi.org/10.1136/rmdopen-2015-000118
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: 254-60.
Sirotti S, Gutierrez M, Pineda C, Clavijo-Cornejo D, Serban T, Dumitru A, et al. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group - CPPD subgroup. Reumatismo. 2021; 73: 106-10. DOI: https://doi.org/10.4081/reumatismo.2021.1403
McCarthy GM, Dunne A. Calcium crystal deposition diseases - beyond gout. Nat Rev Rheumatol. 2018; 14: 592-602. DOI: https://doi.org/10.1038/s41584-018-0078-5
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; 29: 619-32. DOI: https://doi.org/10.1016/j.joca.2021.01.007
Cipolletta E, Abhishek A, Di Matteo A, Grassi W, Filippucci E. Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease. RMD Open. 2023; 9: e002940. DOI: https://doi.org/10.1136/rmdopen-2022-002940
Filippou G, Miguel-Pérez M, Bong D, Coronel L, Sirotti S, Pacini G, et al. The ultrasonographic “pseudo-double contour” sign in calcium pyrophosphate deposition disease. Arthritis Rheumatol. 2023; 75. DOI: https://doi.org/10.1002/art.42397
Girish G, Melville DM, Kaeley GS, Brandon CJ, Goyal JR, Jacobson JA, et al. Imaging appearances in gout. Arthritis. 2013; 2013: 673401. DOI: https://doi.org/10.1155/2013/673401
Grassi W, Okano T, Filippucci E. Use of ultrasound for diagnosis and monitoring of outcomes in crystal arthropathies. Curr Opin Rheumatol. 2015; 27: 147-55. DOI: https://doi.org/10.1097/BOR.0000000000000142
Xu G, Lin J, Liang J,YangY,Ye Z, Zhu G, et al. Entheseal involvement of the lower extremities in gout: an ultrasonographic descriptive observational study. Clin Rheumatol. 2021; 40: 4649-57. DOI: https://doi.org/10.1007/s10067-021-05826-0
35. Perez-Ruiz F, Marimon E, Chinchilla SP. Hyperuricaemia with deposition: latest evidence and therapeutic approach. Ther Adv Musculoskelet Dis. 2015; 7: 225-33. DOI: https://doi.org/10.1177/1759720X15599734
36. Ferrari AJL, Corrêa Fernandes AR, De Almeida Agustinelli R, Seike H, De Ávila Fernandes E. Tophi reduction: ultrasound imaging and correlation with plasma levels of uric acid in patients undergoing treatment for tophaceous gout. Reumatismo. 2019; 71: 75-80. DOI: https://doi.org/10.4081/reumatismo.2019.1058
Christiansen SN, Østergaard M, Slot O, Keen H, Bruyn GAW, D’Agostino MA, et al. Assessing the sensitivity to change of the OMERACT ultrasound structural gout lesions during urate-lowering therapy. RMD Open. 2020; 6: e001144. DOI: https://doi.org/10.1136/rmdopen-2019-001144
Tamborrini G, Distler O, Schmet M, Michel BA. Mixed crystal-induced arthropathy-a rare finding. Clin Exp Rheumatol. 2010; 28: 801.
Wu W-T, Chang K-V, Hsu Y-C, Hsu P-C, Ricci V, Özçakar L. Artifacts in Musculoskeletal Ultrasonography: From Physics to Clinics. Diagnostics (Basel). 2020; 10: 645. DOI: https://doi.org/10.3390/diagnostics10090645
Ricci V, Mezian K, Chang K-V, Özçakar L. Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics (Basel). 2022; 12: 3097. DOI: https://doi.org/10.3390/diagnostics12123097
Chiou HJ, Chou YH, Wu JJ, Huang TF, Ma HL, Hsu CC, et al. The role of high-resolution ultrasonography in management of calcific tendonitis of the rotator cuff. Ultrasound Med Biol. 2001; 27: 735-43. DOI: https://doi.org/10.1016/S0301-5629(01)00353-2
Filippou G, Pacini G, Sirotti S, Zadory M, Carboni D, Damiani A, et al. Comparison of ultrasound attenuation by calcium pyrophosphate, hydroxyapatite and monosodium urate crystals: a proof-of-concept study. Ann Rheum Dis. 2022; 81: 1199-201. DOI: https://doi.org/10.1136/annrheumdis-2022-222316

How to Cite

Tamborrini, G., Hügle, T., Ricci, V., & Filippou, G. (2023). Ultrasound imaging in crystal arthropathies: a pictorial review. Reumatismo, 75(4). https://doi.org/10.4081/reumatismo.2023.1583