Grassi Walter, Okano Tadashi, Filippucci Emilio
aClinica Reumatologica, Università Politecnica delle Marche, Ospedale C Urbani Via dei Colli, Jesi (Ancona), Italy bDepartment of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Japan.
Curr Opin Rheumatol. 2015 Mar;27(2):147-55. doi: 10.1097/BOR.0000000000000142.
In the latest recommendations for the diagnosis and management of gout and calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, the diagnostic potential of ultrasound has been recognized. This review highlights the recent advances of research on ultrasound in gout and CPPD crystal deposition disease.
Ultrasound allows highly sensitive, noninvasive and quick detection of microcrystal aggregates in multiple anatomic areas. Ultrasound can be used as a safe and reliable guide to aspirate even minimal fluid collections suitable for microscopic analysis, and as a tool for monitoring monosodium urate crystal dissolution induced by urate-lowering therapy. The first metatarsophalangeal joint and the knee should be regarded as the anatomic regions with the highest probability of being respectively positive for monosodium urate and CPPD crystal aggregates.
The detection of highly evocative signs in patients with equivocal clinical findings may have a deep impact on the clinical decision-making process, narrowing the differential diagnostic spectrum and avoiding time-consuming and expensive diagnostic procedures. Ultrasound differential diagnosis between gout and CPPD crystal deposition disease is based on the characteristics of crystal aggregates and their preferential localization in different anatomical areas.
在痛风和焦磷酸钙二水合物（CPPD）晶体沉积病的最新诊断和管理建议中，超声的诊断潜力已得到认可。本综述重点介绍了超声在痛风和CPPD晶体沉积病研究方面的最新进展。
超声能够对多个解剖区域的微晶聚集体进行高度敏感、无创且快速的检测。超声可作为一种安全可靠的引导手段，用于抽取即使是极少的适合显微镜分析的积液，还可作为监测降尿酸治疗引起的尿酸钠晶体溶解的工具。第一跖趾关节和膝关节应被视为分别最有可能存在尿酸钠和CPPD晶体聚集体阳性的解剖区域。
在临床症状不明确的患者中检测出高度提示性的体征，可能会对临床决策过程产生深远影响，缩小鉴别诊断范围，避免耗时且昂贵的诊断程序。痛风和CPPD晶体沉积病的超声鉴别诊断基于晶体聚集体的特征及其在不同解剖区域的优先定位。
