腕关节超声与 X 线摄影在焦磷酸钙沉积症诊断中的比较。

Comparison of ultrasonography and radiography of the wrist for diagnosis of calcium pyrophosphate deposition.

机构信息

Service de rhumatologie, hôpital Bichat, université Paris Diderot, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.

出版信息

Joint Bone Spine. 2018 Oct;85(5):615-618. doi: 10.1016/j.jbspin.2017.09.006. Epub 2017 Sep 28.

DOI:10.1016/j.jbspin.2017.09.006

PMID:28965942

Abstract

OBJECTIVE

Ultrasound (US) seems a useful tool for diagnosis of calcium pyrophosphate (CPP) deposition (CPPD). We aimed to compare the performance of US and conventional radiography of the wrist for diagnosis of CPPD.

METHODS

Patients with CPP crystals identified in synovial fluid (SF) (knee, hip, shoulder, ankle or wrist) were consecutively included and compared to patients without CPP crystals in synovial fluid considered as controls. As recommended, we used the term chondrocalcinosis (CC) to assess imaging features suggesting CPPD. In all patients, US and radiographic assessment of CC of the wrists was performed by two distinct operators blinded each other (one operator by imaging modality). The two operators were blinded to clinical data, SF analysis and US or radiography findings.

RESULTS

We included 32 CPPD patients and 26 controls. Among CPPD patients, US revealed CC in 30 (93.7%) and radiography in 17 (53.1%) (P<0.001). The sensitivity and specificity of US for the diagnosis of CPPD were 94% and 85%, respectively; the positive likelihood ratio (LR+) was 6.1. The sensitivity and specificity of radiography were 53.1% and 100%, respectively. At joints level independently of SF analysis, US revealed CC in 35 joints without radiographic CC whereas X-rays showed CC in 3 joints without US CC. The κ coefficient between US and radiography for CC was moderate: 0.33 (0.171-0.408).

CONCLUSION

Our study suggests that wrist US should be considered as a relevant tool for the diagnosis of CPPD, with higher sensitivity than radiography for detecting CPP deposits.

摘要

目的

超声（US）似乎是诊断焦磷酸钙（CPP）沉积（CPPD）的有用工具。我们旨在比较手腕 US 和常规 X 射线摄影对 CPPD 的诊断性能。

方法

连续纳入关节滑液（SF）中存在 CPP 晶体（膝关节、髋关节、肩关节、踝关节或腕关节）的患者，并与 SF 中无 CPP 晶体的患者进行比较，后者被认为是对照组。根据建议，我们使用术语软骨钙质沉着症（CC）来评估提示 CPPD 的影像学特征。在所有患者中，由两位彼此盲法的不同操作者进行腕关节 CC 的 US 和放射学评估（一位操作者通过影像学模式）。两位操作者均对临床数据、SF 分析以及 US 或放射学结果均不知情。

结果

我们纳入了 32 例 CPPD 患者和 26 例对照组。在 CPPD 患者中，US 显示 CC 存在于 30 例（93.7%），而 X 射线显示 CC 存在于 17 例（53.1%）（P<0.001）。US 诊断 CPPD 的敏感性和特异性分别为 94%和 85%，阳性似然比（LR+）为 6.1。X 射线的敏感性和特异性分别为 53.1%和 100%。在独立于 SF 分析的关节水平上，US 显示 35 个关节存在 CC 而 X 射线无 CC，而 X 射线显示 3 个关节存在 CC 而 US 无 CC。US 和 X 射线对 CC 的κ系数为中度：0.33（0.171-0.408）。