Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea.
Osteoarthritis Cartilage. 2019 May;27(5):781-787. doi: 10.1016/j.joca.2018.11.013. Epub 2019 Feb 6.
To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter- and intra-observer reliability.
We consecutively included patients with knee effusion over a 2-year period (43 patients with CPPD and 131 controls). All patients underwent SF analysis, conventional radiography (CR), and US examination using the Outcome Measures in Rheumatology (OMERACT) definition of the US characteristics of CPPD. Two independent operators performed the US, and inter-observer agreement was calculated. Intra-observer agreement was examined with static images obtained for all enrolled patients.
US revealed calcium pyrophosphate (CPP) deposits in menisci, HC, and tendon more frequently in patients with CPPD than in control patients. The presence of US CPP deposits in SF was not significantly different between the two groups. Combined US evaluation of the three components (menisci, HC, and tendon) showed the best diagnostic performance. The sensitivity and specificity for US evaluation of the three components were 74.4% and 77.1%, respectively, while for CR evaluation, the sensitivity and specificity were 44.2% and 96.9%, respectively. Inter- and intra-observer agreement were excellent for medial (κ = 0.930, 0.972) and lateral menisci (κ = 0.905, 0.942), HC (κ = 0.844, 0.957), and SF (κ = 0.817, 0.925). Tendon showed fair inter-observer (κ = 0.532) and good intra-observer reliability (κ = 0.788).
Based on the OMERACT definition, US demonstrated better diagnostic capacity than CR to diagnose CPPD, with excellent reliability. Combined evaluation of menisci, HC, and tendon showed the best diagnostic accuracy.
评估超声（US）在半月板、透明软骨（HC）、肌腱和膝关节滑液（SF）中钙焦磷酸盐（CPP）沉积的诊断性能，并检查其观察者间和观察者内的可靠性。
我们连续纳入了 2 年内膝关节积液的患者（43 例 CPPD 患者和 131 例对照组）。所有患者均接受 SF 分析、常规放射摄影（CR）和 US 检查，采用 OMERACT 对 CPPD 的 US 特征的定义。两名独立的操作人员进行 US 检查，并计算观察者间的一致性。通过对所有纳入患者的静态图像进行检查，评估观察者内的一致性。
US 显示 CPPD 患者的半月板、HC 和肌腱中 CPP 沉积比对照组更频繁。两组患者 SF 中 CPP 沉积的存在无明显差异。对三个部位（半月板、HC 和肌腱）的联合 US 评估显示出最佳的诊断性能。三个部位的 US 评估的敏感性和特异性分别为 74.4%和 77.1%，而 CR 评估的敏感性和特异性分别为 44.2%和 96.9%。内侧（κ=0.930，0.972）和外侧半月板（κ=0.905，0.942）、HC（κ=0.844，0.957）和 SF（κ=0.817，0.925）的观察者间和观察者内一致性均为优。肌腱的观察者间一致性为中等（κ=0.532），观察者内一致性为良好（κ=0.788）。
根据 OMERACT 定义，US 诊断 CPPD 的诊断能力优于 CR，具有良好的可靠性。半月板、HC 和肌腱的联合评估显示出最佳的诊断准确性。
