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Yan YY, Dous YNB, Ouellette HA, Munk PL, Murray N, Mallinson PI, Sheikh MA. Periarticular calcifications. Skeletal Radiol 2022; 51:451-475. [PMID: 34155550 DOI: 10.1007/s00256-021-03842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic, vascular, and foreign bodies. With careful consideration of the clinical and imaging findings as well as awareness of mimickers of periarticular mineralization, the list of differential diagnoses can be narrowed down. This article aims to review the clinical-radiologic findings of periarticular calcified or ossified lesions with relevant imaging illustrations.
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Affiliation(s)
- Y Y Yan
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. .,Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Y N Bin Dous
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - H A Ouellette
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P L Munk
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - N Murray
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P I Mallinson
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - M A Sheikh
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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The role of dual energy computed tomography in the differentiation of acute gout flares and acute calcium pyrophosphate crystal arthritis. Clin Rheumatol 2021; 41:223-233. [PMID: 34626261 PMCID: PMC8724058 DOI: 10.1007/s10067-021-05949-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/27/2022]
Abstract
Objectives To analyse the diagnostic impact of dual energy computed tomography (DECT) in acute gout flares and acute calcium pyrophosphate (CPP) crystal arthritis when compared to the gold standard of arthrocentesis with compensated polarised light microscopy. Microscopy results were also compared to musculoskeletal ultrasound (MUS), conventional radiographs, and the suspected clinical diagnosis (SCD). Methods Thirty-six patients with a suspected gout flare (n = 24) or acute CPP crystal arthritis (n = 11, n = 1 suffered from neither) who received a DECT and underwent arthrocentesis were included. Two independent readers assessed DECT images for signs of monosodium urate crystals or calcium pyrophosphate deposition. Results Sensitivity of DECT for gout was 63% (95% CI 0.41–0.81) with a specificity of 92% (0.41–0.81) while sensitivity and specificity for acute CPP arthritis were 55% (0.23–0.83) and 92% (0.74–0.99), respectively. MUS had the highest sensitivity of all imaging modalities with 92% (0.73–0.99) and a specificity of 83% (0.52–0.98) for gout, while sensitivity and specificity for acute CPP crystal arthritis were 91% (0.59–1.00) and 92% (0.74–0.99), respectively. Conclusion DECT is an adequate non-invasive diagnostic tool for acute gout flares but might have a lower sensitivity than described by previous studies. Both MUS and SCD had higher sensitivities than DECT for acute gout flares and acute CPP crystal arthritis. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-021-05949-4.
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A New Outlook on the Ability to Accumulate an Iodine Contrast Agent in Solid Lung Tumors Based on Virtual Monochromatic Images in Dual Energy Computed Tomography (DECT): Analysis in Two Phases of Contrast Enhancement. J Clin Med 2021; 10:jcm10091870. [PMID: 33925945 PMCID: PMC8123482 DOI: 10.3390/jcm10091870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
For some time, dual energy computed tomography (DECT) has been an established method used in a vast array of clinical applications, including lung nodule assessment. The aim of this study was to analyze (using monochromatic DECT images) how the X-ray absorption of solitary pulmonary nodules (SPNs) depends on the iodine contrast agent and when X-ray absorption is no longer dependent on the accumulated contrast agent. Sixty-six patients with diagnosed solid lung tumors underwent DECT scans in the late arterial phase (AP) and venous phase (VP) between January 2017 and June 2018. Statistically significant correlations (p ≤ 0.001) of the iodine contrast concentration were found in the energy range of 40–90 keV in the AP phase and in the range of 40–80 keV in the VP phase. The strongest correlation was found between the concentrations of the contrast agent and the scanning energy of 40 keV. At the higher scanning energy, no significant correlations were found. We concluded that it is most useful to evaluate lung lesions in DECT virtual monochromatic images (VMIs) in the energy range of 40–80 keV. We recommend assessing SPNs in only one phase of contrast enhancement to reduce the absorbed radiation dose.
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Agostini A, Borgheresi A, Mari A, Floridi C, Bruno F, Carotti M, Schicchi N, Barile A, Maggi S, Giovagnoni A. Dual-energy CT: theoretical principles and clinical applications. Radiol Med 2019; 124:1281-1295. [PMID: 31792703 DOI: 10.1007/s11547-019-01107-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023]
Abstract
The physical principles of dual-energy computed tomography (DECT) are as old as computed tomography (CT) itself. To understand the strengths and the limits of this technology, a brief overview of theoretical basis of DECT will be provided. Specific attention will be focused on the interaction of X-rays with matter, on the principles of attenuation of X-rays in CT toward the intrinsic limits of conventional CT, on the material decomposition algorithms (two- and three-basis-material decomposition algorithms) and on effective Rho-Z methods. The progresses in material decomposition algorithms, in computational power of computers and in CT hardware, lead to the development of different technological solutions for DECT in clinical practice. The clinical applications of DECT are briefly reviewed in relation to the specific algorithms.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy.
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy.
| | - Alessandra Borgheresi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Alberto Mari
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Chiara Floridi
- Department of Health Sciences, Diagnostic and Interventional Radiology, Hospital "San Paolo", University of Milan, Milan, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Marina Carotti
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Nicolò Schicchi
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy
| | - Stefania Maggi
- Department of Radiology - Division of Medical Physics, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona, Italy
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Via Conca 71, 60126, Ancona, AN, Italy
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Dual-Energy CT in Musculoskeletal Imaging: What Is the Role Beyond Gout? AJR Am J Roentgenol 2019; 213:493-505. [DOI: 10.2214/ajr.19.21095] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zell M, Zhang D, FitzGerald J. Diagnostic advances in synovial fluid analysis and radiographic identification for crystalline arthritis. Curr Opin Rheumatol 2019; 31:134-143. [PMID: 30601230 PMCID: PMC6377265 DOI: 10.1097/bor.0000000000000582] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The present review addresses diagnostic methods for crystalline arthritis including synovial fluid analysis, ultrasound, and dual energy CT scan (DECT). RECENT FINDINGS There are new technologies on the horizon to improve the ease, sensitivity, and specificity of synovial fluid analysis. Raman spectroscopy uses the spectral signature that results from a material's unique energy absorption and scatter for crystal identification. Lens-free microscopy directly images synovial fluid aspirate on to a complementary metal-oxide semiconductor chip, providing a high-resolution, wide field of view (∼20 mm) image. Raman spectroscopy and lens-free microscopy may provide additional benefit over compensated polarized light microscopy synovial fluid analysis by quantifying crystal density in synovial fluid samples. Ultrasound and DECT have good sensitivity and specificity for the identification of monosodium urate (MSU) and calcium pyrophosphate (CPP) crystals. However, both have limitations in patients with recent onset gout and low urate burdens. SUMMARY New technologies promise improved methods for detection of MSU and CPP crystals. At this time, limitations of these technologies do not replace the need for synovial fluid aspiration for confirmation of crystal detection. None of these technologies address the often concomitant indication to rule out infectious arthritis.
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Affiliation(s)
- Monica Zell
- David Geffen School of Medicine, University of California at Los Angeles, Department of Medicine
| | - Dawen Zhang
- David Geffen School of Medicine, University of California at Los Angeles, Department of Medicine
| | - John FitzGerald
- David Geffen School of Medicine, University of California at Los Angeles, Department of Medicine
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Checa A. Ultrasonography, an operator-dependent modality versus dual-energy computed tomography (DECT) in the detection of chondrocalcinosis: with regard to Tanikawa et al.'s study. J Orthop Surg Res 2018; 13:255. [PMID: 30326939 PMCID: PMC6192358 DOI: 10.1186/s13018-018-0953-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Angel Checa
- Lourdes Medical Center Burlington County, Willingboro, NJ, 08046, USA.
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Tanikawa H, Ogawa R, Okuma K, Harato K, Niki Y, Kobayashi S, Nagura T. Detection of calcium pyrophosphate dihydrate crystals in knee meniscus by dual-energy computed tomography. J Orthop Surg Res 2018; 13:73. [PMID: 29622016 PMCID: PMC5887196 DOI: 10.1186/s13018-018-0787-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Calcium pyrophosphate dihydrate (CPPD) crystals are commonly observed in osteoarthritic joints. The aim of our study was to investigate the efficacy of a dual-energy computed tomography (DECT) for detecting CPPD crystals in knee meniscus. METHODS Twenty-six patients undergoing primary total knee arthroplasty were included in the study. Radiographs of knee joint and synovial fluid specimens were analyzed for the presence of CPPD crystals. Meniscus extracted during surgery was scanned using DECT. Sensitivity and specificity of DECT and radiograph for detecting CPPD crystals were calculated against a reference standard (polarizing light microscopy of synovial fluid aspirate). Meniscus in which CPPD crystals were suspected with DECT was further examined to confirm the crystals using a polarized microscopy. RESULTS CPPD crystals in synovial fluid were observed in 9 (36%) patients. The sensitivity and specificity of DECT in the detection of CPPD crystals, against microscopic identification, were 77.8 and 93.8%, respectively. The sensitivity and specificity of conventional radiography in the detection of CPPD crystals were 44.4 and 100%, respectively. DECT was able to detect the area where CPPD crystals were deposited in the meniscus. CONCLUSION DECT provides good diagnostic sensitivity and specificity for detection of CPPD crystals in knee meniscus as well as spatial information about CPPD crystals. DECT is currently a research tool, but we believe that DECT can be a useful instrument to diagnose CPPD deposition disease, especially for the regions where aspiration is difficult to be performed such as pubic symphysis, atlantoaxial joint, interphalangeal joint.
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Affiliation(s)
- Hidenori Tanikawa
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi, Yokohama, Kanagawa, Japan.
| | - Ryo Ogawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinamomachi, Shinjyuku, Tokyo, Japan
| | - Kazunari Okuma
- Department of Orthopaedic Surgery, Saitama City Hospital, 2460 Minuma, Midoriku, Saitamashi, Saitama, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinamomachi, Shinjyuku, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinamomachi, Shinjyuku, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinamomachi, Shinjyuku, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinamomachi, Shinjyuku, Tokyo, Japan
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Dual-Energy Computed Tomography Demonstrating Destructive Calcium Pyrophosphate Deposition Disease of the Distal Radioulnar Joint Mimicking Tophaceous Gout. J Clin Rheumatol 2016; 21:314-7. [PMID: 26267716 DOI: 10.1097/rhu.0000000000000292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Calcium pyrophosphate dihydrate deposition (CPPD) disease is a common etiology of crystalline arthropathy; however, it can manifest in multiple patterns such as acute calcium pyrophosphate (CPP) crystal arthritis, osteoarthritis with CPPD, and chronic CPP crystal inflammatory arthritis. Tumoral or tophaceous-like CPPD is a rare manifestation that is occasionally mistaken for gouty tophus or a soft tissue malignancy. Dual-energy computed tomography (DECT) is a new imaging modality currently utilized in assessing monosodium urate crystal deposition; however, its value in CPPD is uncertain. We describe a case using DECT to diagnose tumoral CPPD mimicking tophaceous gout versus recurrence of a previous synovial sarcoma. The imaging findings on DECT prevented unnecessary surgery to assess for possible malignancy, allowing for the prompt diagnosis of tumoral CPPD. Further studies should be performed to determine the role of DECT in assessing for crystalline deposition disease other than gout.
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Abstract
Calcium pyrophosphate deposition disease (CPPD) is a common and clinically heterogeneous form of arthritis caused by the deposition of calcium pyrophosphate (CPP) crystals in articular tissues. The diagnosis of CPPD is supported by the presence of radiographic chondrocalcinosis; yet, conventional radiography detects only about 40 % of clinically important CPPD. Here, we critically review the recent literature on imaging in CPPD. New studies inform our use of conventional radiographic screening methodologies for CPPD and provide additional evidence for the utility of diagnostic ultrasound. Recent work also highlights the polyarticular nature of CPPD, its association with tissue damage, and the high prevalence of tendon involvement. While dual energy CT and diffraction-enhanced synchrotron imaging remain research tools, they present potential avenues for improved visualization of CPP deposits. Advances in imaging in CPPD will increase diagnostic accuracy and eventually result in better management of this common form of arthritis.
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Affiliation(s)
- Jennifer Miksanek
- Division of Rheumatology, Department of Medicine, Medical College of Wisconsin and the Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, WI, 53295-1000, USA,
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