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New Developments in Imaging in Crystalline Arthritis.

Ralf G Thiele¹

¹Department of Medicine, Allergy/Immunology & Rheumatology Division, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 695, Rochester, NY 14642, USA.

Rheumatic Diseases Clinics of North America

|October 17, 2024

Summary

Imaging techniques like ultrasound and dual-energy CT are increasingly recommended for diagnosing crystalline arthropathies, potentially replacing traditional joint aspiration and microscopy for conditions such as gout.

Keywords:

CPPD disease Crystalline arthritis Gout Osteoarthritis Pseudogout Radiography Ultrasonography Ultrasound

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Area of Science:

Rheumatology
Medical Imaging

Background:

Crystalline arthropathies are common medical conditions.
Traditionally diagnosed via joint aspiration and microscopy.
Recent guidelines suggest imaging may suffice.

Purpose of the Study:

To review the role of imaging in diagnosing crystalline arthropathies.
To highlight ultrasound and dual-energy CT (DECT) in gout, CPPD, and BCPPD assessment.

Main Methods:

Review of current recommendations for crystalline arthropathy diagnosis.
Discussion of ultrasound capabilities in identifying tophi and inflammation.
Explanation of DECT's utility in detecting tophaceous deposits in challenging areas.

Main Results:

Ultrasound effectively visualizes tophi and associated inflammatory changes.
DECT excels at locating tophaceous material not accessible by physical or ultrasound exam.
Imaging modalities offer a non-invasive alternative to joint aspiration.

Conclusions:

Imaging, particularly ultrasound and DECT, plays a crucial role in diagnosing crystalline arthropathies.
These techniques can aid in the assessment of gout, calcium pyrophosphate crystal deposition disease, and basic calcium phosphate-related disease.
Non-invasive imaging may reduce the need for joint aspiration in many cases.