usfdУльтразвуковая и функциональная диагностикаUltrasound & Functional Diagnostics1607-07712408-9494RDS-Media Ltd.10.24835/1607-0771-337usfd-337Research ArticleДругие вопросы ультразвуковой диагностикиOther trends in ultrasound diagnosticsУльтразвуковая диагностика болезни депонирования кристаллов пирофосфата кальцияUltrasound diagnosis of calcium pyrophosphate deposition diseasehttps://orcid.org/0000-0002-8760-4880ПолухинаЕ. В.PolukhinaE. V.

Полухина Елена Владимировна – доктор мед. наук, доцент, профессор кафедры лучевой и функциональной диагностики КГБОУ ДПО “Институт повышения квалификации специалистов здравоохранения” Министерства здравоохранения Хабаровского края, Хабаровскhttps://orcid.org/0000-0002-8760-4880

Elena V. Polukhina – MD, Doct. of Sci. (Med.), Associate Professor, Professor of Division of Rаdiology and Functional Diagnostics, Postgraduate Institute for Public Health Workers, Khabarovskhttps://orcid.org/0000-0002-8760-4880

polukhina@inbox.ruКГБОУ ДПО “Институт повышения квалификации специалистов здравоохранения” Министерства здравоохранения Хабаровского краяPostgraduate Institute for Public Health Workers; 9, Krasnodarskaya str., Khabarovsk 680009, Russian Federation20252811202531493104Copyright © Полухина Е.В., 20252025Полухина Е.В.Polukhina E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://usfd.rdsmedia.ru/jour/article/view/337

Болезнь депонирования кристаллов пирофосфата кальция (БДПК) является одной из наиболее распространенных воспалительных артропатий. Характеризуется отложением депозитов пирофосфата кальция дигидрата в суставах и периартикулярных тканях. В повседневной клинической практике методы лучевой визуализации играют центральную роль в диагностике БДПК. В последние годы ультразвуковое исследование рассматривается в качестве ведущего метода раннего выявления депозитов кристаллов в различных анатомических зонах, мониторинга течения заболевания, навигации при аспирации. В статье представлен иллюстрированный обзор литературы, посвященный роли ультразвукового метода в диагностике БДПК. С позиций последних клинических рекомендаций даны представления об основных эхографических признаках БДПК (выявление депозитов пирофосфата кальция в фиброзном и гиалиновом хрящах, сухожилиях, суставной капсуле и внутрисуставном содержимом), позволяющих правильно интерпретировать выявленные изменения для своевременной диагностики заболевания, дифференциальной диагностики и оценки на фоне лечебных мероприятий.

Calcium pyrophosphate deposition disease (CPPD) is one of the most common inflammatory arthropathies. It is characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals within joints and periarticular tissues. In routine clinical practice, imaging plays a central role in the diagnosis of CPPD. In recent years, ultrasound has emerged as a leading modality for early detection of crystal deposits across various anatomical regions, for monitoring disease progression, and for guiding aspiration procedures. The article presents a pictorial literature review highlighting the role of ultrasound in the diagnosis of calcium pyrophosphate deposition disease. Based on current clinical recommendations, the main ultrasound features of CPPD are described (detection of calcium pyrophosphate deposits in fibrous and hyaline cartilage, tendons, joint capsule, and intra-articular contents) allowing for correct interpretation of findings for timely diagnosis, differential diagnosis, and dynamical assessment during therapy.

ультразвуковое исследованиекристаллическая артропатияболезнь депонирования кристаллов пирофосфата кальцияхондрокальцинозultrasoundcrystal-related arthropathiescalcium pyrophosphate deposition diseasechondrocalcinosisReferencesRosenthal A.K., Ryan LM. Calcium Pyrophosphate Deposition Disease. N. Engl. J. Med. 2016; 374 (26): 2575–2584. http://doi.org/10.1056/NEJMra1511117Rosenthal A.K., Ryan LM. Calcium Pyrophosphate Deposition Disease. N. Engl. J. Med. 2016; 374 (26): 2575–2584. http://doi.org/10.1056/NEJMra1511117Zhang W., Doherty M., Bardin T. et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann. Rheum. Dis. 2011; 70 (4): 563–570. http://doi.org/10.1136/ard.2010.139105Zhang W., Doherty M., Bardin T. et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann. Rheum. Dis. 2011; 70 (4): 563–570. http://doi.org/10.1136/ard.2010.139105Abhishek A. Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr. Opin. Rheumatol. 2016; 28 (2): 133–139. http://doi.org/10.1097/BOR.0000000000000246Abhishek A. Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr. Opin. Rheumatol. 2016; 28 (2): 133–139. http://doi.org/10.1097/BOR.0000000000000246Beutler A., Rothfuss S., Clayburne G. et al. Calcium pyrophosphate dihydrate crystal deposition in synovium. Relationship to collagen fibers and chondrometaplasia. Arthritis Rheum. 1993; 36 (5): 704–715. http://doi.org/10.1002/art.1780360520Beutler A., Rothfuss S., Clayburne G. et al. Calcium pyrophosphate dihydrate crystal deposition in synovium. Relationship to collagen fibers and chondrometaplasia. Arthritis Rheum. 1993; 36 (5): 704–715. http://doi.org/10.1002/art.1780360520Sirotti S., Gutierrez M., Pineda C. et al. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group – CPPD subgroup. Reumatismo. 2021; 73 (2): 106–110. http://doi.org/10.4081/reumatismo.2021.1403Sirotti S., Gutierrez M., Pineda C. et al. Accuracy of synovial fluid analysis compared to histology for the identification of calcium pyrophosphate crystals: an ancillary study of the OMERACT US Working Group – CPPD subgroup. Reumatismo. 2021; 73 (2): 106–110. http://doi.org/10.4081/reumatismo.2021.1403Tedeschi S.K., Becce F., Pascart T. et al. Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group. Arthritis Care Res. (Hoboken). 2023; 75 (4): 825–834. http://doi.org/10.1002/acr.24898Tedeschi S.K., Becce F., Pascart T. et al. Imaging Features of Calcium Pyrophosphate Deposition Disease: Consensus Definitions From an International Multidisciplinary Working Group. Arthritis Care Res. (Hoboken). 2023; 75 (4): 825–834. http://doi.org/10.1002/acr.24898Cipolletta E., Filippou G., Scirè C.A. et al. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 2021; 29 (5): 619–632. http://doi.org/10.1016/j.joca.2021.01.007Cipolletta E., Filippou G., Scirè C.A. et al. The diagnostic value of conventional radiography and musculoskeletal ultrasonography in calcium pyrophosphate deposition disease: a systematic literature review and meta-analysis. Osteoarthritis Cartilage. 2021; 29 (5): 619–632. http://doi.org/10.1016/j.joca.2021.01.007Filippou G., Sirotti S. How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification. Curr. Opin. Rheumatol. 2023; 35 (3): 185–193. http://doi.org/10.1097/BOR.0000000000000939Filippou G., Sirotti S. How can ultrasonography help in the management of CPPD? From diagnosis to clinical subset identification. Curr. Opin. Rheumatol. 2023; 35 (3): 185–193. http://doi.org/10.1097/BOR.0000000000000939Coari G., Iagnocco A., Zoppini A. Chondrocalcinosis: sonographic study of the knee. Clin. Rheumatol. 1995; 14 (5): 511–514. http://doi.org/10.1007/BF02208146Coari G., Iagnocco A., Zoppini A. Chondrocalcinosis: sonographic study of the knee. Clin. Rheumatol. 1995; 14 (5): 511–514. http://doi.org/10.1007/BF02208146Grassi W., Meenagh G., Pascual E., Filippucci E. “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin. Arthritis Rheum. 2006; 36 (3): 197–202. http://doi.org/10.1016/j.semarthrit.2006.08.001Grassi W., Meenagh G., Pascual E., Filippucci E. “Crystal clear”-sonographic assessment of gout and calcium pyrophosphate deposition disease. Semin. Arthritis Rheum. 2006; 36 (3): 197–202. http://doi.org/10.1016/j.semarthrit.2006.08.001Abhishek A, Tedeschi S.K., Pascart T. et al. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol. 2023; 75 (10): 1703–1713. http://doi.org/10.1002/art.42619Abhishek A, Tedeschi S.K., Pascart T. et al. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol. 2023; 75 (10): 1703–1713. http://doi.org/10.1002/art.42619Filippou G., Scirè C.A., Damjanov N. et al. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J. Rheumatol. 2017; 44 (11): 1744–1749. http://doi.org/10.3899/jrheum.161057Filippou G., Scirè C.A., Damjanov N. et al. Definition and Reliability Assessment of Elementary Ultrasonographic Findings in Calcium Pyrophosphate Deposition Disease: A Study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force. J. Rheumatol. 2017; 44 (11): 1744–1749. http://doi.org/10.3899/jrheum.161057Cipolletta E., Moscioni E., Sirotti S. et al. Diagnosis of calcium pyrophosphate crystal deposition disease by ultrasonography: how many and which sites should be scanned? Rheumatology (Oxford). 2024; 1; 63 (8): 2205–2212. http://doi.org/10.1093/rheumatology/kead565Cipolletta E., Moscioni E., Sirotti S. et al. Diagnosis of calcium pyrophosphate crystal deposition disease by ultrasonography: how many and which sites should be scanned? Rheumatology (Oxford). 2024; 1; 63 (8): 2205–2212. http://doi.org/10.1093/rheumatology/kead565Adinolfi A., Sirotti S., Sakellariou G. et al. Which are the most frequently involved peripheral joints in calcium pyrophosphate crystal deposition at imaging? A systematic literature review and meta-analysis by the OMERACT ultrasound – CPPD subgroup. Front. Med. (Lausanne). 2023; 9; 10: 1131362. http://doi.org/10.3389/fmed.2023.1131362Adinolfi A., Sirotti S., Sakellariou G. et al. Which are the most frequently involved peripheral joints in calcium pyrophosphate crystal deposition at imaging? A systematic literature review and meta-analysis by the OMERACT ultrasound – CPPD subgroup. Front. Med. (Lausanne). 2023; 9; 10: 1131362. http://doi.org/10.3389/fmed.2023.1131362Filippou G., Scanu A., Adinolfi A. et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann. Rheum. Dis. 2021; 80 (2): 261–267. http://doi.org/10.1136/annrheumdis-2020-217998Filippou G., Scanu A., Adinolfi A. et al. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann. Rheum. Dis. 2021; 80 (2): 261–267. http://doi.org/10.1136/annrheumdis-2020-217998Lee K.A., Lee S.H., Kim H.R. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint. Osteoarthritis Cartilage. 2019; 27 (5):781–787. http://doi.org/10.1016/j.joca.2018.11.013Lee K.A., Lee S.H., Kim H.R. Diagnostic value of ultrasound in calcium pyrophosphate deposition disease of the knee joint. Osteoarthritis Cartilage. 2019; 27 (5):781–787. http://doi.org/10.1016/j.joca.2018.11.013Cipolletta E., Smerilli G., Mashadi Mirza R. et al. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament. Joint Bone Spine. 2020; 87 (6): 611–617. http://doi.org/10.1016/j.jbspin.2020.04.012Cipolletta E., Smerilli G., Mashadi Mirza R. et al. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament. Joint Bone Spine. 2020; 87 (6): 611–617. http://doi.org/10.1016/j.jbspin.2020.04.012Filippou G., Sirotti S., Cipolletta E., Filippucci E. Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up. Gout Urate Cryst. Depos. Dis. 2024; 2: 17–33. https://doi.org/10.3390/gucdd2010002Filippou G., Sirotti S., Cipolletta E., Filippucci E. Optimizing the Use of Ultrasound in Calcium Pyrophosphate Deposition (CPPD): A Review from the Ground Up. Gout Urate Cryst. Depos. Dis. 2024; 2: 17–33. https://doi.org/10.3390/gucdd2010002Cipolletta E., Di Matteo A., Smerilli G. et al. Ultrasound findings of calcium pyrophosphate deposition disease at metacarpophalangeal joints. Rheumatology (Oxford). 2022; 61 (10): 3997–4005. https://doi.org/10.1093/rheumatology/keac063Cipolletta E., Di Matteo A., Smerilli G. et al. Ultrasound findings of calcium pyrophosphate deposition disease at metacarpophalangeal joints. Rheumatology (Oxford). 2022; 61 (10): 3997–4005. https://doi.org/10.1093/rheumatology/keac063Filippucci E., Riveros M.G., Georgescu D. et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage. 2009; 17 (2): 178–181. https://doi.org/10.1016/j.joca.2008.06.003Filippucci E., Riveros M.G., Georgescu D. et al. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis Cartilage. 2009; 17 (2): 178–181. https://doi.org/10.1016/j.joca.2008.06.003Kenneth P.H. Articular Pathology of Gout, Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate Crystal Deposition Arthropathies. Editor(s): Robert Terkeltaub, Gout and Other Crystal Arthropathies. 2012; 2–19. https://doi.org/10.1016/B978-1-4377-2864-4.10001-6Kenneth P.H. Articular Pathology of Gout, Calcium Pyrophosphate Dihydrate and Basic Calcium Phosphate Crystal Deposition Arthropathies. Editor(s): Robert Terkeltaub, Gout and Other Crystal Arthropathies. 2012; 2–19. https://doi.org/10.1016/B978-1-4377-2864-4.10001-6Filippou G., Miguel-Pérez M., Coronel L. et al. EULAR Study Group on Anatomy for the Image. The ultrasonographic pseudo-double contour sign in calcium pyrophosphate deposition disease: an anatomic explanation and how to distinguish it from gout. Arthritis Rheumatol. 2023; 75 (4): 639–640. https://doi.org/10.1002/art.42397Filippou G., Miguel-Pérez M., Coronel L. et al. EULAR Study Group on Anatomy for the Image. The ultrasonographic pseudo-double contour sign in calcium pyrophosphate deposition disease: an anatomic explanation and how to distinguish it from gout. Arthritis Rheumatol. 2023; 75 (4): 639–640. https://doi.org/10.1002/art.42397Cipolletta E., Abhishek A., Di Matteo A. et al. Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease. RMD Open. 2023; 9 (1): e002940. https://doi.org/10.1136/rmdopen-2022-002940Cipolletta E., Abhishek A., Di Matteo A. et al. Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease. RMD Open. 2023; 9 (1): e002940. https://doi.org/10.1136/rmdopen-2022-002940Filippou G., Pacini G., Sirotti S. et al. Comparison of ultrasound attenuation by calcium pyrophosphate, hydroxyapatite and monosodium urate crystals: a proof-of-concept study. Ann. Rheum. Dis. 2022; 81 (8): 1199–1201. https://doi.org/10.1136/annrheumdis-2022-222316Filippou G., Pacini G., Sirotti S. et al. Comparison of ultrasound attenuation by calcium pyrophosphate, hydroxyapatite and monosodium urate crystals: a proof-of-concept study. Ann. Rheum. Dis. 2022; 81 (8): 1199–1201. https://doi.org/10.1136/annrheumdis-2022-222316Sirotti S., Terslev L., Filippucci E. et al.; OMERACT Ultrasound working group-CPPD subgroup. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. Lancet Rheumatol. 2023; 5 (8): e474–e482. https://doi.org/10.1016/S2665-9913(23)00136-4Sirotti S., Terslev L., Filippucci E. et al.; OMERACT Ultrasound working group-CPPD subgroup. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. Lancet Rheumatol. 2023; 5 (8): e474–e482. https://doi.org/10.1016/S2665-9913(23)00136-4

The authors declare that there are no conflicts of interest present.