Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease

Cipolletta, Edoardo; Abhishek, Abhishek; Di Matteo, Andrea; Grassi, Walter; Filippucci, Emilio

Abstract

Objective To test whether the double contour (DC) sign has a different dynamic behaviour in gout and calcium pyrophosphate deposition (CPPD) and whether the dynamic assessment of the DC sign increases its accuracy in gout diagnosis. Methods This cross-sectional analysis included patients with gout meeting the 2015 ACR/EULAR classification criteria and patients with crystal-proven diagnosis of CPPD. Hyaline cartilages were explored by ultrasound (US) to detect the DC sign (ie, abnormal hyperechoic band over the superficial margin of hyaline cartilages) and its dynamic behaviour during joint movement was evaluated ((ie, movement of the DC sign together with subchondral bone (DC sign), or in the opposite direction (pseudo DC sign)). Results Eighty-one patients with gout and 84 patients with CPPD underwent US assessment. Among them, 47 patients with gout and 9 patients with CPPD had evidence of the DC sign. During dynamic assessment, in all 47/47 patients with gout there was a DC sign. Conversely, in 7/9 (77.8%) patients with CPPD, there was a pseudo DC sign (p<0.01). The presence of DC sign during static assessment had a sensitivity, specificity and accuracy of 58.0% (95% CI 46.5% to 68.9%), 89.3% (95% CI 80.6% to 95.0%) and 73.9% (95% CI 66.5% to 80.5%) for gout, respectively. The dynamic evaluation improved the DC sign's diagnostic performance (p=0.01) as the specificity (97.6% (95% CI 91.7% to 99.7%)) and the accuracy (78.2% (95% CI 71.1% to 84.2%)) increased without loss in sensitivity. Conclusion The dynamic US assessment of the DC sign may help to differentiate the DC sign due to MSU crystals from the pseudo DC sign seen in CPPD, as they move in opposite directions.

Citation

Cipolletta, E., Abhishek, A., Di Matteo, A., Grassi, W., & Filippucci, E. (2023). Dynamic assessment of the double contour sign by ultrasonography helps to distinguish between gout and calcium pyrophosphate deposition disease. RMD Open, 9(1), Article e002940. https://doi.org/10.1136/rmdopen-2022-002940

• Journal Article Type: Article
• Acceptance Date: Mar 2, 2023
• Online Publication Date: Mar 16, 2023
• Publication Date: 2023-03
• Deposit Date: May 19, 2023
• Publicly Available Date: May 22, 2023
• Journal: RMD Open
• Electronic ISSN: 2056-5933
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 1
• Article Number: e002940
• DOI: https://doi.org/10.1136/rmdopen-2022-002940
• Keywords: Cross-Sectional Studies, Gout - diagnostic imaging, Ultrasonography, Calcium Pyrophosphate, Chondrocalcinosis, Crystal arthropathies, Humans, Chondrocalcinosis - diagnostic imaging, Gout, Calcinosis
• Public URL: https://nottingham-repository.worktribe.com/output/19287211
• Publisher URL: https://rmdopen.bmj.com/content/9/1/e002940