藉由超音波評估雙氫氧化焦磷酸鈣沈積疾病

Evaluation of calcium pyrophosphate dehydrate deposition disease by ultrasound

目的：描繪在雙氫氧化焦磷酸鈣沈積疾病的病患裡所表現的超音波特徵，並且比較X光和超音波在評估雙氫氧化焦磷酸鈣沈積疾病上的區別。方法︰在這回顧研究中，收集71位病患在2004年至2007年間經關節液證實罹患雙氫氧化焦磷酸鈣沈積疾病。分析其中38位皆接受X光和超音波檢查的病患。結果︰全部病患皆為老年人（>65歲）並且大多數同時存在退化性關節炎。膝關節侵犯是最常見的位置。9位病患發現有膕窩囊腫。在38位雙氫氧化焦磷酸鈣沈積疾病的病患，關節液分析顯示總白血球細胞數的平均值是25592.1 ± 16697.8 /mm3併嗜中性球占絕對多數。統計分析顯示超音波診斷雙氫氧化焦磷酸鈣沈積疾病比X光更具可信（p=0.002）。此外，我們並沒有病患的X光認為是雙氫氧化焦磷酸鈣沈積，但超音波是陰性的結果。結論︰我們發現在超音波上看到明亮點刻狀的點在關節液裡或關節區周圍，薄的高回音條帶狀平行於透明軟骨表面，以及纖維軟骨鈣化可代表雙氫氧化焦磷酸鈣沈積。我們的數據顯示超音波是用於診斷性研究雙氫氧化焦磷酸鈣沈積疾病病患的一項有用且重要的工具。

Objective: Our aim was to characterize the ultrasonographic features of patients with calcium pyrophosphate dihydrate (CPPD) deposition disease, and compare X-ray and ultrasound in evaluating CPPD deposition disease. Methods: In this retrospective study, all 71 patients between 2004 and 2007 with CPPD deposition disease proved by microscopic synovial fluid analysis were enrolled. We collected and analyzed 38 patients of those, on whom both conventional X-ray and high-resolution ultrasound had been carried out. Results: All patients were elderly (i.e. >65 y/o) and mostly coexisted with osteoarthritis. The involvement of knee joint was the most common site. Popliteal cyst was detected in 9 of 71 patients. Synovial fluid analysis of 38 patients with CPPD deposition disease revealed that the average total white cell count was 25592.1 ± 16697.8 /mm3, with significant neutrophil predominance. There was significant evidence that ultrasound was more reliable than X-ray in the diagnosis of CPPD deposition disease (p=0.002). Besides, there were no patients with CPPD deposition disease in whom X-rays suggested CPPD deposition disease, but for whom ultrasound results were negative. Conclusion: We found that bright stippled foci in the synovial fluid or around the articular region, the thin hyperechoic band parallel to the surface of the hyaline cartilage, and the calcification of fibrocartilage seen on ultrasound could represent CPPD deposits. Our data showed that ultrasound is a useful and important tool in the diagnostic investigation of patients with CPPD deposition disease.