CT Area of Interest Without IV Contrast CT without IV contrast can identify chondrocalcinosis and mineralization of tendons, ligaments, and joint capsules as well as show that osseous changes related to CPPD, such as arthropathy characteristically involving the radiocarpal, metacarpophalangeal, atlantoaxial, and patellofemoral joints, are also well demonstrated by CT [69]. Chronic Extremity Joint Pain Both conventional CT without IV contrast and DECT have similarly high sensitivity for the detection of chondrocalcinosis [69-71]. DECT combines the information offered by conventional CT and adds information about the molecular compositions of the tissues. Therefore, the potential advantage of DECT over conventional CT is not an increased sensitivity but the ability to characterize (for example in distinguishing gout and pseudogout) and quantify crystal deposition. For the purposes of this document, DECT is considered a technique categorized under this procedure subheading. FDG-PET/CT Whole Body There is no relevant literature supporting the use of FDG-PET/CT whole body for the evaluation of CPPD in the extremities following initial radiographs. Image-Guided Aspiration Area of Interest Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection [68]. Diagnosis is often challenging; however, because the reference standard of synovial fluid analysis has been shown to have a high specificity (100%) but a lower sensitivity (75%) [68]. MRI Area of Interest Without and With IV Contrast Chondrocalcinosis may be seen as foci of low signal on MRI, and detection may be improved on gradient echo and ultra-short time to echo sequences [72]. Future research is needed to determine the role of MRI in the evaluation of CPPD in the extremities. There is insufficient evidence to support routine use of MRI with or without IV contrast in the diagnosis of CPPD.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. CT Area of Interest Without IV Contrast CT without IV contrast can identify chondrocalcinosis and mineralization of tendons, ligaments, and joint capsules as well as show that osseous changes related to CPPD, such as arthropathy characteristically involving the radiocarpal, metacarpophalangeal, atlantoaxial, and patellofemoral joints, are also well demonstrated by CT [69]. Chronic Extremity Joint Pain Both conventional CT without IV contrast and DECT have similarly high sensitivity for the detection of chondrocalcinosis [69-71]. DECT combines the information offered by conventional CT and adds information about the molecular compositions of the tissues. Therefore, the potential advantage of DECT over conventional CT is not an increased sensitivity but the ability to characterize (for example in distinguishing gout and pseudogout) and quantify crystal deposition. For the purposes of this document, DECT is considered a technique categorized under this procedure subheading. FDG-PET/CT Whole Body There is no relevant literature supporting the use of FDG-PET/CT whole body for the evaluation of CPPD in the extremities following initial radiographs. Image-Guided Aspiration Area of Interest Image-guided aspiration may be helpful in confirming and characterizing crystal deposition disease and excluding infection [68]. Diagnosis is often challenging; however, because the reference standard of synovial fluid analysis has been shown to have a high specificity (100%) but a lower sensitivity (75%) [68]. MRI Area of Interest Without and With IV Contrast Chondrocalcinosis may be seen as foci of low signal on MRI, and detection may be improved on gradient echo and ultra-short time to echo sequences [72]. Future research is needed to determine the role of MRI in the evaluation of CPPD in the extremities. There is insufficient evidence to support routine use of MRI with or without IV contrast in the diagnosis of CPPD.