MRI Area of Interest Without 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 without IV contrast in the diagnosis of CPPD. US Area of Interest CPPD can be seen as echogenic foci in in hyaline cartilage, tendons, and the menisci. US has been shown to outperform radiography in detection of chondrocalcinosis [73,74]. Filippou et al [75] found that US had an overall diagnostic accuracy of 75%, with a sensitivity of 91% and a specificity of 59% with histology as the reference standard. The positive predicative value and negative predicative value were 88% and 76%, respectively. When considering combination of medial meniscus and medial condyle hyaline cartilage in combination, US has a sensitivity and specificity of 88% and 76%, respectively. Variant 5: Chronic extremity joint pain. Suspect erosive osteoarthritis. Radiographs normal or inconclusive. Next imaging study. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of erosive osteoarthritis in the extremities following initial radiographs. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of erosive osteoarthritis in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV contrast for the evaluation of erosive osteoarthritis in the extremities following initial radiographs.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. MRI Area of Interest Without 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 without IV contrast in the diagnosis of CPPD. US Area of Interest CPPD can be seen as echogenic foci in in hyaline cartilage, tendons, and the menisci. US has been shown to outperform radiography in detection of chondrocalcinosis [73,74]. Filippou et al [75] found that US had an overall diagnostic accuracy of 75%, with a sensitivity of 91% and a specificity of 59% with histology as the reference standard. The positive predicative value and negative predicative value were 88% and 76%, respectively. When considering combination of medial meniscus and medial condyle hyaline cartilage in combination, US has a sensitivity and specificity of 88% and 76%, respectively. Variant 5: Chronic extremity joint pain. Suspect erosive osteoarthritis. Radiographs normal or inconclusive. Next imaging study. Bone Scan Whole Body There is no relevant literature supporting the use of bone scan whole body for the evaluation of erosive osteoarthritis in the extremities following initial radiographs. CT Area of Interest With IV Contrast There is no relevant literature supporting the use of CT area of interest with IV contrast for the evaluation of erosive osteoarthritis in the extremities following initial radiographs. CT Area of Interest Without and With IV Contrast There is no relevant literature supporting the use of CT area of interest without and with IV contrast for the evaluation of erosive osteoarthritis in the extremities following initial radiographs.