Article Text

Download PDFPDF
OP0122 Inter-Reader and Intra-Reader Reliability of The New Omeract Ultrasonographic Criteria for The Diagnosis of CPPD
  1. G. Filippou1,
  2. C.A. Scirè2,
  3. N. Damjanov3,
  4. A. Adinolfi1,
  5. G. Carrara2,
  6. V. Picerno1,
  7. C. Toscano1,
  8. G. Bruyn4,
  9. M.A. D'Agostino5,
  10. A. Delle Sedie6,
  11. E. Filippucci7,
  12. M. Gutierrez8,
  13. M. Micu9,
  14. I. Moller10,
  15. E. Naredo11,
  16. C. Pineda8,
  17. F. Porta12,
  18. W.A. Schmidt13,
  19. L. Terslev14,
  20. V. Vlad15,
  21. P. Zufferey16,
  22. B. Frediani1,
  23. A. Iagnocco17,
  24. on behalf of OMERACT group “US in CPPD”
  1. 1University of Siena, Siena
  2. 2SIR Epidemiology Unit, Milan, Italy
  3. 3University of Belgrade, Belgrade, Serbia
  4. 4Department of Rheumatology, MC Groep, Lelystad, Netherlands
  5. 5Université Versailles Saint-Quentin en Yvelines, Paris, France
  6. 6University of Pisa, Pisa
  7. 7Università Politecnica delle Marche, Jesi, Italy
  8. 8Instituto Nacional de Rehabilitaciόn, Mexico City, Mexico
  9. 9Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
  10. 10InstitutoPoal, Barcelona
  11. 11Hospital GU Gregorio Marañόn, Madrid, Spain
  12. 12University of Florence, Florence, Italy
  13. 13Immanuel Krankenhaus Berlin, Berlin, Germany
  14. 14Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
  15. 15Sf. Maria Hospital, Bucharest, Romania
  16. 16Lausanne University Hospital, Lausanne, Switzerland
  17. 17Università la Sapienza, Rome, Italy


Background Ultrasonography (US) has been implemented recently as a possible diagnostic method for CPPD [1]. However, data on the reliability of US in CPPD diagnosis are lacking

Objectives To assess the inter-reader and intra-reader reliability of US on detecting CPP deposition in fibrocartilage (FC), hyaline cartilage (HC), tendons (T) and synovial fluid (SF)

Methods The OMERACT “US in CPPD” group defined firstly the US CPPD identification criteria according to methods described in an another abstract submitted in this congress. Subsequently, a two steps procedure for the assessment of the reliability has been followed. Firstly, the panel gave a dichotomous score on the presence absence of CPPD in 150 photos of FC, HC, T and SF equally distributed, on a web based platform. The assessment has been carried out twice in order to calculate both inter and intra-reader reliability. In the second step, the experts met for a real life-patient based assessment of CPPD in a workshop organised in Siena-Italy. In that occasion, FC/HC/T/SF of the right knee and FC and SF of the right wrist of 8 patients were assessed twice in a day by all experts giving again a dichotomous score for CPPD. 8 US scanners (ESAOTE mylab seven) equipped with the same probe and the same preset (made ad hoc before the meeting), have been used for the workshop.

Results Reliability values of the web based exercise and of the workshop are presented in table 1. Tendons and synovial fluid analysis did not reach sufficient strength of agreement neither on the web based nor in the patient based exercise regarding the inter-reader kappa and independently of the site. However, in the static exercise, both tendons and SF reached a good intra-reader reliability meaning that scanning technique of these structures is very important for CPPD identification. On the other hand, menisci (but not triangular FC of the wrist) and HC reached good kappa values for inter-reader and intra-reader agreement both on static and web-based exercise

Conclusions Knee cartilage and fibrocartilage structures resulted to be reliable enough for identification of CPPD. On the other hand, CPPD identification in tendons and synovial fluid is challenging and the actual OMERACT criteria for these sites do not ensure a safe classification of patients.

OMERACT US criteria for CPPD identification in knee menisci and HC allow a reliable classification of patients and should be used when CPPD is suspected.

  1. Zhang 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;70:563–70

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.