![]() There was a significant positive relation between spinal calcification and wrist joint calcification by plain radiography. The result of intra-rater analysis between SFA by polarized light microscopy and MSUS was kappa 0.767 ( p < 0.001) this indicates substantial level of agreement between SFA and MSUS between plain radiography and MSUS, it was kappa 0.188 ( p = 0.32) which indicates slight agreement, and between plain radiography and SFA, it was kappa 0.037 ( p = 0.1) which fails to reach a significant level of agreement. The accuracy of MSUS to diagnose CPPD deposition disease is more than double that of plain radiography, and it is comparable to that of synovial fluid analysis. Characteristic CPPD calcifications by MSUS on the knee and wrist joints presented in 93% and 27% respectively. Characteristic CPPD calcifications by plain radiography on the knee and wrist joints were present in 38% and 16% respectively. The commonest site was anterior longitudinal ligament (43%). Spinal calcification was present in 55% of patients. Plain radiography on the spines, pelvis, and affected joints, MSUS on affected joints, and synovial fluid analysis (SFA) were done. One hundred patients with CPPD disease diagnosed according to the modified proposed diagnostic criteria by McCarty 1994 were included. To assess the presence and relation between calcification of intervertebral discs, other articular and periarticular spinal structures, and synovial fluid analysis (SFA) and MSUS calcifications in patients with CPPD deposition disease. Axial involvement with intervertebral disc calcification, sacroiliac erosions, and sub-chondral cysts of the facet joints occurs with CPPD deposition. Diagnosis is achieved by detection of crystals by polarized light microscopy and/or detection of hyaline cartilage or fibrocartilage calcifications characteristic of CPPD deposition by musculoskeletal ultrasound (MSUS). Gordon C, Swan A, Dieppe P (1989) Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability.Calcium pyrophosphate dihydrate deposition disease (CPPD) is the second most common form of the crystal-associated arthritis. Petrocelli A, Wong AL, Swezey RL (1998) Identification of pathologic synovial fluid crystals on gram stains. Selvi E, Manganelli S, Catenaccio M, De Stefano R, Frati E, Cucini S et al (2001) Diff Quik staining method for detection and identification of monosodium urate and calcium pyrophosphate crystals in synovial fluids. McGill NW, Swan A, Dieppe PA (1991) Survival of calcium pyrophosphate crystals in stored synovial fluids. Storage has little influence on the results. Salinas M, Rosas J, Iborra J, Manero H, Pascual E (1997) Comparison of manual and automated cell counts in EDTA preserved synovial fluids. Galvez J, Saiz E, Linares LF, Climent A, Marras C, Pina MF et al (2002) Delayed examination of synovial fluid by ordinary and polarised microscopy to detect and identify crystals. Robier C, Neubauer M, Stettin M, Rainer F (2011) Microscopic examination of stained cytospin preparations is a reliable method for the detection of calcium pyrophosphate crystals in synovial fluid. Kerolus G, Clayburne G, Schumacher HR Jr (1989) Is it mandatory to examine synovial fluids promptly after arthrocentesis? Arthritis Rheum 34(1):118–20 In conclusion, dried cytospin preparations were confirmed as a suitable material for long-time storage and delayed crystal identification. Thus, compared to the examined wet preparations at baseline, there were no false positive or false negative results observed. The crystal content of the initially MSU- and CPPD-positive samples was positively confirmed at any time point of the study, whereas the controls remained crystal-negative during the whole study period. After cytocentrifugation for 10 min at 700 rpm in a Shandon Cytospin 4 cytocentrifuge (Thermo Fisher Scientific, Waltham, USA), the sediments were dried on the slides and examined in blinded fashion at any time point by an experienced analyst using polarized microscopy. For this purpose, we analyzed ten MSU-positive, ten CPPD-positive and 20 crystal-negative SF at baseline (wet preparation), after 24 h, 1 week, 4 weeks, 6 months and 12 months for the occurrence of crystals. The aim of this study was to evaluate dried SF cytospin preparations as a suitable medium for long-time storage and delayed crystal analysis.
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