This study suggests that there is room for improvement regarding crystal identification of particularly CPP and other non-MSU crystals even in this highly motivated group. Different crystals can closely resemble each other morphologically. free-floating crystals can become enmeshed or hidden in fibrin. numerous artifacts are also birefringent.
MSU crystals were well identified, but incorrect identification of non-MSU crystals occurred frequently. The microscopic examination of synovial fluid for crystals can be difficult because. Correct identification of all MSU images was achieved by 81%, correct identification of all 8 pre-defined non-MSU, CPP images, and all 22 non-MSU images as non-MSU by 68, 68, and 23%, respectively. The online test was completed by 110 participants.
#Synovial fluid image plus#
The primary outcome was defined as the correct identification of all eight MSU slides plus the identification of all eight pre-defined non-MSU slides as non-MSU. Of the 22 non-MSU slides, a subset of 8 was pre-designated that were thought to be clinically important to be identified as non-MSU. The test consisted of 30 images: 8 monosodium urate (MSU) crystals, 5 calcium pyrophosphate (CPP), 4 cholesterol, 2 depot methylprednisolone, 2 calcium oxalate, 2 rice bodies, 1 hydroxyapatite, 1 liquid lipid, 1 fibrin, 1 Charcot-Leyden, and 5 different artifacts. Rheumatologists, trainees, lab technicians, and other physicians with an interest in crystal arthritis completed an online test.
The objective of this study was to assess current performance of crystal identification by professionals involved in examining synovial fluid in routine care. Testing a reading exercise for identification of several typical crystal such as the negatively birefringent needle-shaped crystals that are under polarized light microscopy is the gold standard for diagnosing gout.
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