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Calcium Pyrophosphate Dihydrate Deposition (CPPD), Cervical Spine
Lubdha M. Shah, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Calcium pyrophosphate dihydrate deposition (CPPD) disease
            • Definitions

              • Pseudogout: Acute painful episode due to CPPD
              • Crowned dens syndrome: CPPD of atlantooccipital joint causing periodic acute cervicooccipital pain with fever, neck stiffness, and laboratory inflammatory signs

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Ferrone C et al: Calcium pyrophosphate deposition disease: clinical manifestations. Reumatismo. 63(4):246-52, 2012
                                              2. Ali S et al: CPPD Crowned Dens Syndrome with clivus destruction: A case report. J Radiol Case Rep. 5(8):30-7, 2011
                                              3. Zhang W et al: EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 70(4):571-5, 2011
                                              4. Zhang W et al: European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 70(4):563-70, 2011
                                              5. Roverano S et al: Calcification of the transverse ligament of the atlas in chondrocalcinosis. J Clin Rheumatol. 16(1):7-9, 2010
                                              6. Fenoy AJ et al: Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 8(1):22-9, 2008
                                              7. Finckh A et al: The cervical spine in calcium pyrophosphate dihydrate deposition disease. A prevalent case-control study. J Rheumatol. 31(3):545-9, 2004
                                              8. Chen CF et al: Calcium pyrophosphate dihydrate crystal deposition disease in cervical radiculomyelopathy. J Chin Med Assoc. 66(4):256-9, 2003
                                              9. Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
                                              10. Fujishiro T et al: Pseudogout attack of the lumbar facet joint: a case report. Spine. 27(17):E396-8, 2002
                                              11. Steinbach LS et al: Calcium pyrophosphate dihydrate crystal deposition disease: imaging perspectives. Curr Probl Diagn Radiol. 29(6):209-29, 2000
                                              12. Berlemann U et al: Calcium pyrophosphate dihydrate deposition in degenerate lumbar discs. Eur Spine J. 7(1):45-9, 1998
                                              13. Markiewitz AD et al: Calcium pyrophosphate dihydrate crystal deposition disease as a cause of lumbar canal stenosis. Spine. 21(4):506-11, 1996
                                              14. Jones AC et al: Diseases associated with calcium pyrophosphate deposition disease. Semin Arthritis Rheum. 22(3):188-202, 1992
                                              15. Brown TR et al: Deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: evaluation with MR imaging and CT. Radiology. 178(3):871-3, 1991
                                              16. el-Khoury GY et al: Massive calcium pyrophosphate crystal deposition at the craniovertebral junction. AJR Am J Roentgenol. 145(4):777-8, 1985
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Calcium pyrophosphate dihydrate deposition (CPPD) disease
                                                        • Definitions

                                                          • Pseudogout: Acute painful episode due to CPPD
                                                          • Crowned dens syndrome: CPPD of atlantooccipital joint causing periodic acute cervicooccipital pain with fever, neck stiffness, and laboratory inflammatory signs

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Ferrone C et al: Calcium pyrophosphate deposition disease: clinical manifestations. Reumatismo. 63(4):246-52, 2012
                                                                                          2. Ali S et al: CPPD Crowned Dens Syndrome with clivus destruction: A case report. J Radiol Case Rep. 5(8):30-7, 2011
                                                                                          3. Zhang W et al: EULAR recommendations for calcium pyrophosphate deposition. Part II: management. Ann Rheum Dis. 70(4):571-5, 2011
                                                                                          4. Zhang W et al: European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis. 70(4):563-70, 2011
                                                                                          5. Roverano S et al: Calcification of the transverse ligament of the atlas in chondrocalcinosis. J Clin Rheumatol. 16(1):7-9, 2010
                                                                                          6. Fenoy AJ et al: Calcium pyrophosphate dihydrate crystal deposition in the craniovertebral junction. J Neurosurg Spine. 8(1):22-9, 2008
                                                                                          7. Finckh A et al: The cervical spine in calcium pyrophosphate dihydrate deposition disease. A prevalent case-control study. J Rheumatol. 31(3):545-9, 2004
                                                                                          8. Chen CF et al: Calcium pyrophosphate dihydrate crystal deposition disease in cervical radiculomyelopathy. J Chin Med Assoc. 66(4):256-9, 2003
                                                                                          9. Muthukumar N et al: Tumoral calcium pyrophosphate dihydrate deposition disease of the ligamentum flavum. Neurosurgery. 53(1):103-8; discussion 108-9, 2003
                                                                                          10. Fujishiro T et al: Pseudogout attack of the lumbar facet joint: a case report. Spine. 27(17):E396-8, 2002
                                                                                          11. Steinbach LS et al: Calcium pyrophosphate dihydrate crystal deposition disease: imaging perspectives. Curr Probl Diagn Radiol. 29(6):209-29, 2000
                                                                                          12. Berlemann U et al: Calcium pyrophosphate dihydrate deposition in degenerate lumbar discs. Eur Spine J. 7(1):45-9, 1998
                                                                                          13. Markiewitz AD et al: Calcium pyrophosphate dihydrate crystal deposition disease as a cause of lumbar canal stenosis. Spine. 21(4):506-11, 1996
                                                                                          14. Jones AC et al: Diseases associated with calcium pyrophosphate deposition disease. Semin Arthritis Rheum. 22(3):188-202, 1992
                                                                                          15. Brown TR et al: Deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: evaluation with MR imaging and CT. Radiology. 178(3):871-3, 1991
                                                                                          16. el-Khoury GY et al: Massive calcium pyrophosphate crystal deposition at the craniovertebral junction. AJR Am J Roentgenol. 145(4):777-8, 1985