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Musculoskeletal
Diagnosis
Non-Trauma
Arthritis
Due to Biochemical Disorders or Depositional Disease
Pyrophosphate Arthropathy
Pyrophosphate Arthropathy
Stephanie A. Bernard, MD; Kirkland W. Davis, MD, FACR; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Synonyms

        • Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, pseudogout, chondrocalcinosis
          • Not true synonyms but often incorrectly used interchangeably

      • Definitions

        • Terminology has been confusing
          • Terms have been used interchangeably though they are not synonymous
        • Chondrocalcinosis: general term for cartilage calcification (seen by pathology or imaging)
          • May or may not result in arthropathy
          • Calcification may be within hyaline or fibrocartilage
          • Calcification may be deposition of pyrophosphate, calcium hydroxyapatite, or dicalcium phosphate dihydrate crystals (or combinations)
        • Pyrophosphate arthropathy: specific pattern of structural joint damage that occurs from CPPD crystal deposition in intraarticular and paraarticular locations
        • Pseudogout: gout-like acute inflammation produced by CPPD crystal deposition; not radiologic diagnosis

      IMAGING

      • General Features

        • Imaging Recommendations

          • Radiographic Findings

            • CT Findings

              • MR Findings

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Gross Pathologic & Surgical Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Shen G et al: A case of tophaceous pseudogout on 18F-FDG PET/CT imaging. Clin Nucl Med. 44(2):e98-100, 2019
                                    2. McCarthy GM et al: Calcium crystal deposition diseases - beyond gout. Nat Rev Rheumatol. 14(10):592-602, 2018
                                    3. Wold A et al: Non-union rate of type II and III odontoid fractures in CPPD versus a control population. Skeletal Radiol. 47(11):1499-504, 2018
                                    4. Jacques T et al: Conventional radiology in crystal arthritis: gout, calcium pyrophosphate deposition, and basic calcium phosphate crystals. Radiol Clin North Am. 55(5):967-84, 2017
                                    5. Abhishek A: Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr Opin Rheumatol. 28(2):133-9, 2016
                                    6. Seeger LL et al: Intra-articular calcifications following arthroscopic ACL reconstruction: prevalence and possible significance. Skeletal Radiol. 43(2):209-12, 2014
                                    7. Bahk WJ et al: Huge tophaceous pseudogout associated with tenosynovial chondromatosis arising from flexor digitorum tendon sheaths of the foot: a case report. Skeletal Radiol. 42(12):1755-9, 2013
                                    8. Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
                                    9. Doita M et al: Calcium pyrophosphate dihydrate deposition in the transverse ligament of the atlas: an unusual cause of cervical myelopathy. Skeletal Radiol. 36(7):699-702, 2007
                                    10. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                    11. Suan JC et al: 4 T MRI of chondrocalcinosis in combination with three-dimensional CT, radiography, and arthroscopy: a report of three cases. Skeletal Radiol. 34(11):714-21, 2005
                                    12. Zaka R et al: Genetics of chondrocalcinosis. Osteoarthritis Cartilage. 13(9):745-50, 2005
                                    13. Marsot-Dupuch K et al: Massive calcium pyrophosphate dihydrate crystal deposition disease: a cause of pain of the temporomandibular joint. AJNR Am J Neuroradiol. 25(5):876-9, 2004
                                    14. Kaushik S et al: Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol. 177(4):905-9, 2001
                                    15. Kakitsubata Y et al: Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 216(1):213-9, 2000
                                    16. Steinbach LS et al: Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology. 200(1):1-9, 1996
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        TERMINOLOGY

                                        • Synonyms

                                          • Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, pseudogout, chondrocalcinosis
                                            • Not true synonyms but often incorrectly used interchangeably

                                        • Definitions

                                          • Terminology has been confusing
                                            • Terms have been used interchangeably though they are not synonymous
                                          • Chondrocalcinosis: general term for cartilage calcification (seen by pathology or imaging)
                                            • May or may not result in arthropathy
                                            • Calcification may be within hyaline or fibrocartilage
                                            • Calcification may be deposition of pyrophosphate, calcium hydroxyapatite, or dicalcium phosphate dihydrate crystals (or combinations)
                                          • Pyrophosphate arthropathy: specific pattern of structural joint damage that occurs from CPPD crystal deposition in intraarticular and paraarticular locations
                                          • Pseudogout: gout-like acute inflammation produced by CPPD crystal deposition; not radiologic diagnosis

                                        IMAGING

                                        • General Features

                                          • Imaging Recommendations

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Gross Pathologic & Surgical Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Shen G et al: A case of tophaceous pseudogout on 18F-FDG PET/CT imaging. Clin Nucl Med. 44(2):e98-100, 2019
                                                                      2. McCarthy GM et al: Calcium crystal deposition diseases - beyond gout. Nat Rev Rheumatol. 14(10):592-602, 2018
                                                                      3. Wold A et al: Non-union rate of type II and III odontoid fractures in CPPD versus a control population. Skeletal Radiol. 47(11):1499-504, 2018
                                                                      4. Jacques T et al: Conventional radiology in crystal arthritis: gout, calcium pyrophosphate deposition, and basic calcium phosphate crystals. Radiol Clin North Am. 55(5):967-84, 2017
                                                                      5. Abhishek A: Calcium pyrophosphate deposition disease: a review of epidemiologic findings. Curr Opin Rheumatol. 28(2):133-9, 2016
                                                                      6. Seeger LL et al: Intra-articular calcifications following arthroscopic ACL reconstruction: prevalence and possible significance. Skeletal Radiol. 43(2):209-12, 2014
                                                                      7. Bahk WJ et al: Huge tophaceous pseudogout associated with tenosynovial chondromatosis arising from flexor digitorum tendon sheaths of the foot: a case report. Skeletal Radiol. 42(12):1755-9, 2013
                                                                      8. Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
                                                                      9. Doita M et al: Calcium pyrophosphate dihydrate deposition in the transverse ligament of the atlas: an unusual cause of cervical myelopathy. Skeletal Radiol. 36(7):699-702, 2007
                                                                      10. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                                                      11. Suan JC et al: 4 T MRI of chondrocalcinosis in combination with three-dimensional CT, radiography, and arthroscopy: a report of three cases. Skeletal Radiol. 34(11):714-21, 2005
                                                                      12. Zaka R et al: Genetics of chondrocalcinosis. Osteoarthritis Cartilage. 13(9):745-50, 2005
                                                                      13. Marsot-Dupuch K et al: Massive calcium pyrophosphate dihydrate crystal deposition disease: a cause of pain of the temporomandibular joint. AJNR Am J Neuroradiol. 25(5):876-9, 2004
                                                                      14. Kaushik S et al: Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol. 177(4):905-9, 2001
                                                                      15. Kakitsubata Y et al: Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients. Radiology. 216(1):213-9, 2000
                                                                      16. Steinbach LS et al: Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology. 200(1):1-9, 1996