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Pyrophosphate Arthropathy
B.J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Abbreviations

        • Calcium pyrophosphate dihydrate (CPPD)
      • Synonyms

        • 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 thereof)
        • Pyrophosphate arthropathy: Specific pattern of structural joint damage that occurs from CPPD crystal deposition in intraarticular and paraarticular locations
        • Pseudogout: Gout-like clinical syndrome 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

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Seeger LL et al: Intra-articular calcifications following arthroscopic ACL reconstruction: prevalence and possible significance. Skeletal Radiol. 43(2):209-12, 2014
                                  2. 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
                                  3. Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
                                  4. 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
                                  5. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                  6. 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
                                  7. Zaka R et al: Genetics of chondrocalcinosis. Osteoarthritis Cartilage. 13(9):745-50, 2005
                                  8. 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
                                  9. Kaushik S et al: Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol. 177(4):905-9, 2001
                                  10. 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
                                  11. 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

                                      • Abbreviations

                                        • Calcium pyrophosphate dihydrate (CPPD)
                                      • Synonyms

                                        • 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 thereof)
                                        • Pyrophosphate arthropathy: Specific pattern of structural joint damage that occurs from CPPD crystal deposition in intraarticular and paraarticular locations
                                        • Pseudogout: Gout-like clinical syndrome 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

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Seeger LL et al: Intra-articular calcifications following arthroscopic ACL reconstruction: prevalence and possible significance. Skeletal Radiol. 43(2):209-12, 2014
                                                                  2. 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
                                                                  3. Chang EY et al: Frequency of atlantoaxial calcium pyrophosphate dihydrate deposition at CT. Radiology. 269(2):519-24, 2013
                                                                  4. 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
                                                                  5. Wise CM: Crystal-associated arthritis in the elderly. Rheum Dis Clin North Am. 33(1):33-55, 2007
                                                                  6. 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
                                                                  7. Zaka R et al: Genetics of chondrocalcinosis. Osteoarthritis Cartilage. 13(9):745-50, 2005
                                                                  8. 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
                                                                  9. Kaushik S et al: Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol. 177(4):905-9, 2001
                                                                  10. 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
                                                                  11. Steinbach LS et al: Calcium pyrophosphate dihydrate crystal deposition disease revisited. Radiology. 200(1):1-9, 1996