Download PDF
Semin Musculoskelet Radiol 2003; 7(3): 175-186
DOI: 10.1055/s-2003-43228
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease

Jenny T. Bencardino1,2 , Alvand Hassankhani2,3
  • 1Medical Arts Radiological Group, P.C., Bayshore, NY
  • 2Department of Radiology, Harvard Medical School, Boston, MA
  • 3Brookhaven Memorial Hospital Medical Center, Patchogue, NY
Further Information

Publication History

Publication Date:
31 October 2003 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues. Various terms have been utilized to describe this arthropathy, which has led to some confusion. CPPD crystal deposition disease is among many conditions that may result in crystal deposition within cartilage. Chondrocalcinosis is a pathologic and radiographic term denoting calcification of cartilage within joints including both hyaline articular cartilage and fibrocartilage. Pseudogout is a clinical term applied to an acute inflammatory process in a joint(s) mimicking a gout attack. Pseudogout is just one of the multiple clinical presentations for CPPD crystal deposition disease. Pyrophosphate arthropathy is a term that has been used to describe the peculiar pattern of joint destruction associated with CPPD crystal deposition disease. This article reviews the protean manifestations of CPPD crystal deposition disease with emphasis on diagnostic imaging.

KEYWORDS

Calcium pyrophosphate dihydrate - imaging - pseudogout

REFERENCES

  • 1 McCarty D J, Kohn N N, Faires J S. The significance of calcium pyrophosphate crystals in the synovial fluid of arthritic patients: the pseudogout syndrome. I. Clinical aspects.  Ann Intern Med . 1962;  56 711
    PubMedGoogle Scholar
  • 2 Steinbach L S, Resnick D. Calcium pyrophosphate dihydrate crystal deposition disease: imaging perspectives.  Curr Probl Diagn Radiol . 2000;  29 209-229
    PubMedGoogle Scholar
  • 3 Hayashi M, Matsunaga T, Tanikawa H. Idiopathic widespread calcium pyrophosphate dihydrate crystal deposition disease in a young patient.  Skeletal Radiol . 2002;  31 246-250
    CrossrefPubMedGoogle Scholar
  • 4 Fox I H, Koopman W J, Schumacher Jr R H. Gout and pseudogout in primary care.  Patient Care . 1989;  23 84-126
    PubMedGoogle Scholar
  • 5 Hirose J, Ryan L M, Masuda I. Up-regulated expression of cartilage intermediate-layer protein and ANK in articular hyaline cartilage from patients with calcium pyrophosphate dihydrate crystal deposition disease.  Arthritis Rheum . 2002;  46 3218-3229
    CrossrefPubMedGoogle Scholar
  • 6 Williams C J, Zhang Y, Timms A. et al . Autosomal dominant familial CPPD deposition disease is caused by mutation in transmembrane protein ANKH.  Am J Hum Genet . 2002;  71 985-991
    CrossrefPubMedGoogle Scholar
  • 7 Reginato A J, Tamesis E, Netter P. Familial and clinical aspects of CPPD deposition disease.  Curr Rheumatol Rep . 1999;  1 112-120
    PubMedGoogle Scholar
  • 8 Fam A G. What is new about crystal other than monosodium urate.  Curr Opin Rheumatol . 2000;  12 228-234
    CrossrefPubMedGoogle Scholar
  • 9 Masuda I, Hisode J. Animal models of pathologic calcification.  Curr Opin Rheumatol . 2002;  14 287-291
    CrossrefPubMedGoogle Scholar
  • 10 Ryan L M, McCarty D J. Understanding inorganic pyrophosphate metabolism: toward prevention of calcium pyrophosphate dihydrate crystal deposition.  Ann Rheum Dis . 1995;  54 939-941
    PubMedGoogle Scholar
  • 11 Doherty M, Chuck A, Husking D. et al . Inorganic pyrophosphate in metabolic diseases predisposing to crystal pyrophosphate dehydrate crystal deposition.  Arthritis Rheum . 1991;  34 1294-1303
    PubMedGoogle Scholar
  • 12 Pritzker K PH. Calcium pyrophosphate crystal arthropathy: a biomineralization disorder.  Hum Pathol . 1986;  17 543-545
    PubMedGoogle Scholar
  • 13 McCarthy E F, Frassica F J. Diseases of the joints. In: McCarthy EF, Frassica FJ, eds. Pathology of Bone and Joint Disorders Philadelphia: WB Saunders 1998: 348-350
    Google Scholar
  • 14 Agarwal A K. Gout and pseudogout.  Arthritis . 1993;  20 839-855
    PubMedGoogle Scholar
  • 15 Canhao H, Fonseca J E, Leandro M J. et al . Cross sectional study of 50 patients with crystal pyrophosphate dihydrate crystal arthropathy.  Clin Rheumatol . 2002;  20 119-122
    PubMedGoogle Scholar
  • 16 Bennet R M, Lehr J R, McCarty D J. Crystal shedding and acute pseudogout. A hypothesis based on therapeutic failure.  Arthritis Rheum . 1976;  19 93-97
    PubMedGoogle Scholar
  • 17 Kroesen S, Schmid W, Theiler R. Induction of an acute attack of CPPD arthritis by intra-articular injection of Hylan 6-F20 (Synvisc).  Clin Rheumatol . 2000;  19 147-149
    CrossrefPubMedGoogle Scholar
  • 18 Minezaki T, Tomatsu T, Hanada K. Calcium pyrophosphate dihydrate crystal deposition disease after anterior cruciate ligament reconstruction.  Arthroscopy . 1998;  14 634-636
    PubMedGoogle Scholar
  • 19 Perez-Ruiz F, Testillano M, Gastaca M A. et al . "Pseudoseptic" pseudogout associated with hypomagnesemia in liver transplant patients.  Transplantation . 2001;  71 696-698
    PubMedGoogle Scholar
  • 20 Fam A G, Topp J R, Stein H B, et al Clinical and roentgenographic aspects of pseudogout: a study of 50 cases and review. Can Med Assoc J .  1981;  124 545-551
    PubMedGoogle Scholar
  • 21 Schumacher Jr H R, Klippel J H, Koopman W J. Calcium pyrophosphate dihydrate crystal deposition disease. In: Schumacher HR Jr, Klippel JH, Koopman WJ, eds. Primer on the Rheumatic Diseases Atlanta: Arthritis Foundation 1993: 219-222
    Google Scholar
  • 22 Ishida T, Dorfman H D, Bullough P G. Tophaceous pseudogout (tumoral calcium pyrophosphate dihydrate crystal deposition disease).  Hum Pathol . 1995;  26 587-593
    CrossrefPubMedGoogle Scholar
  • 23 Yu S L, Li R Z, Bian Z H. Tumoral calcium pyrophosphate dihydrate deposition disease. Review of the literature.  Chin Med J . 1992;  105 780-784
    PubMedGoogle Scholar
  • 24 Yamakawa K, Iwasaki H, Ohjimi Y. et al . Tumoral calcium pyrophosphate dihydrate crystal deposition disease. A clinicopathologic analysis of five cases.  Pathol Res Pract . 2001;  197 499-506
    PubMedGoogle Scholar
  • 25 Lambrecht N, Nelson S D, Seeger L. et al . Tophaceous pseudogout: a pitfall in the diagnosis of chondrosarcoma.  Diagn Cytopathol . 2001;  25 258-261
    CrossrefPubMedGoogle Scholar
  • 26 Santos-Ocampo A S, Tupasi T E, Villanueva F. et al . Mycobacterium tuberculosis infection of a tophaceous pseudogout nodule.  J Rheumatol . 2002;  29 1093-1096
    PubMedGoogle Scholar
  • 27 Elman M H, Brown N L, Levin B. Prevalence of knee chondrocalcinosis in hospital and clinic patients aged 50 or older.  J Am Geriatr Soc . 1981;  29 189-192
    PubMedGoogle Scholar
  • 28 Sanmarti R, Panella D, Brancos M A. et al . Prevalence of articular chondrocalcinosis in a rural area of Catalonia.  Ann Rheum Dis . 1993;  52 418-422
    PubMedGoogle Scholar
  • 29 Resnick D, Niwayama G, Goergen T G. et al . Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate crystal deposition disease (CPPD): pseudogout.  Radiology . 1977;  122 1-15
    CrossrefPubMedGoogle Scholar
  • 30 Kwak S M, Resnick D, Haghighi P. Calcium pyrophosphate dihydrate crystal deposition disease simulating spontaneous osteoneocrosis.  Clin Rheumatol . 1999;  18 355-356
    CrossrefPubMedGoogle Scholar
  • 31 Jobanputra P, Gibson T. Diagnosis of pseudogout and septic arthritis.  Br J Rheumatol . 1987;  26 379-380
    PubMedGoogle Scholar
  • 32 Smathers R L, Stelling C B, Keats T E. The destructive wrist arthropathy of pseudogout.  Skeletal Radiol . 1982;  7 255-258
    CrossrefPubMedGoogle Scholar
  • 33 Adamson III C T, Resnik C S, Guerra Jr J. et al . Hand and wrist arthropathies of hemochromatosis and calcium pyrophosphate deposition disease: distinct radiographic features.  Radiology . 1983;  147 377-381
    PubMedGoogle Scholar
  • 34 Kuhinara K, Mizuseki K, Saiki T. et al . Tophaceous pseudogout of the temporomandibular joint: report of a case.  Pathol Int . 1997;  47 578-580
    PubMedGoogle Scholar
  • 35 Olin H B, Pedersen K, Francis D. et al . A very rare benign tumor in the parotid region: calcium pyrophosphate dihydrate crystal deposition disease.  J Laryngol Otol . 2001;  115 504-506
    CrossrefPubMedGoogle Scholar
  • 36 Gerster J C, Landry M, Dufresne L. et al . Imaging of tophaceous gout: computed topography provides specific images compared to magnetic resonance imaging and ultrasonography.  Ann Rheum Dis . 2002;  61 52-54
    CrossrefPubMedGoogle Scholar
  • 37 Sato R, Takahashi M, Yamashita Y. et al . Calcium crystal deposition in cervical ligamentum flavum: CT and MR findings.  J Comput Assist Tomogr . 1992;  16 352-355
    PubMedGoogle Scholar
  • 38 Zunkeler B, Schelper R, Menezes A H. Peri-odontoid calcium pyrophosphate dihydrate deposition disease: "pseudogout" mass lesions of the craniocervical junction.  J Neurosurg . 1996;  85 803-809
    PubMedGoogle Scholar
  • 39 Grant G A, Wener M H, Yazji H. et al . Destructive tophaceous calcium hydroxyapatite tumor of the infratemporal fossa. Case report and review of the literature.  J Neurosurg . 1999;  90 148-152
    PubMedGoogle Scholar
  • 40 Zapletal J, Hekster R EM, Straver J S. et al . Association of transverse ligament calcification with anterior atlanto-odontoid osteoarthritis: CT findings.  Neuroradiology . 1995;  37 667-669
    CrossrefPubMedGoogle Scholar
  • 41 Constantin A, Marin F, Bon E. et al . Calcification of the transverse ligament of the atlas in chondrocalcinosis: computed tomography study.  Ann Rheum Dis . 1996;  55 137-139
    PubMedGoogle Scholar
  • 42 Baysal T, Bausal O, Kutlu R. et al . The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease.  Eur Radiol . 2000;  10 1003-1005
    CrossrefPubMedGoogle Scholar
  • 43 Assaker R, Louis E, Boutry N. et al . Foramen magnum syndrome secondary to calcium pyrophosphate crystal deposition in the transverse ligament of the atlas.  Spine . 2001;  26 1396-1400
    CrossrefPubMedGoogle Scholar
  • 44 Hasegawa H, Nakajima Y, Mabuchi E. et al . Retro-odontoid massive calcium pyrophosphate crystal deposition-case report.  Neurol Med Chir . 2000;  40 387-390
    CrossrefPubMedGoogle Scholar
  • 45 Kakitsubata Y, Boutin R D, Theodorou D J. et al . Calcium pyrophosphate dihydrate crystal deposition in and around the atlantoaxial joint: association with type 2 odontoid fractures in nine patients.  Radiology . 2000;  216 213-219
    CrossrefPubMedGoogle Scholar
  • 46 Resnick D, Pineda C. Vertebral involvement in calcium pyrophosphate dihydrate crystal disease.  Radiology . 1984;  15 55-60
    PubMedGoogle Scholar
  • 47 Berlemann U, Gries N C, Moore R J. et al . Calcium pyrophosphate dihydrate deposition in degenerate lumbar discs.  Eur Spine J . 1998;  7 45-49
    CrossrefPubMedGoogle Scholar
  • 48 Yamagami T, Kawano N, Nakano H. Calcification of the cervical ligamentum flavum-case report.  Neurol Med Chir . 2000;  40 234-238
    PubMedGoogle Scholar
  • 49 Gomez H, Chou S M. Myeloradiculopathy secondary to pseudogout in the cervical ligamentum flavum: case report.  Neurosurgery . 1989;  25 298-302
    PubMedGoogle Scholar
  • 50 Furasawa N, Baba H, Maezawa Y. et al . Calcium crystal deposition in the ligamentum flavum of the lumbar spine.  Clin Exp Rheumatol . 1997;  15 641-647
    PubMedGoogle Scholar
  • 51 Delamarter R B, Sherman J E, Carr J. Lumbar spinal stenosis secondary to calcium pyrophosphate crystal deposition (pseudogout).  Clin Orthop . 1993;  289 127-130
    PubMedGoogle Scholar
  • 52 Fujishiro T, Nabeshima Y, Yasui S. et al . Pseudogout attack of the lumbar facet joint: a case report.  Spine . 2002;  27 E396-E398
    CrossrefPubMedGoogle Scholar
  • 53 Fidler W K, Dewar C L, Fenton P V. Cervical spine pseudogout with myelopathy and Charcot joints.  J Rheumatol . 1996;  23 1445-1448
    PubMedGoogle Scholar
  • 54 el Maghraoui A, Lecooules S, Lechevalier D. et al . Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease.  Clin Exp Rheumatol . 1999;  17 477-478
    PubMedGoogle Scholar
  • 55 Huang G S, Bachmann D, Taylor J A. et al . Calcium pyrophosphate dihydrate crystal deposition disease and pseudogout of the acromioclavicular joint: radiographic and pathologic features.  J Rheumatol . 1993;  20 2077-2082
    PubMedGoogle Scholar
  • 56 Richman K M, Boutin R D, Vaughan L M. et al . Tophaceous pseudogout of the sternoclavicular joint.  Am J Roentgenol . 1999;  172 1587-1589
    PubMedGoogle Scholar
  • 57 Monteforte P, Brignone A, Rovetta G. Tissue changes detectable by sonography before radiological evidence of elbow chondrocalcinosis.  Int J Tissue React . 2000;  22 23-25
    PubMedGoogle Scholar
  • 58 Yang B Y, Sartoris D J, Djukic S. et al . Distribution of calcification in the triangular fibrocartilage region in 181 patients with calcium pyrophosphate dihydrate crystal deposition disease.  Radiology . 1995;  196 547-550
    PubMedGoogle Scholar
  • 59 Chen C, Chandnani V P, Kang H S. et al . Scapholunate advance collapse: a common wrist abnormality in calcium pyrophosphate crystal deposition disease.  Radiology . 1990;  177 459-461
    CrossrefPubMedGoogle Scholar
  • 60 Stabler A, Heuck A, Resier M. Imaging of the hand: degeneration, impingement and overuse.  Eur J Radiol . 1997;  25 118-122
    CrossrefPubMedGoogle Scholar
  • 61 Donich A S, Lektrakul N, Liu C C. et al . Calcium pyrophosphate dihydrate crystal deposition disease of the wrist: trapezioscaphoid joint abnormality.  J Rheumatol . 2000;  27 2628-2634
    PubMedGoogle Scholar
  • 62 Hunkeler M, Gerster J C. Rapid osteolysis of the hip and chondrocalcinosis.  Schweiz Rundsch Med Prax . 1996;  85 513-516
    PubMedGoogle Scholar
  • 63 Richards A J, Hamilton E B. Destructive arthropathy in chondrocalcinosis articularis.  Ann Rheum Dis . 1974;  33 196-203
    PubMedGoogle Scholar
  • 64 Foldes K, Lenchik L, Jaovisidha S. et al . Association of gastrocnemius tendon calcification with chondrocalcinosis of the knee.  Skeletal Radiol . 1996;  25 621-624
    CrossrefPubMedGoogle Scholar
  • 65 Yang B Y, Sartoris D J, Resnick D. et al . Calcium pyrophosphate dihydrate crystal deposition disease: frequency of tendon calcification about the knee.  J Rheumatol . 1996;  23 883-888
    PubMedGoogle Scholar
  • 66 Resnick D, Kang H S. Knee. In: Resnick D, Kang HS, eds. Internal Derangements of Joints: Emphasis on MR Imaging Philadelphia: WB Saunders 1997: 683-684
    Google Scholar
  • 67 Tateyama Y, Takano Y, Tohno Y. et al . Correlations of calcium accumulations in arteries, veins, cartilages, ligaments, and bones in humans.  Biol Trace Elem Res . 2000;  74 211-221
    CrossrefPubMedGoogle Scholar
  • 68 Tohno Y, Mrowake Y, Takano Y. et al . Age-related changes of elements in human anterior cruciate ligaments and ligamenta capitis femorum.  Biol Trace Elem Res . 1999;  68 181-192
    PubMedGoogle Scholar
  • 69 Derfus B A, Kurian J B, Butler J J. et al . The high prevalence of pathologic calcium crystals in pre-operative knees.  J Rheumatol . 2002;  29 570-574
    PubMedGoogle Scholar
  • 70 Beltran J, Marty-Delfaut E, Bencardino J. et al . Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations.  Skeletal Radiol . 1998;  27 369-374
    CrossrefPubMedGoogle Scholar
  • 71 Disler D G, McCauley T R, Kelman C G. et al . Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy.  Am J Roentgenol . 1996;  167 127-132
    CrossrefPubMedGoogle Scholar
  • 72 Burke B J, Escobedo E M, Wilson A J. Chondrocalcinosis mimicking a meniscal tear on MR imaging.  Am J Roentgenol . 1998;  170 69-70
    PubMedGoogle Scholar
  • 73 Eustace S, Buff B, McCarthy C. et al . Magnetic resonance imaging of hemochromatosis arthropathy.  Skeletal Radiol . 1994;  23 547-549
    PubMedGoogle Scholar
  • 74 Gale D R, Gianturco L E, Gale M E. MR characteristics of chondrocalcinosis of the knee (abstract).  Radiology . 1996;  201 332
    PubMedGoogle Scholar
  • 75 Kaushik S, Erickson J K, Palmer W E. et al . Effect of chondrocalcinosis on the MR imaging of the knee menisci.  Am J Roentgenol . 2001;  177 905-909
    PubMedGoogle Scholar
      >