The first and most specific test is visualization of weakly birefringent rhomboid CPPD crystals in synovial fluid aspirates from the affected joint. These expensive research tools are not commonly used in the clinical evaluation of patients, and most clinicians rely on two clinical tests to diagnose CPPD. In the only proposed set of diagnostic criteria, the gold standard for CPPD diagnosis is chemical or structural validation of the presence of articular CPP crystals with Fourier transform infrared (FTIR) spectroscopy or x-ray diffraction. Because of its clinical heterogeneity, as well as the propensity of CPPD to complicate other types of arthritis such as OA and even rheumatoid arthritis, rapid and accurate diagnosis can prevent unnecessary treatment when the diagnosis of CPPD is uncertain. For example, 25–30 % percent of knee specimens harvested at the time of surgery for a diagnosis of knee osteoarthritis (OA) contain CPP crystals. There are few population-based studies of its prevalence, but conservative estimates suggest that CPPD affects up to 10 million Americans. While advanced age is the major risk factor for sporadic CPPD, a handful of metabolic diseases including hemochromatosis, hyperparathyroidism, hypomagnesemia, and hypophosphatasia are associated with an increased prevalence of CPPD.ĬPPD is under-recognized and under-studied.

It comprises a heterogeneous group of clinical syndromes which range from an acute inflammatory mono-articular arthritis, previously known as pseudogout, to a group of chronic polyarticular degenerative processes with or without features of inflammation. Advances in imaging in CPPD will increase diagnostic accuracy and eventually result in better management of this common form of arthritis.Ĭalcium pyrophosphate deposition disease (CPPD) is caused by the deposition of calcium pyrophosphate (CPP) crystals in and around articular tissues. While dual energy CT and diffraction-enhanced synchrotron imaging remain research tools, they present potential avenues for improved visualization of CPP deposits.

Recent work also highlights the polyarticular nature of CPPD, its association with tissue damage, and the high prevalence of tendon involvement. New studies inform our use of conventional radiographic screening methodologies for CPPD and provide additional evidence for the utility of diagnostic ultrasound. Here, we critically review the recent literature on imaging in CPPD.

The diagnosis of CPPD is supported by the presence of radiographic chondrocalcinosis yet, conventional radiography detects only about 40 % of clinically important CPPD. Calcium pyrophosphate deposition disease (CPPD) is a common and clinically heterogeneous form of arthritis caused by the deposition of calcium pyrophosphate (CPP) crystals in articular tissues.

Cppd crystals in synovial fluid