Crystal deposition diseases
11 Jun 2019
Crystal deposition diseases are a group of disorders characterised by the deposition of crystals around joints and periarticular soft tissues. The three main crystal arthropathies are: gout (monosodium urate crystals); pseudogout (calcium pyrophosphate crystals); hydroxyapatite deposition disease (calcium hydroxyapatite crystals).
Whilst diagnosis is often made on clinical grounds and with synovial fluid aspiration alone, imaging is vital for diagnosis of difficult cases, exclusion of other differential diagnoses and for monitoring response to treatment.
Plain radiography remains the mainstay of imaging crystal arthropathies due to its ready availability, relatively low cost, and easy reproducibility. It is ideal for visualisation of bony erosions and for characterisation of intra and extra-articular calcifications.
The utility of CT has been advanced recently with the advent of dual-echo CT (DECT). This novel technique is now the first-line investigation for detecting MSU crystals in cases of diagnostic difficulty.
Ultrasound (US) is increasingly used for diagnosis and detection of gout and HADD, if soft tissue manifestations are apparent in the absence of bony changes, e.g. in very early disease. The added benefit of US over other imaging modalities is the possibility of simultaneous diagnosis and percutaneous aspiration of crystals.
Educational aims:
• To recognise the salient imaging features of gout, pseudogout and HADD with various imaging modalities
• To describe the use of DECT in the detection of MSU crystals
References:
• Soldatos T et al. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol. 2016; 45(9): 1173-91.
• Onoumi P et al. Imaging in gout and other crystal-related arthropathies. Rheum Dis Clin North Am. 2016; 42(4): 621-44.
Further reading:
• Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016; 68(1): 53-5.
1 CPD credit
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Whilst diagnosis is often made on clinical grounds and with synovial fluid aspiration alone, imaging is vital for diagnosis of difficult cases, exclusion of other differential diagnoses and for monitoring response to treatment.
Plain radiography remains the mainstay of imaging crystal arthropathies due to its ready availability, relatively low cost, and easy reproducibility. It is ideal for visualisation of bony erosions and for characterisation of intra and extra-articular calcifications.
The utility of CT has been advanced recently with the advent of dual-echo CT (DECT). This novel technique is now the first-line investigation for detecting MSU crystals in cases of diagnostic difficulty.
Ultrasound (US) is increasingly used for diagnosis and detection of gout and HADD, if soft tissue manifestations are apparent in the absence of bony changes, e.g. in very early disease. The added benefit of US over other imaging modalities is the possibility of simultaneous diagnosis and percutaneous aspiration of crystals.
Educational aims:
• To recognise the salient imaging features of gout, pseudogout and HADD with various imaging modalities
• To describe the use of DECT in the detection of MSU crystals
References:
• Soldatos T et al. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol. 2016; 45(9): 1173-91.
• Onoumi P et al. Imaging in gout and other crystal-related arthropathies. Rheum Dis Clin North Am. 2016; 42(4): 621-44.
Further reading:
• Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med. 2016; 68(1): 53-5.
1 CPD credit
Watch the video and complete the online self-reflection form. Go to "My events" to download your certificate. You must login to watch the video and receive CPD.
Duration:35 mins
Speaker info
Dhiren Shah
Consultant Radiologist, Northwick Park Hospital Dr Dhiren Shah MA(Cantab) MRCS FRCR has been a Consultant Musculoskeletal Radiologist at London North West Healthcare NHS Trust since 2012. He has completed two MSK radiology fellowships in Oxford and Toronto. He has a special interest in spinal radiology and sports imaging. He has treated elite athletes, including the GB rowing team and has provided MSK radiology support to athletes at the Glasgow Commonwealth Games in 2014, the Baku European Games in 2015 and London World Athletics Championships in 2017. Dr Shah has co-authored two books on musculoskeletal radiology and published in peer-reviewed radiology journals. He has presented at local, national and international radiology meetings and has received the Magna Cum Laude award from the Radiological Society of North America for an educational exhibit. He is a member of the British Society of Skeletal Radiologists and European Society of Skeletal Radiology.