DOI QR코드

DOI QR Code

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease Involving the Ligamentum Flavum of the Cervical Spine with Intense Enhancement on MRI: A Case Report

자기공명영상에서 뚜렷한 조영증강을 보이는 경추 황색인대의 칼슘수산화인회석 결정침착질환: 증례 보고

  • Junyoung Lee (Department of Radiology, Hanyang University Seoul Hospital) ;
  • Seunghun Lee (Department of Radiology, Hanyang University Seoul Hospital) ;
  • Jiyoon Bae (Department of Pathology, National Police Hospital)
  • 이준영 (한양대학교 서울병원 영상의학과) ;
  • 이승훈 (한양대학교 서울병원 영상의학과) ;
  • 배지윤 (국립경찰병원 병리과)
  • Received : 2019.04.01
  • Accepted : 2019.12.06
  • Published : 2020.09.01

Abstract

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterized by chondrocalcinosis, which mainly affects the knees, wrists, pelvis, and rarely, the spine. According to previous reports, CPPD crystal deposits display heterogeneous enhancement on MRI. When combined with inflammation of the surrounding soft tissue, strong enhancement by CPPD crystal deposition may appear similar to imaging features of other conditions such as infectious spondylitis. In these conditions, CT plays an important role in differential diagnosis. Here, we present a case of CPPD crystal deposition disease in the ligamentum flavum of the cervical spine that showed intense enhancement on MRI.

칼슘수산화인회석(calcium pyrophosphate dehydrate; 이하 CPPD) 결정침착질환은 연골석회증을 특징으로 하는 질환으로, 주로 무릎, 손목, 골반, 드물게는 척추를 침범한다. 이전 보고에 따르면, CPPD 결정침착은 MRI에서 불균질하게 조영증강이 될 수 있다. 주변 연부 조직의 염증과 동반된 CPPD 결정침착의 뚜렷한 조영증강은 감염성 척추염 등 다른 질환과 유사한 영상 소견을 보일 수 있다. 이 경우 CT는 감별진단에 중요한 역할을 한다. 저자들은 MRI에서 황색인대에 저명한 조영증강을 보이는 CPPD 결정침착 증례를 보고하고자 한다.

Keywords

References

  1. Resnick D, Niwayama G, Goergen TG, Utsinger PD, Shapiro RF, Haselwood DH, et al. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate dihydrate deposition disease (CPPD): pseudogout. Radiology 1977;122:1-15 https://doi.org/10.1148/122.1.1
  2. Pawelek SA, Illes JD, Taylor JA. Calcium pyrophosphate dihydrate crystal deposition disease simulating osteoarthrosis of the knee: a case report. J Chiropr Med 2016;15:219-223 https://doi.org/10.1016/j.jcm.2016.04.005
  3. Kato H, Nishimoto K, Yoshikawa T, Kusuzaki K, Sudo A. Tophaceous pseudogout in the knee joint mimicking a soft-tissue tumour: a case report. J Orthop Surg (Hong Kong) 2010;18:118-121 https://doi.org/10.1177/230949901001800127
  4. Bartels CM, Singh JA, Parperis K, Huber K, Rosenthal AK. Validation of administrative codes for calcium pyrophosphate deposition: a Veterans Administration study. J Clin Rheumatol 2015;21:189-192 https://doi.org/10.1097/RHU.0000000000000251
  5. Roet M, Spoor JK, De Waal M, Kros MJ, Harhangi SB, Dammers R. Extensive calcification of the ligamentum flavum causing cervical myelopathy in a Caucasian woman. Springerplus 2016;5:1927
  6. Sekijima Y, Yoshida T, Ikeda S. CPPD crystal deposition disease of the cervical spine: a common cause of acute neck pain encountered in the neurology department. J Neurol Sci 2010;296:79-82 https://doi.org/10.1016/j.jns.2010.05.028
  7. Brown TR, Quinn SF, D'Agostino AN. Deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: evaluation with MR imaging and CT. Radiology 1991;178:871-873 https://doi.org/10.1148/radiology.178.3.1994435
  8. Rosenthal AK, Ryan LM. Calcium pyrophosphate deposition disease. N Engl J Med 2016;374:2575-2584 https://doi.org/10.1056/NEJMra1511117
  9. Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation? Radiographics 2009;29:599-612 https://doi.org/10.1148/rg.292085137
  10. Ikushima I, Hirai T, Korogi Y, Norio M, Koganemaru M, Suga R, et al. Spinal MR findings in continuous epidural analgesia without infection. AJNR Am J Neuroradiol 2005;26:991-995