Abstract:
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Purpose: To demonstrate and determine the frequency and location of calcification in the internal structures of cadaveric knees with or without cartilage calcification typical of CPPD crystal deposition disease, utilizing histologic, radiographic and MRI techniques.
Methods and Materials: Ten cadaveric knees of elderly individuals that demonstrated no radiographic evidence of prior surgery or trauma were included in our study. These 10 knees were studied with MRI and subsequently sectioned in planes corresponding to those obtained with MR imaging. The slices were imaged with high-resolution radiography. Two musculoskeletal radiologists correlated the anatomic, MR and radiographic findings. Four knees demonstrated calcific deposits within internal structures of the joint. Three of the knees, which did not demonstrate calcifications, were utilized as controls. Histologic sections were obtained from the 4 knees that contained calcifications and from the 3 controls and analyzed with special histological stains that demonstrate phosphorus and calcium in the tissues.
Results: Radiographic imaging and histologic analysis demonstrated widespread CPPD crystal deposition in 4 of the 10 knee specimens (40%). MRI demonstrated some calcifications only within the articular cartilage of the femoral condyles in 3 of the 4 (75%) specimens that had CPPD deposits. In all 4 specimens radiographs and histologic analysis were more sensitive than MR imaging and demonstrated CPPD deposits, not only in the articular cartilage of the femoral condyles and tibial plateaus, but also within the substance of the cruciate ligaments, popliteus tendon and menisci. Histologic analysis demonstrated no evidence of CPPD crystals in the control specimens.
Conclusion: MRI is insensitive to the presence of CPPD deposits in the knee, even when such deposits are widespread. Our study suggests that the sensitivity of MRI was significantly better in detecting CPPD deposits in the hyaline cartilage of the femoral condyles when compared to other internal structures, even when such structures contained a higher amount of calcification. CPPD crystalline deposits in ligaments about the knee appear more frequent and widespread than indicated in previous literature.
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De Lima MD, J,
Calcifications in Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease in the Knee: Anatomic, Radiographic, MR imaging, and Histologic Study in Cadavers. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3102888.html
