Eugenia Shmidt, Presenter: Nothing to Disclose

Naveen Srinivasa Murthy MD, Abstract Co-Author: Nothing to Disclose

John Marshall Knudsen MD, Abstract Co-Author: Nothing to Disclose

Roger H. Weenig MD, Abstract Co-Author: Nothing to Disclose

M. Amanda Jacobs MD, Abstract Co-Author: Nothing to Disclose

Autumn Starnes DO, Abstract Co-Author: Nothing to Disclose

Mark Davis MD, Abstract Co-Author: Nothing to Disclose

Calciphylaxis is a rare, life-threatening syndrome marked by soft-tissue calcification and cutaneous necrosis. Currently skin biopsy is the gold standard for diagnosis despite increased risk of infection and poor wound healing. We aim to investigate the potential role of plain radiographic imaging in the diagnosis of calciphylaxis.

Medical charts were reviewed from patients diagnosed with calciphylaxis between January 1, 1996 and December 31, 2010 at Mayo Clinic Rochester.  Two control dialysis patients were age- and sex-matched to each of the calciphylaxis patients.  Plain radiographs were obtained closest to the date of diagnosis of calciphylaxis patients and corresponding controls. Two radiologists, blind to cases and controls, read each image together.  Imaged body parts were classified as “core” or “peripheral.” Core body parts were chest, abdomen, hips and spine while peripheral body parts were upper extremities, lower extremities and head. The following information was recorded: size of calcified vessels, diffuse or focal pattern of calcifications, presence of net-like calcifications, extent of calcifications, bone density/mineralization and other calcifications.  

Twenty-nine calciphylaxis patients (mean age 57 years, 21 female) were identified. The mean age at diagnosis was 57 years (range, 36-75 years). Compared to controls, plain radiographs of calciphylaxis patients had a characteristic net-like pattern of calcifications and more vascular calcification, especially small vessel calcifications.  A net-like pattern of calcification had a greater than 9-fold strength of association with calciphylaxis and a specificity of nearly 90% (p<0.001). These findings were preserved even upon reading only a single image per patient.  Additionally, the sensitivity of a net-like pattern of calcifications was greater in peripheral images versus core images (63.2% extremities vs. 44.4% core, p<0.05). This difference held up in the examination of a single image (72.7% peripheral vs. 44.4% core, p<0.05).

A net-like pattern of calcifications on plain radiographs is a unique characteristic of calciphylaxis and can be potentially used as a diagnostic tool.

Plain soft-tissue X-ray imaging is a potential tool in diagnosing calciphylaxis and avoids the potential risks of infection and poor wound healing associated with skin biopsy.

Shmidt, E, Murthy, N, Knudsen, J, Weenig, R, Jacobs, M, Starnes, A, Davis, M, Characterization of Calciphylaxis Using Plain Soft-Tissue X-rays.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034203.html