CT Findings on Crystals of Calcium Pyrophosphate Dihydrate Deposited in the Flaval Ligament

  • Iida Hideo
    Department of Neurosurgery, Kitasato University School of Medicine
  • Kawano Nobuyuki
    Department of Neurosurgery, Kitasato University School of Medicine
  • Wang Renzhi
    Department of Neurosurgery, Kitasato University School of Medicine
  • Matsuno Takashi
    Department of Chemistry, Kitasato University School of Medicine
  • Miyazawa Shichiro
    Department of Electron Microscope Laboratory Center, Kitasato University School of Medicine
  • Tanaka Toshihiko
    Department of Neurosurgery, Kitasato University School of Medicine
  • Mii Kimihiko
    Department of Neurosurgery, Kitasato University School of Medicine
  • Tachibana Shigekuni
    Department of Neurosurgery, Kitasato University School of Medicine
  • Yada Kenzoh
    Department of Neurosurgery, Kitasato University School of Medicine
  • Kan Shinichi
    Department of Radiology, Kitasato University School of Medicine
  • Yagishita Saburo
    Department of Pathology, Kitasato University School of Medicine

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Other Title
  • 黄色靱帯ピロリン酸カルシウム結晶沈着症のCT所見

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Description

In one male patient (age 76) and one female patient (age 64) having cervical radiculomyelopathy, CT scan disclosed dihydrate crystals of calcium pyrophosphate deposited in the flaval ligaments of the cervical area. The CT scan showed two deposition pattern in both cases, a linear high density area and a nodular high density area. With further investigation by electron microscopy and X-ray diffraction, the linear high density area was identified as pure calcium pyrophosphate dihydrate (CPPD) crystals, and the nodular high density area was found to be a deposition of mixed crystals including CPPD and hydroxyapatite. Consequently, differential diagnosis using neuroradiology was concluded to be valid in locating deposits attributable to the cause of cervical radiculomyelopathy. CPPD crystals were characteristically indicated by the linear density area shown in the CT scan, and moreover, CT images ranging in shape from linear to nodular differentiated between the multiple types of calcification anatomically appearing in the various flaval ligaments arranged throughout the cervical region. Therefore, CT scan is believed to enable preoperative identification of crystal deposits in the flaval ligaments, particularly in the cervical area.

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