The crowned dens syndrome. Evaluation with CT imaging

Abstract

CT is the gold standard in identifying crowned dens syndrome, as it is able to depict the shape and site of calcification and any bone erosions. Radiography of other joints (wrist, knee, pubic symphysis) may help to ascertain whether the disease is due to calcium pyrophosphate dihydrate or hydroxyapatite crystals, and is therefore recommended for routine patient management. Magnetic resonance imaging (MRI) is indicated for the study of neurological complications.

CPPD crystal deposition disease of the cervical spine: A common cause of acute neck pain encountered in the neurology department

“…However, based on our experience in 14 patients, the distribution and character of the pain (i.e., mostly from the suboccipital region to the posterior part of the neck on both sides without specific points of tenderness and abnormal superficial sensation) and restricted neck motion, particularly in rotation, are strongly suggestive of crowned dens syndrome. As described previously (7,8,14,15), CT imaging of the cervical spine was superior to MRI in confirming CPPD crystal deposition in our patients, especially when calcifications were small. Ideally, CT should be analyzed multidirectionally using reconstruction images, as the axial view is useful for detecting calcification of the transverse ligament, ligamenta flava, and alar ligament; the coronal view is useful for detecting calcification of the apical ligament; and the sagittal view is useful for detecting calcification of the longitudinal fibres of the cruciate ligament (Figs.…”

Calcium pyrophosphate dihydrate deposition disease of the filum terminale

“…In particular at the cervical level, the CPPD deposition may appear as a periodontoid mass (not distinguishable by rheumatoid disease) or as focal ossification of the ligamentum flavum in the subaxial cervical spine [3]. The thoracic and lumbar localization may involve the nucleus pulposus of the intervertebral disc, the annulus fibrosus, the yellow ligaments and the posterior longitudinal ligaments with secondary myelopathy for spinal cord compression and vertebral stenosis [5,9]. Markiewitz et al [10] measured the incidence of CPPDCD in specimens of ligamenta flava in a series of consecutive patients undergoing spinal decompression for vertebral stenosis.…”

“…Patients affected by CPPDD often present a mono or oligoarthropathy, generally involving knees, wrists, metacarpophalangeal joints, pubic symphysis and hip; tophaceous pseudogout (tumoral or massive CPPDD) is one of its rarest clinical forms characterized by focal deposition of CPPD [1,[3][4][5]. It has been rarely described with spinal localization, where it affects prevalently the fibrous and cartilaginous structures such as intervertebral disc and annulus fibrosus, ligamentum flavum, posterior longitudinal ligaments and transverse ligaments [5].…”

Incidence, Age and Gender of Subjects With the Calcium Pyrophosphate Deposition Around the Dens, and Clinical Characteristics of Patients With Crowned Dens Syndrome

“…Clinical symptoms are due to pseudogout of the atlantoaxial junction induced by calcifications around the dens [1]. The computed tomography (CT) is the gold standard in identifying CDS, as it is able to depict the shape and site of calcification, and CT shows radiopaque densities surrounding the top and sides of the odontoid process in a crown-like distribution [1][2][3][4]. Characteristic CT findings have been reported [5][6][7][8].…”