Imaging

Pseudogout

Preliminary Diagnosis: Pseudogout

I. What imaging technique is first-line for this diagnosis?

Plain radiography.

II. Describe the advantages and disadvantages of this technique for diagnosing pseudogout.

Advantages

  • Relatively inexpensive and fast imaging modality.

  • Offers exquisite visualization of focal areas of mineralization noted in pseudogout, predominantly calcium pyrophosphate deposition disease.

  • Highly portable imaging modality.

Disadvantages

  • Limited sensitivity and specificity in evaluating the surrounding soft tissues.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant women.

IV. What alternative imaging techniques are available?

  • CT imaging without contrast of the joint of concern.

  • MR imaging without contrast of the joint of concern.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pseudogout.

CT imaging without contrast of the joint of concern

Advantages

  • Highly sensitive and specific in detecting subtle changes from pseudogout and detecting subtle areas of calcium pyrophosphate deposition.

  • Offers exquisite evaluation and detail of mineralized structures.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Limited in sensitivity and specificity for evaluating the surrounding soft tissues.

MR imaging without contrast of the joint of concern

Advantages

  • Highly sensitive and specific in characterizing the surrounding soft tissues and cartilaginous structures.

  • Better adept in detecting any subtle marrow edema or fracture not identified on CT imaging.

Disadvantages

  • Less adept in detailing and characterizing the surrounding osseous structures and noting subtle mineralization.

  • Subject to motion and susceptibility weighted artifact, degrading image quality.

  • Longer imaging modality and less portable than other imaging modalities.

  • Expensive.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging without contrast of the joint of concern

May be contraindicated in patients who are pregnant.

MR imaging without contrast of the joint of concern

Contraindicated in patients with non MR compatible hardware.

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