IMAGING OF TUMORAL CALCINOSIS - NEW OBSERVATIONS

Five patients with tumoral calcinosis were evaluated with radiography, bone scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging. The arthropathy of calcium pyrophosphate dihydrate deposition disease was seen in two of the patients and pseudoxanthoma elasticum-like syndrome in three. Identification of calcific paraarticular masses on radiographs is characteristic of tumoral calcinosis. Marrow lesions could be identified as patchy areas of calcification (calcific myelitis) in long bones and the calvarium. Bone scintigraphy appears to be the best modality for detection of the masses and marrow lesions and for monitoring therapy. At CT the masses demonstrated a varied appearance, from small and solid to large and cystic. The marrow abnormality appears as an area of increased attenuation and spotty calcification that in the skull may be associated with dural and vascular calcifications. MR imaging of the paraarticular masses was remarkable in that the masses displayed high signal intensity on T2-weighted images despite a large calcific component. Marrow lesions also showed increased signal intensity on T2-weighted images. When calcified paraarticular masses are present the diagnosis is rarely in question. The diagnosis may be overlooked, however, when calcific myelitis is the only manifestation.