Dual-energy computed tomography (DECT) imaging can be useful in the evaluation of scleroderma-related calcinosis (SSc calcinosis) of the hands.
We performed DECT scans of the hands of patients with symptomatic SSc calcinosis to better characterize the location and radiographic details of the calcinosis and exclude any monosodium urate (MSU) crystal deposition. DECT is an advanced imaging modality useful for assessing soft tissue MSU deposition attributable to gout and visualization of bone and soft tissue structures such as ligaments and tendons1,2,3.
We present here DECT images from 2 patients with SSc calcinosis. Figure 1 is the right hand and wrist of an African American woman with 10 years of diffuse SSc and seropositive polyarthritis, whose calcinosis presented 2 years ago as painful wrist swelling. She failed surgical debulking and these painful deposits continue to drain from the wrist. The plain radiograph shows similar changes but in lesser detail, particularly in osteopenic areas where there are large deposits of SSc-calcinosis overlying the bone destruction.
Figure 2 is the right hand of a white woman with a 14-year history of diffuse SSc, whose calcinosis presented 8 years ago in both arms and hands. The hand is completely disabled from these enlarging and widespread deposits.
DECT imaging found calcinosis deposits most commonly in the subcutaneous fat pads of the fingertips, along tendon sheaths, within the carpal tunnel, and adjacent to muscle groups. No MSU crystal deposition has been identified. We propose that DECT imaging can be a useful imaging modality to assess SSc-calcinosis of the hands.