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CPPD Crowned Dens Syndrome CT & MRI Spine

Crowned dens is a manifestation of Calcium Pyrophosphate deposition diseases (CPPD) in the cervical spine.


Peri odontoid deposition of Calcium Pyrophosphate crystals.


The diagnosis is easier on CT as high density of calcium is seen around the dens.


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Image above: Increased density ( Pink arrows) centred in the region of the transverse ligament.

  • The diagnosis is harder on MRI as often what we seen is thickening of soft tissue in the region of the transverse ligament.
  • A Gradient Echo sequence can help to look for areas of dephasing (low signal) from the calcium. 


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Image above: Axial T2 scans demonstrates low signal thickening of soft tissue (Pink arrow) centered in the region of the transverse ligament. Green arrow Dens.

Sagittal Gradient echo sequence demonstrates areas of low signal (Yellow arrow) in keeping with calcification.



We look at the Pathology, Imaging, Scans and Diagnosis of Crowned Dens Syndrome and the Differential Diagnosis of Retro Odontoid Pseudo Tumour, in much more detail in our Spine Arthropathy & Spondyloarthropathy Mini Fellowship.

Click on the LEARN WITH US image link below.

radiology rheumatology imaging dr joe thomas

Thank you to Dr Joe Thomas a Senior Consultant Rheumatologist for his input in the case. We will have Dr Thomas  joining us in presenting the Spine Arthropathy & Spondyloarthropathy course to give us the important clinical aspects we need to know as radiologists and also what a Rheumatologist wants from our reports.  More by clicking on the image below.

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