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A narrative review of imaging in calcinosis associated with systemic sclerosis

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Abstract

Calcinosis is dystrophic calcification of the soft tissue which can lead to painful and debilitating disease. It is commonly seen in patients with systemic sclerosis (SSc). Imaging can assist in diagnosis, quantification of disease, and better pathophysiologic understanding of calcinosis. Traditionally, X-rays have been the most frequently used imaging modality for diagnosis; however, advances in ultrasound (US), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have led to greater ability to characterize these lesions and surrounding structures. This narrative review aims to describe the use of imaging for calcinosis in patients with SSc.

Key Points

• Imaging is useful in the diagnosis of calcinosis, assessment of disease severity, and disease monitoring.

• X-ray is commonly used and offers high sensitivity and specificity, but both ultrasound and CT-scans are alternatives when greater anatomic detail is sought regarding surrounding structures.

• Investigational imaging modalities include dual energy CT-scans, cinematic rendering CT-scans, and PET- CT scans.

• Conventional MRI scans have less sensitivity and specificity for detection of calcinosis.

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Acknowledgements

The authors would like to thank Dr. Aya Kamaya for comments on the manuscript.

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Authors and Affiliations

  1. Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA

    Diane Mar, Lorinda Chung & Robert M. Fairchild

  2. Department of Rheumatology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

    Antonia Valenzuela

  3. Department of Radiology, Musculoskeletal Imaging, Stanford University Medical Center, Palo Alto, CA, USA

    Kathryn J. Stevens

  4. Department of Medicine, Rheumatology Section, Palo Alto VA Health Care System, Palo Alto, CA, USA

    Lorinda Chung

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Dr. Lorinda Chung has received consulting fees from Eicos, Mitsubishi Tanabe, and Boehringer Ingelheim. Dr. Lorinda Chung receives funding from the Scleroderma Research Foundation. Dr. Antonia Valenzuela acknowledges the support from Development (ANID) Grant Fondecyt de Iniciación en Investigación Nº 11190426. Dr. Robert Fairchild recieves support from Boehringer Ingelheim. The other authors declare they have no conflict of interest related to this manuscript.

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Mar, D., Valenzuela, A., Stevens, K.J. et al. A narrative review of imaging in calcinosis associated with systemic sclerosis. Clin Rheumatol 40, 3867–3874 (2021). https://doi.org/10.1007/s10067-021-05696-6

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