Radiography detects calciphylaxis earlier than histopathology

The calcification of blood vessels, blood clots and skin necrosis, also known as calciphylaxis, is commonly diagnosed through a skin biopsy, which risks poor healing of the biopsy site, extensive bleeding or a continuation of necrosis.  

However, a study published in March by JAAD aims to determine if radiologic imaging is a more effective diagnostic approach in detecting blood vessel calcification.  

"Collaborating with radiology colleagues to identify small vessel calcification that might otherwise be overlooked can assist in early diagnosis of calciphylaxis," said lead author Charles L. Halasz, MD. "Radiologic imaging might enable more rapid diagnosis of calciphylaxis when skin biopsy specimen is pending or not available."  

Authors of the study Charles L. Halasz, MD, David P. Munger, MD, Heather Frimmer, MD, Michael Dicorato, MD, and Sandra Wainwright, MD, compared diameters of calcified blood vessels from both skin biopsy and radiology imaging results from a series of patients with known calciphylaxis between 2009 and 2016.  

The seven patients ranged from 29 to 76 years old, including four males and three females. Five of the patients had diabetes and all had chronic kidney disease, among other health complications.  

Mammographic imaging, CT scans and plain film radiography were used by the researchers. After analyzing the seven patients' blood vessels from both a histopathology and radiology approach, Halasz and colleagues found a small-vessel calcification of 0.1 to 0.3 mm identified on plain films in three patients, 0.1 to 0.2 mm by mammography in three patients and 0.1 to 0.2 mm by computed tomography imaging in one patient. On the other hand, diameters of the smallest calcified vessels measured on skin biopsy specimens ranged from 0.04 to 0.3 mm, according to study results.   

"We found that consultation with radiology colleagues can reveal small arterial and arteriolar calcification less than 1 mm, potentially hastening the diagnosis of calciphylaxis before tissue pathology results are available," Halasz concluded from the study.