The clinical records and hand and wrist radiographs of 51 patients with calcium pyrophosphate dihydrate crystal deposition disease have been analyzed, and symptomatology and radiologic abnormalities have been correlated. Characteristic roentgenographic features included cartilage and synovial calcification and arthropathy of the metacarpophalangeal joints and the radiocarpal compartment of the wrist, including scapholunate dissociation. Clinical-radiologic correlation revealed many asymptomatic patients with calcification and arthropathy and many symptomatic patients with normal radiographs. Thorough radiologic evaluation may reveal many patients with this disorder before the onset of clinical symptoms.