Prevalence of brain calcifications in a Brazilian cohort: A retrospective study in radiology services

Oliveira, Matheus Fernandes de; Silva, Edison Barros e; Oliveira, João Ricardo Mendes de

doi:10.1590/S1980-57642013DN70200012

ABSTRACT

Brain calcifications may be present in a wide range of neuropsychiatric, infectious traumatic, neoplastic and endocrine conditions, associated with motor and cognitive symptoms. They are often considered "physiologic" or pathologic. Objective: To determine the prevalence of brain calcifications in a Brazilian cohort. Methods: 1898 consecutive patients underwent skull CTs, comprising 836 men and 1062 women. Results: Among all 1898 patients, 333 (197 women and 136 men) presented with brain calcifications, representing an overall prevalence of 17.54%. The prevalence in the female group was 18.54% versus 16.26% in the male group. Conclusions: A growth in incidental findings on CT scans are likely as these exams become more widely available. However, a current debate between radiologists and regulators is set to redefine the CT usage, especially in the United States and the United Kingdom, considering new norms for use and radiation dosage per exam.

Key words:
brain calcinosis; basal ganglia calcification; neuroimaging; neuroepidemiology

RESUMO

Calcificações cerebrais podem estar presentes em uma grande variedade de condições médicas, incluindo doenças infecciosas, endocrinológicas, traumáticas, neoplásicas, psiquiátricas e neurológicas, associados a diferentes manifestações clínicas. Elas são muitas vezes consideradas "fisiológicas" ou patológicas. Objetivo: Determinar a prevalência de calcificações cerebrais em uma coorte brasileira. Métodos: 1898 pacientes consecutivos realizaram tomografia de crânio simples. 836 eram homens e 1062 eram mulheres. Resultados: Entre todos os 1.898 pacientes, 333 (197 mulheres e 136 homens) apresentaram calcificações cerebrais. Assim, a prevalência total foi de 17,54%. No grupo feminino a prevalência foi de 18,54% e nos homens, 16,26%. Conclusões: Provavelmente os achados incidentais em tomografias computadorizadas (TC) serão crescentes, uma vez que estes exames estão mais disponíveis. No entanto, um debate atual entre radiologistas provavelmente deverá redefinir o uso de TC muito em breve, especialmente nos Estados Unidos e Reino Unido.

Palavras-chave:
neuroepidemiologia; calcinose cerebral; neuroimagem

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERENCES

Manyam BV. What is and what is not 'Fahr's disease'. Parkinsonism Relat Disord 2005;11:73-80.
Oliveira MF, Oliveira JRM. A Comorbid Case of Familial Idiopathic Basal Ganglia Calcification ("Fahr´s Disease") Associated with Post-Polio Syndrome. J Neuropsychiatry Clin Neurosci 2012;24:E14-5.
Oliveira MF, Steinberg SS, Oliveira JRM. The challenging interpretation of genetic and neuroimaging features in basal ganglia calcification. Gen Hosp Psychiatry 2013;35:210-211.
Daghighi MH, Rezaei V, Zarrintan S, et al. Intracranial physiological calcifications in adults on computed tomography in Tabriz, Iran. Folia Morphol (Warsz) 2007;66:115-119.
Kwak R, Takeuchi F, Ito S, Kadoya S. Intracranial physiological calcification on computed tomography (Part 1): Calcification of the pineal region. No To Shinkei 1988;40:569-574.
Kwak R, Takeuchi F, Yamamoto N, Nakamura T, Kadoya S. Intracranial physiological calcification on computed tomography (Part 2): Calcification in the choroid plexus of the lateral ventricles. No To Shinkei1988;40:707-711.
Uduma FU, Pius F, Mathieu M. Computed tomographic pattern of physiological intracranial calcifications in a city in central Africa. Glob J Health Sci 2011;4:184-191.
Chew AP, Gupta G, Alatakis S, Schneider-Kolsky M, Stuckey SL. Hippocampal calcification prevalence at CT: a retrospective review. Radiology 2012;265:504-510.
Doyle AJ, Anderson GD. Physiologic calcification of the pineal gland in children on computed tomography: prevalence, observer reliability and association with choroid plexus calcification. Acad Radiol 2006;13:822-826.
Turgut AT, Karakas HM, Ozsunar Y, et al. Age-related changes in the incidence of pineal gland calcification in Turkey: A prospective multicenter CT study. Pathophysiology 2008;15:41-48.
Gomille T, Meyer RA, Falkai P, Gaebel W, Königshausen T, Christ F. Prevalence and clinical significance of computerized tomography verified idiopathic calcinosis of the basal ganglia. Radiologe 2001;41:205-210.
Geschwind DH, Loginov M, Stern JM. Identification of a locus on chromosome 14q for idiopathic basal ganglia calcification (Fahr disease). Am J Hum Genet 1999;65:764-72.
Oliveira JRM, Sobrido MJ, Spiteri E, et al. Analysis of Candidate Genes at the IBGC1 Locus Associated with Idiopathic Basal Ganglia Calcification ("Fahr's Disease"). J Mol Neurosci 2007;33:151-154.
Oliveira JR, Steinberg SS. Far from rare: revisiting the relevance of idiopathic basal ganglia calcifications. Neurol Sci 2010;31:679.
Lemos RR, Oliveira MF, Oliveira JRM. Reporting a new mutation at the SLC20A2 gene in familial idiopatic basal ganglia calcification. Eur J Neurol 2013;20:e43-e44.
Oliveira JRM, Lemos RR, Oliveira MF. Updating Genetic studies in familial idiopathic basal ganglia calcification. Southern Med J 2009;102:989.
Oliveira JRM. Managing Idiopathic Basal Ganglia Calcification ("Fahr's Disease"). Nova Publishing, New York, 2012.
Ostling S, Andreasson LA, Skoog I. Basal ganglia calcification and psychotic symptoms in the very old. Int J Geriatr Psychiatry 2003;18:983-987.
Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 2005;63:550-553; discussion 553.
Radaideh AM, Jaradat DM, Haddad FH. Prevalence of incidental basal ganglia calcification on routine brain computed tomography. RMJ 2012; 37:1-9.
Negrón D, Colón-Castillo L, Morales-Melecio I, Correa-Rivas M. Association of extensive brain calcifications, myelofibrosis, and retinopathy in a 12-year-old child. Pediatr Dev Pathol 2008;11:148-151.
Shirahama M, Akiyoshi J, Ishitobi Y, et al. A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease. Acta Psychiatr Scand 2010;121:75-77.
Bugnicourt JM, Leclercq C, Chillon JM, et al. Presence of intracranial artery calcification is associated with mortality and vascular events in patients with ischemic stroke after hospital discharge: a cohort study. Stroke 2011;42:3447-3453.
Koton S, Tashlykov V, Schwammenthal Y, et al. Cerebral artery calcification in patients with acute cerebrovascular diseases: determinants and long-term clinical outcome. Eur J Neurol2012;19:739-745.
Chung PW, Park KY, Moon HS, et al. Intracranial internal carotid artery calcification: a representative for cerebral artery calcification and association with white matter hyperintensities. Cerebrovasc Dis 2010;30:65-71.
Gilardini L, Pasqualinotto L, DiMatteo S, et al. Factors associated with early atherosclerosis and arterial calcifications in young subjects with a benign phenotype of obesity. Obesity (Silver Spring) 2011;19:1684-1689.
Koch B, Blackham A, Jones B. Incidental internal carotid artery calcifications on temporal bone CT in children. Pediatr Radiol 2007;37:141-144.
Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002;106:100-105.
Mahlberg R, Walther S, Kalus P, et al. Pineal calcification in Alzheimer's disease: an in vivo study using computed tomography. Neurobiol Aging 2008;29:203-209.
Bersani G, Garavini A, Taddei I, Tanfani G, Nordio M, Pancheri P. Computed tomography study of pineal calcification in schizophrenia. Eur Psychiatry 1999;14:163-166.
Schenkman L. Radiology. Second thoughts about CT imaging. Science 2011;331(6020):1002-1004.

Publication Dates

Publication in this collection
Apr-Jun 2013

History

Received
13 Feb 2012
Accepted
26 Apr 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Manyam BV. What is and what is not 'Fahr's disease'. Parkinsonism Relat Disord 2005;11:73-80.

[2] Oliveira MF, Oliveira JRM. A Comorbid Case of Familial Idiopathic Basal Ganglia Calcification ("Fahr´s Disease") Associated with Post-Polio Syndrome. J Neuropsychiatry Clin Neurosci 2012;24:E14-5.

[3] Oliveira MF, Steinberg SS, Oliveira JRM. The challenging interpretation of genetic and neuroimaging features in basal ganglia calcification. Gen Hosp Psychiatry 2013;35:210-211.

[4] Daghighi MH, Rezaei V, Zarrintan S, et al. Intracranial physiological calcifications in adults on computed tomography in Tabriz, Iran. Folia Morphol (Warsz) 2007;66:115-119.

[5] Kwak R, Takeuchi F, Ito S, Kadoya S. Intracranial physiological calcification on computed tomography (Part 1): Calcification of the pineal region. No To Shinkei 1988;40:569-574.

[6] Kwak R, Takeuchi F, Yamamoto N, Nakamura T, Kadoya S. Intracranial physiological calcification on computed tomography (Part 2): Calcification in the choroid plexus of the lateral ventricles. No To Shinkei1988;40:707-711.

[7] Uduma FU, Pius F, Mathieu M. Computed tomographic pattern of physiological intracranial calcifications in a city in central Africa. Glob J Health Sci 2011;4:184-191.

[8] Chew AP, Gupta G, Alatakis S, Schneider-Kolsky M, Stuckey SL. Hippocampal calcification prevalence at CT: a retrospective review. Radiology 2012;265:504-510.

[9] Doyle AJ, Anderson GD. Physiologic calcification of the pineal gland in children on computed tomography: prevalence, observer reliability and association with choroid plexus calcification. Acad Radiol 2006;13:822-826.

[10] Turgut AT, Karakas HM, Ozsunar Y, et al. Age-related changes in the incidence of pineal gland calcification in Turkey: A prospective multicenter CT study. Pathophysiology 2008;15:41-48.

[11] Gomille T, Meyer RA, Falkai P, Gaebel W, Königshausen T, Christ F. Prevalence and clinical significance of computerized tomography verified idiopathic calcinosis of the basal ganglia. Radiologe 2001;41:205-210.

[12] Geschwind DH, Loginov M, Stern JM. Identification of a locus on chromosome 14q for idiopathic basal ganglia calcification (Fahr disease). Am J Hum Genet 1999;65:764-72.

[13] Oliveira JRM, Sobrido MJ, Spiteri E, et al. Analysis of Candidate Genes at the IBGC1 Locus Associated with Idiopathic Basal Ganglia Calcification ("Fahr's Disease"). J Mol Neurosci 2007;33:151-154.

[14] Oliveira JR, Steinberg SS. Far from rare: revisiting the relevance of idiopathic basal ganglia calcifications. Neurol Sci 2010;31:679.

[15] Lemos RR, Oliveira MF, Oliveira JRM. Reporting a new mutation at the SLC20A2 gene in familial idiopatic basal ganglia calcification. Eur J Neurol 2013;20:e43-e44.

[16] Oliveira JRM, Lemos RR, Oliveira MF. Updating Genetic studies in familial idiopathic basal ganglia calcification. Southern Med J 2009;102:989.

[17] Oliveira JRM. Managing Idiopathic Basal Ganglia Calcification ("Fahr's Disease"). Nova Publishing, New York, 2012.

[18] Ostling S, Andreasson LA, Skoog I. Basal ganglia calcification and psychotic symptoms in the very old. Int J Geriatr Psychiatry 2003;18:983-987.

[19] Eskandary H, Sabba M, Khajehpour F, Eskandari M. Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol 2005;63:550-553; discussion 553.

[20] Radaideh AM, Jaradat DM, Haddad FH. Prevalence of incidental basal ganglia calcification on routine brain computed tomography. RMJ 2012; 37:1-9.

[21] Negrón D, Colón-Castillo L, Morales-Melecio I, Correa-Rivas M. Association of extensive brain calcifications, myelofibrosis, and retinopathy in a 12-year-old child. Pediatr Dev Pathol 2008;11:148-151.

[22] Shirahama M, Akiyoshi J, Ishitobi Y, et al. A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease. Acta Psychiatr Scand 2010;121:75-77.

[23] Bugnicourt JM, Leclercq C, Chillon JM, et al. Presence of intracranial artery calcification is associated with mortality and vascular events in patients with ischemic stroke after hospital discharge: a cohort study. Stroke 2011;42:3447-3453.

[24] Koton S, Tashlykov V, Schwammenthal Y, et al. Cerebral artery calcification in patients with acute cerebrovascular diseases: determinants and long-term clinical outcome. Eur J Neurol2012;19:739-745.

[25] Chung PW, Park KY, Moon HS, et al. Intracranial internal carotid artery calcification: a representative for cerebral artery calcification and association with white matter hyperintensities. Cerebrovasc Dis 2010;30:65-71.

[26] Gilardini L, Pasqualinotto L, DiMatteo S, et al. Factors associated with early atherosclerosis and arterial calcifications in young subjects with a benign phenotype of obesity. Obesity (Silver Spring) 2011;19:1684-1689.

[27] Koch B, Blackham A, Jones B. Incidental internal carotid artery calcifications on temporal bone CT in children. Pediatr Radiol 2007;37:141-144.

[28] Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002;106:100-105.

[29] Mahlberg R, Walther S, Kalus P, et al. Pineal calcification in Alzheimer's disease: an in vivo study using computed tomography. Neurobiol Aging 2008;29:203-209.

[30] Bersani G, Garavini A, Taddei I, Tanfani G, Nordio M, Pancheri P. Computed tomography study of pineal calcification in schizophrenia. Eur Psychiatry 1999;14:163-166.

[31] Schenkman L. Radiology. Second thoughts about CT imaging. Science 2011;331(6020):1002-1004.

Brasil