Classification and clinical significance of intracranial calcifications: a pictorial essay

Intracranial calcifications, which are common in the daily routine of radiologists, can have a physiological or pathological origin. Determining the cause of intracranial calcifications can represent a challenge. The anatomical location, distribution, dimensions and morphology of such calcifications are important findings, which, in conjunction with the clinical history and age group, can facilitate the differential diagnosis. The aim of this pictorial essay is to demonstrate the different types of intracranial calcifications and their origins. The images evaluated were those stored in picture archiving and communication systems. All of the cases included were studied by computed tomography, magnetic resonance imaging, or both. We identified, classified, and described 64 types of intracranial calcifications.

Keywords:
Intracranial calcifications; Computed tomography; Magnetic resonance imaging

Authorship

Marcelo dos Santos Guedes Correspondence: Dr. Marcelo dos Santos Guedes. Hospital Alvorada. Avenida Ministro Gabriel de Rezende Passos, 550, Moema. São Paulo, SP, Brazil, 05421-022. Email: maguedes1@uol.com.br.

Hospital Alvorada, São Paulo, SP, Brazil.Hospital AlvoradaBrazilSão Paulo, SP, BrazilHospital Alvorada, São Paulo, SP, Brazil.

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil.

http://orcid.org/0000-0002-6607-7006

Isadora Carvalho Queiroz

Hospital Alvorada, São Paulo, SP, Brazil.Hospital AlvoradaBrazilSão Paulo, SP, BrazilHospital Alvorada, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-1349-4172

Cláudio Campi de Castro

http://orcid.org/0000-0002-3531-4232

Correspondence: Dr. Marcelo dos Santos Guedes. Hospital Alvorada. Avenida Ministro Gabriel de Rezende Passos, 550, Moema. São Paulo, SP, Brazil, 05421-022. Email: maguedes1@uol.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Hospital Alvorada, São Paulo, SP, Brazil.Hospital AlvoradaBrazilSão Paulo, SP, BrazilHospital Alvorada, São Paulo, SP, Brazil.

Figures

Figures (8)

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Figure 1
Unenhanced axial cranial CT scans, with soft-tissue window settings, showing physiological calcifications in the globus pallidus, choroid plexus, and pineal gland/habenulae (arrows in A), as well as in the cerebral sickle (arrow in B).

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Figure 2
Unenhanced axial and sagittal cranial CT scans (A and B, respectively), with soft-tissue window settings, showing periventricular and particularly subcortical calcifications, in a case of neurocysticercosis (A), as well as periventricular and cortical (sometimes rope-like), calcifications in a child with microcephaly with an apparently “collapsed” skull, in a case of congenital Zika virus infection (B).

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Figure 3
Unenhanced axial cranial CT scans, with soft-tissue window settings, showing calcifications on the walls of blood vessels (arrow) in a case of atherosclerosis (A), multiple punctiform and elongated calcifications, with extensive areas of confluence in both brain hemispheres (arrows) in a case of lupus (B), and punctiform vascular calcifications, some nodular (arrow), in a case of arteriovenous malformation (C).

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Figure 4
Unenhanced axial cranial CT scans, with soft-tissue window settings (A,B), and axial T2*-weighted gradient-recalled echo MRI sequence of the skull (C), showing confluent calcifications in the region of dentate nuclei (arrow) in a case of pseudo-hypoparathyroidism (A), confluent calcifications in the area of basal ganglia (arrow) in a case of Fahr’s disease (B), and areas of markedly hypointense signals, corresponding to calcifications in the region of the basal ganglia and pulvinar of the thalamus (arrows), in a case of Fabry disease (C).

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Figure 5
Unenhanced axial cranial CT scans, with soft-tissue window settings, showing gyral calcifications (arrow) with parenchymal atrophy in a case of Sturge-Weber syndrome (A), as well as small intraventricular, periventricular, and subependymal calcifications (arrows) in a case of tuberous sclerosis (B).

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Figure 6
A: Axial T2*-weighted gradient-recalled echo MRI sequence of the skull, showing areas of markedly hypointense signals, corresponding to calcifications in the area of the lentiformis nuclei (arrow) in a case of Cockayne syndrome. B: Unenhanced axial cranial CT scan, with soft-tissue window settings, showing small calcifications in the posterior aspect of the brainstem, in the region of the abducens nuclei (arrow), in a case of Moebius syndrome.

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Figure 7
Unenhanced axial cranial CT scans, with soft-tissue window settings, showing lesion with fat attenuation and calcified nodules (arrow) in its anterior aspect, in a case of dermoid cyst (A), as well as expansile, hemorrhagic, formations within the meninges, some with odontogenic calcifications (arrow), in a case of hemorrhagic hamartomatous meningioangiomatosis (B).

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Figure 8
Unenhanced axial cranial CT scans, with soft-tissue window settings, showing coarse, peripheral calcifications (arrow), together with a temporal cystic lesion, in a case of ganglioglioma (A), multiple, small confluent calcifications (arrow) in an expansive lesion in the posterior fossa, in a case of ependymoma (B), small, sparse calcifications (arrows) in a voluminous expansive supratentorial lesion in a child with a pineal gland tumor (C), and small sparse calcifications (arrow) in an expansive lesion in the posterior fossa in a case of medulloblastoma (D).

Figure 1 Unenhanced axial cranial CT scans, with soft-tissue window settings, showing physiological calcifications in the globus pallidus, choroid plexus, and pineal gland/habenulae (arrows in A), as well as in the cerebral sickle (arrow in B).

Figure 2 Unenhanced axial and sagittal cranial CT scans (A and B, respectively), with soft-tissue window settings, showing periventricular and particularly subcortical calcifications, in a case of neurocysticercosis (A), as well as periventricular and cortical (sometimes rope-like), calcifications in a child with microcephaly with an apparently “collapsed” skull, in a case of congenital Zika virus infection (B).

Figure 3 Unenhanced axial cranial CT scans, with soft-tissue window settings, showing calcifications on the walls of blood vessels (arrow) in a case of atherosclerosis (A), multiple punctiform and elongated calcifications, with extensive areas of confluence in both brain hemispheres (arrows) in a case of lupus (B), and punctiform vascular calcifications, some nodular (arrow), in a case of arteriovenous malformation (C).

Figure 4 Unenhanced axial cranial CT scans, with soft-tissue window settings (A,B), and axial T2*-weighted gradient-recalled echo MRI sequence of the skull (C), showing confluent calcifications in the region of dentate nuclei (arrow) in a case of pseudo-hypoparathyroidism (A), confluent calcifications in the area of basal ganglia (arrow) in a case of Fahr’s disease (B), and areas of markedly hypointense signals, corresponding to calcifications in the region of the basal ganglia and pulvinar of the thalamus (arrows), in a case of Fabry disease (C).

Figure 5 Unenhanced axial cranial CT scans, with soft-tissue window settings, showing gyral calcifications (arrow) with parenchymal atrophy in a case of Sturge-Weber syndrome (A), as well as small intraventricular, periventricular, and subependymal calcifications (arrows) in a case of tuberous sclerosis (B).

Figure 6 A: Axial T2*-weighted gradient-recalled echo MRI sequence of the skull, showing areas of markedly hypointense signals, corresponding to calcifications in the area of the lentiformis nuclei (arrow) in a case of Cockayne syndrome. B: Unenhanced axial cranial CT scan, with soft-tissue window settings, showing small calcifications in the posterior aspect of the brainstem, in the region of the abducens nuclei (arrow), in a case of Moebius syndrome.

Figure 7 Unenhanced axial cranial CT scans, with soft-tissue window settings, showing lesion with fat attenuation and calcified nodules (arrow) in its anterior aspect, in a case of dermoid cyst (A), as well as expansile, hemorrhagic, formations within the meninges, some with odontogenic calcifications (arrow), in a case of hemorrhagic hamartomatous meningioangiomatosis (B).

Figure 8 Unenhanced axial cranial CT scans, with soft-tissue window settings, showing coarse, peripheral calcifications (arrow), together with a temporal cystic lesion, in a case of ganglioglioma (A), multiple, small confluent calcifications (arrow) in an expansive lesion in the posterior fossa, in a case of ependymoma (B), small, sparse calcifications (arrows) in a voluminous expansive supratentorial lesion in a child with a pineal gland tumor (C), and small sparse calcifications (arrow) in an expansive lesion in the posterior fossa in a case of medulloblastoma (D).

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Classification and clinical significance of intracranial calcifications: a pictorial essay

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[1] Correspondence: Dr. Marcelo dos Santos Guedes. Hospital Alvorada. Avenida Ministro Gabriel de Rezende Passos, 550, Moema. São Paulo, SP, Brazil, 05421-022. Email: maguedes1@uol.com.br.