Specific Imaging Findings

Intracranial calcifications from hyperparathyroidism are typically nodular and symmetric on CT, most commonly seen along dural surfaces, particularly the tentorium and falx. Parenchymal calcifications in the deep gray matter, subcortical regions, and cerebellar folia are frequently dense and bulky. Both parenchymal and dural calcifications can occur in isolation. Extracranial calcifications may be observed in corneas, sclerae, and salivary glands. The calcifications are of variable MR signal intensities, with parenchymal calcifications being frequently T1 hyperintense. T2*-weighted sequences demonstrate signal loss with blooming due to magnetic susceptibility.

Pertinent Clinical Information

Neurologic presentations are related to hypercalcemia and include weakness, fatigue, lethargy, depression, or cognitive impairment. Intracranial calcifications are primarily reported with secondary or tertiary hyperparathyroidism.

Differential Diagnosis

Physiologic Basal Ganglia Calcifications (187)

1. • typically localized to globus pallidus

2. • no dural involvement

Fahr Disease

1. • no dural involvement

2. • periventricular white matter may be affected

Hypoparathyroidism

1. • no dural involvement

Aicardi–Goutières Syndrome (186)

1. • also periventricular calcifications

2. • no dural involvement

3. • leukodystrophy with abnormal white matter and atrophy

4. • presents in infancy

Radiation/Chemotherapy-Induced Leukoencephalopathy (26, 190)

1. • CT hypodense and T2 hyperintense white matter

2. • calcifications primarily in the white matter