Specific Imaging Findings

Dystrophic calcifications within previously damaged CNS tissue are best seen as very bright lesions on non-enhanced CT images. They occur in a wide range of diseases, more commonly in young children. Underlying areas of encephalomalacia are usually a consequence of ischemic injury, infections, trauma, and iatrogenic causes. Dural calcification is commonly associated with chronic subdural hematomas. Dystrophic calcification with mineralizing microangiopathy occurs in children treated with whole-brain radiation. The calcifications are characteristically bilateral and most commonly found in a cerebral subcortical location at the gray–white matter junction, followed by the basal ganglia and cerebellar dentate nuclei. Associated leukoencephalopathy with diffusely hypodense/T2 hyperintense white matter is usually present. The findings are more severe in younger children, particularly if they received radiation therapy under 3 years of age.

Pertinent Clinical Information

Dystrophic calcifications are usually not a major clinical concern as they occur in a previously already-injured tissue. The incidence of mineralizing microangiopathy has substantially decreased with improved treatment regimens for pediatric malignancies.

Differential Diagnosis

Physiologic Basal Ganglia Calcifications (187)

1. • typically localized to globus pallidus

2. • no underlying encephalomalacia

Hyperparathyroidism (188)

1. • no underlying encephalomalacia or leukoencephalopathy

Aicardi–Goutières Syndrome (186)

1. • scattered basal ganglia, thalamic, periventricular and cerebellar calcifications

2. • leukodystrophy with abnormal white matter signal and cerebral atrophy

3. • presents in infancy

Meningioangiomatosis (189)

1. • focal gyriform cortical calcifications, adjacent edema may be present

Sturge–Weber Syndrome (86)

1. • gyriform cortical calcifications with associated cerebral hemiatrophy

2. • additional typical findings are usually present