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Intracranial calcifications refer to focal or diffuse deposits of calcium within brain structures or intracranial spaces. They may be physiologic (normal) or pathologic, and can involve vascular, parenchymal, meningeal, or extra-axial tissues.
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Imaging modalities:
| Modality | Notes |
|---|---|
| CT (non-contrast) | Best modality to detect and characterize calcifications (high-density, hyperattenuating) |
| MRI | Less sensitive; calcifications appear as signal voids on T2 and blooming on GRE/SWI |
| X-ray | Historical, limited use |
| Dual-energy CT or Spectral CT | Can differentiate calcium from other high-attenuation substances (e.g., hemorrhage) |
| Site | Description |
|---|---|
| Pineal gland | Seen in >70% of adults |
| Choroid plexus | Especially in lateral ventricles |
| Basal ganglia | Symmetric; especially globus pallidus |
| Falx cerebri and tentorium | Dural calcification, linear |
| Habenulae and petroclinoid ligaments | Less common but normal |
Common causes of midsagittal calcifications in children arising from the sellar/suprasellar region, 3rd ventricle, corpus callosum, habenular commissure, pineal gland, dura mater of the falx and tentorium and 4th ventricle
Gonçalves, F.G., Caschera, L., Teixeira, S.R. et al. Intracranial calcifications in childhood: Part 1. Pediatr Radiol 50, 1424–1447 (2020). https://doi.org/10.1007/s00247-020-04721-1
Intraparenchymal (brain tissue):
| Condition | Calcification Pattern |
|---|---|
| ‣ (TORCH, especially CMV, Toxoplasmosis) | Periventricular, subependymal (CMV); diffuse basal ganglia (Toxo) |
| ‣ | Tram-track gyriform calcifications in cerebral cortex (usually occipital) |
| ‣ | Subependymal nodules (calcify with age), cortical tubers |
| ‣ | Parenchymal nodules with “starry sky” appearance; end-stage = dense, punctate |
| Neoplasms | |
| (e.g., oligodendroglioma, ependymoma, craniopharyngioma) | Speckled or chunky calcifications within tumor mass |
| Old infarcts or hemorrhage | Laminar or punctate dystrophic calcification |
| ‣ (familial idiopathic basal ganglia calcification) | Extensive symmetric calcification of basal ganglia, thalami, dentate nuclei |
Common causes of calcification arising from deep gray matter structures (thalami and basal ganglia). HIV human immunodeficiency virus, IBGC-1 idiopathic basal ganglia calcification 1, MELAS mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes
Gonçalves, F.G., Caschera, L., Teixeira, S.R. et al. Intracranial calcifications in childhood: Part 1. Pediatr Radiol 50, 1424–1447 (2020). https://doi.org/10.1007/s00247-020-04721-1
Intraventricular:
| Site | Common Causes |
|---|---|
| Choroid plexus | Physiologic or choroid plexus papilloma |
| Subependymal | Tuberous sclerosis, CMV, chronic hydrocephalus |
| Colloid cyst of 3rd ventricle | Rarely calcifies |
Extra-axial (meninges, CSF spaces):
| Condition | Calcification Pattern |
|---|---|
| Meningioma | “Psammomatous” calcification, often dense and chunky |
| Dural metastasis | May calcify (rare) |
| Dermoid/Epidermoid cyst | Rim calcification (dermoid more commonly calcifies) |
| Calcified subdural hematoma | Chronic SDH, curvilinear calcification along convexity |
| Arachnoid cyst with hemorrhage | May develop peripheral calcification |