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How to look for intracranial calcification in children with neurological disorders: CT, MRI, or both of them?

Abstract

Background

Intracranial calcification (ICC) is an important diagnostic clue in pediatric neurology. Considering the radiation-induced cancer risk associated with computed tomography (CT), we aim to define the diagnostic value of magnetic resonance imaging (MRI) sequences sensitive to paramagnetic/diamagnetic substances in the detection of ICC, comparing with CT scanning.

Materials and methods

We selected MRI and CT scans performed in children affected by neurological conditions associated with ICC referred to the participating centers between 2005 and 2018. Inclusion criteria were age at neuroradiological investigation < 18 years, availability of good quality CT positive for calcification, and MRI scan that included GE or/and SWI sequences, performed no more than 6 months apart.

Results

Eighty-one patients were included in the study. CT and MRI scans were reviewed by consensus. MRI failed to detect ICC in 14% of the cases. Susceptibility-weighted imaging (SWI) was the best MRI sequence to use in this setting, followed by gradient echo imaging. In 19% of the cases, CT could have been avoided because the identification or monitoring of ICC has not been necessary for the clinical management of the patient.

Conclusion

In the diagnostic workup of pediatric-onset neurological disorders of unknown cause, the first step to look for ICC should be an MRI that includes SWI and GE sequences. If ICC is absent on MRI, brain CT scanning should be performed at least once. When the identification or monitoring of ICC is unlikely to add information useful for patient’s follow-up or treatment, we recommend not performing CT scanning.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Dr. Catherine Wrenn for the English revision.

Funding

This study was partially supported by grants of the Italian Ministry of Health RC 2017–2019 to IRCCS Mondino Foundation, Pavia, Italy.

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design, material preparation, data collection, and analysis. The first draft of the manuscript was written by Davide Tonduti and Anna Pichiecchio, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Davide Tonduti.

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Ethics approval and consents

The study adheres to the principles of the Code of Ethics of the World Medical Association—Helsinki Declaration and concerns data gathered during routine diagnostic activity. The study was approved by the local ethics committee. The study complied with the institutional regulations for anonymized retrospective studies.

Conflict of interest

The authors declare no competing interests.

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Tonduti, D., Pichiecchio, A., Uggetti, C. et al. How to look for intracranial calcification in children with neurological disorders: CT, MRI, or both of them?. Neurol Sci 43, 2043–2050 (2022). https://doi.org/10.1007/s10072-021-05510-w

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  • DOI: https://doi.org/10.1007/s10072-021-05510-w

Keywords

  • Brain MRI
  • Brain CT
  • Leukodystrophy
  • Leukoencephalopathy
  • Intracranial calcification
  • Aicardi-Goutières syndrome