Abstract
Background and aim
Intracranial calcifications (ICs) occur when metals such as calcium or iron accumulate in blood vessels, glands or other structures related to the brain. They can be physiological or pathological. Currently, the most sensitive method for imaging IC is cranial computed tomography (CT). The aim of this retrospective study was to evaluate physiological ICs and the co-existence of them by CT.
Patients and methods
1,000 cranial CT scans of patients were retrospectively evaluated. Pineal calcification, choroid plexus calcification, habenular calcification, petroclinoid ligament calcification, basal ganglia calcification, falx cerebri and tentorium cerebelli calcification were evaluated and recorded.
Results
Of 1,000 patients, 65.7% had IC. The incidence of ICs in different sites were as follows: pineal calcification (37.7%), choroid plexus calcification (52.1%), habenular calcification (33.5%), petroclinoid calcification (21.8%), basal ganglia calcification (0.6%), falx cerebri calcification (6.2%) and tentorium cerebelli calcification (0.2%). The incidence and co-existence of calcifications were significantly higher in females than in males (P < 0.05). Pineal, choroid plexus, petroclinoid ligament calcifications were significantly higher in females than in males (P < 0.05). The incidence and co-existence of calcifications increased with age. Tentorium Cerebelli calcification did not differ significantly between age groups (P > 0.05).
Conclusions
ICs may be a common finding and encountered incidentally on CT scans which is gold standard to evaluate them. It is important to distinguish physiological calcifications from pathological ones, in the differentiation of pathological lesions with calcifications.
Introduction
Intracranial calcifications (ICs) occur when metals such as calcium or iron are deposited in blood vessels, glands, or other structures related to the brain. They can be physiological or pathological [1].
Physiological ICs are not accompanied by any finding of disease and have no provable pathological cause [2]. Although age and degenerative changes are thought to be connected with physiological calcifications; the reason is not clear [3]. The most frequent areas of ICs are the pineal gland, habenula, choroid plexus, basal ganglia, falx cerebri, tentorium cerebelli, petroclinoid ligaments, and sagittal sinus. Pineal gland calcification occurs in two-thirds of the adult population and increases with age. Pineal calcification greater than 1 cm may suggest neoplasm [4]. Although it can be seen in all ventricles, choroid plexus calcifications are generally localized in the atria. Habenular commissural calcifications are observed in the anterior component of the pineal gland, generally 3–5 mm in size, and characteristically posteriorly facing crescent-shaped calcifications appear on the concave surface [3]. Calcification can also exist between the posterior surface of the dorsum sella and the petrosal process, which is called the petroclinoid ligament, and the petroclinoid dural fold [5]. Petroclinoid ligament calcification has been stated as an anatomical anomaly as well as radiological characteristics of basal cell carcinoma syndrome and systemic fluorosis [6]. Basal ganglia calcifications are idiopathic coincidental findings that are generally seen in 0.3–1.5% and increase with age. They usually show a pale punctuation or coarse conglomerate symmetrical calcification pattern [2]. Calcifications of the falx cerebri, dura mater or tentorium cerebelli are seen in approximately 10% of the elderly population [4]. Dural and tentorial calcifications usually occur in a laminar pattern and can occur anywhere in the skull [2, 4].
The use of computed tomography (CT) scans has greatly contributed to the correct diagnosis, localization and classification of ICs [7]. Despite the introduction of Magnetic Resonance Imaging, CT has proven to be superior in detecting and characterizing brain calcifications [8].
The aim of this study is to assess ICs and co-existence of them in all age groups in the province of Hatay (south of Turkey), the relationship with age and gender, and to present the relevant basic data in comparison with the literature.
Patients and Methods
The study protocol was carried out in accordance with the principles stated in the Declaration of Helsinki and ethical approval was obtained by the Hatay Mustafa Kemal University Local Ethics Committee (Date: 15.12.2022, Decision No: 19). 1,000 cranial CT scans of patients (431 females; 569 males; mean age: 30.6; range 1–96 years) referred to the Radiology Department of Hatay Education and Research Hospital for various reasons, were evaluated retrospectively. The cases were divided into 3 groups as 1–18, 18–35 and >35. The 1–18 age group was named as Group A, the 18–35 age group as Group B, and the >35 age group as Group C. Patients with calcium metabolic disorders (such as chronic kidney failure, hyperparatiroidism etc.), bone disease (especially osteoporosis) and using related drugs, congenital defects, a history of skeletal asymmetry or trauma, a history of any tumor, malignancy, surgery and radiotherapy, and low-quality images were excluded from the study.
Radiographic images were obtained with a slice thickness of 0.625 mm using a Philips Brilliance 64-slice CT device (Philips Healthcare, Cleveland, OH, USA) with 120 kV, 250 mA acquisition values. CT images were analyzed using the 64-bit RadiAnt DICOM version 2020.2.3 (Medixant, Poznan-Poland) viewer software in the axial, coronal, sagittal and three dimensional reformatted scan.
Pineal calcification, choroid plexus calcification, habenular calcification, petroclinoid ligament calcification, basal ganglia calcification, falx cerebri and tentorium cerebelli calcification were evaluated on the images (Fig. 1). Image analysis was performed by neuroradiology board certificated radiologist (MS) with 7 years of experience in radiology. Window settings (width: 120 HU/level: 40 HU) were used for evaluation of ICs. In visual examination, hyperdensities in these regions were considered as calcifications. When ICs could not be visually identified by the observer, the circular ROI (region of interest) was used to calculate the intensity of the hyperdense region thought to be calcification when the maximum calculated HU of the ROI exceeded 100 HU [7]. Single or co-existence of ICs were analyzed (Fig. 2).
Physiologic IC types on axial CT scans (A) Pineal (blue arrow), choroid plexus (red arrow) and habenular calcification (green arrow) (B) Petroclinoid ligament calcification (C) Falx cerebri calcification (D) Tentorium cerebelli calcification (E) Bilateral basal ganglia calcification (red circles)
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Physiologic IC types on axial CT scans (A) Pineal (blue arrow), choroid plexus (red arrow) and habenular calcification (green arrow) (B) Petroclinoid ligament calcification (C) Falx cerebri calcification (D) Tentorium cerebelli calcification (E) Bilateral basal ganglia calcification (red circles)
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Physiologic IC types on axial CT scans (A) Pineal (blue arrow), choroid plexus (red arrow) and habenular calcification (green arrow) (B) Petroclinoid ligament calcification (C) Falx cerebri calcification (D) Tentorium cerebelli calcification (E) Bilateral basal ganglia calcification (red circles)
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
The co-existence of pineal (red circle), habenular (black circle) and choroid plexus (white circle) calcifications
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
The co-existence of pineal (red circle), habenular (black circle) and choroid plexus (white circle) calcifications
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
The co-existence of pineal (red circle), habenular (black circle) and choroid plexus (white circle) calcifications
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Statistical analysis
In the descriptive statistics of the data, mean, standard deviation, median minimum, maximum, frequency and ratio values were used. The distribution of variables was measured with the Kolmogorov-Smirnov test. The Mann-Whitney U test was used in the analysis of quantitative independent data. Chi-square test was used in the analysis of qualitative independent data, and fischer test was used when the chi-square test conditions were not met. SPSS 28.0 program was used in the analysis.
Results
Demographic information was shown in Table 1. Age of females was significantly higher than males (P < 0.05). The incidence and co-existence of IC was significantly higher in females than in males (P < 0.05). Pineal, choroid plexus, petroclinoid ligament calcifications were significantly higher in females than in males (P < 0.05). Habenular, falx cerebri, tentorium cerebelli calcifications did not differ significantly between males and females (P > 0.05) (Fig. 3, Table 2). Duplicate co-existence (25.2%) was the most common among multiple co-existences (Table 2).
Demographic information, incidence of calcifications types and co-existence
| Min–Max | Median | Mean ± sd/n-% | ||||||
| Age | 1.0 | – | 96.0 | 28.0 | 30.6 | ± | 21.9 | |
| Age groups | 1–18 | 354 | 35.4% | |||||
| 18–35 | 262 | 26.2% | ||||||
| >35 | 384 | 38.4% | ||||||
| Gender | Female | 431 | 43.1% | |||||
| Male | 569 | 56.9% | ||||||
| Calcification | (−) | 343 | 34.3% | |||||
| (+) | 657 | 65.7% | ||||||
| Co-existence of calcifications | I | 140 | 14.0% | |||||
| II | 252 | 25.2% | ||||||
| III | 195 | 19.5% | ||||||
| IV | 63 | 6.3% | ||||||
| V | 8 | 0.8% | ||||||
| Pineal | (−) | 623 | 62.3% | |||||
| (+) | 377 | 37.7% | ||||||
| Chroid plexus | (−) | 479 | 47.9% | |||||
| (+) | 521 | 52.1% | ||||||
| Habenular | (−) | 665 | 66.5% | |||||
| (+) | 335 | 33.5% | ||||||
| Petroclinoid Ligament | (−) | 782 | 78.2% | |||||
| (+) | 218 | 21.8% | ||||||
| Basal Ganglia | (−) | 994 | 99.4% | |||||
| (+) | 6 | 0.6% | ||||||
| Falx Cerebri | (−) | 938 | 93.8% | |||||
| (+) | 62 | 6.2% | ||||||
| Tentorium Cerebelli | (−) | 998 | 99.8% | |||||
| (+) | 2 | 0.2% | ||||||
Graph showing the percentage of calcification types and co-existence according to gender
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Graph showing the percentage of calcification types and co-existence according to gender
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Graph showing the percentage of calcification types and co-existence according to gender
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
The incidence of calcification types and co-existence according to gender
| Female | Male | P | |||||||||
| Mean ± sd/n-% | Median | Mean ± sd/n-% | Median | ||||||||
| Age | 36.6 | ± | 21.3 | 35.0 | 26.0 | ± | 21.3 | 20.0 | 0.000 | m | |
| Age group | 1–18 | 94 | 21.8% | 260 | 45.7% | 0.000 | X2 | ||||
| 18–35 | 122 | 28.3% | 140 | 24.6% | |||||||
| >35 | 215 | 49.9% | 169 | 29.7% | |||||||
| Calcification | (−) | 108 | 25.1% | 235 | 41.3% | 0.000 | X2 | ||||
| (+) | 323 | 74.9% | 334 | 58.7% | |||||||
| Co-existence of calcifications | I | 83 | 19.3% | 57 | 10.0% | 0.000 | X2 | ||||
| II | 132 | 30.6% | 120 | 21.1% | |||||||
| III | 86 | 20.0% | 109 | 19.2% | |||||||
| IV | 21 | 4.9% | 42 | 7.4% | |||||||
| V | 2 | 0.5% | 6 | 1.1% | |||||||
| Pineal | (−) | 251 | 58.2% | 372 | 65.4% | 0.021 | X2 | ||||
| (+) | 180 | 41.8% | 197 | 34.6% | |||||||
| Chroid plexus | (−) | 177 | 41.1% | 302 | 53.1% | 0.000 | X2 | ||||
| (+) | 254 | 58.9% | 267 | 46.9% | |||||||
| Habenular | (−) | 278 | 64.5% | 387 | 68.0% | 0.244 | X2 | ||||
| (+) | 153 | 35.5% | 182 | 32.0% | |||||||
| Petroclinoid Ligament | (−) | 350 | 81.2% | 432 | 75.9% | 0.045 | X2 | ||||
| (+) | 81 | 18.8% | 137 | 24.1% | |||||||
| Basal Ganglia | (−) | 426 | 98.8% | 568 | 99.8% | 0.046 | X2 | ||||
| (+) | 5 | 1.2% | 1 | 0.2% | |||||||
| Falx Cerebri | (−) | 406 | 94.2% | 532 | 93.5% | 0.648 | X2 | ||||
| (+) | 25 | 5.8% | 37 | 6.5% | |||||||
| Tentorium Cerebelli | (−) | 430 | 99.8% | 568 | 99.8% | 1.000 | X2 | ||||
| (+) | 1 | 0.2% | 1 | 0.2% | |||||||
mMann-whitney u test/X2 Chi-Square test (Fischer test).
The incidence of IC in the Group C was significantly higher compared to the Group A and B (P < 0.05). The incidence of IC in the Group B was significantly higher (P < 0.05) compared to the Group A. The co-existence of 3 or more ICs in the Group C was significantly higher compared to the Group A and B (P < 0.05). The co-existence of 3 or more ICs in the Group B was significantly higher compared to the Group A (P < 0.05). Pineal calcification was significantly higher in the Group B and C than in the Group A (P < 0.05). Pineal calcification did not differ between Group B and C (P > 0.05). Choroid plexus calcification was significantly higher in the Group C than in the Group A and B and also was significantly higher in the Group B than in the Group A (P < 0.05). Habenular calcification was significantly higher in the Group B and C than in the Group A (P < 0.05). However, it did not differ significantly between Group B and C (P > 0.05). Petroclinoid ligament calcification was significantly higher in the Group B and C than in the Group A (P < 0.05). However, it did not differ significantly between Group B and C (P > 0.05). Basal ganglia calcification was significantly higher in the Group C compared to the Group A and B (P < 0.05). However, it did not differ significantly between the Group A and B (P > 0.05). Falx cerebri calcification was significantly higher in the Group C than Group A and B (P < 0.05). It was significantly higher in the Group B than Group A (P < 0.05). Tentorium Cerebelli calcification did not differ significantly between Group A, B and C (P > 0.05) (Fig. 4, Table 3).
Graph showing the percentage of calcification types and co-existence according to age groups
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Graph showing the percentage of calcification types and co-existence according to age groups
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
Graph showing the percentage of calcification types and co-existence according to age groups
Citation: Imaging 15, 1; 10.1556/1647.2023.00114
The incidence of calcification types and co-existence according to age groups
| Age groups | 1–18 | 18–35 | >35 | P | |||||
| n | % | n | % | n | % | ||||
| Calcification | (−) | 276 | 78.0% | 39 | 14.9% | 28 | 7.3% | 0.000 | X2 |
| (+) | 78 | 22.0% | 223 | 85.1% | 356 | 92.7% | |||
| Co-existence of calcifications | I | 36 | 10.2% | 56 | 21.4% | 48 | 12.5% | 0.000 | X2 |
| II | 35 | 9.9% | 82 | 31.3% | 135 | 35.2% | |||
| III | 8 | 2.3% | 63 | 24.0% | 124 | 32.3% | |||
| IV | 0 | 0.0% | 21 | 8.0% | 42 | 10.9% | |||
| V | 0 | 0.0% | 1 | 0.4% | 7 | 1.8% | |||
| Pineal | (−) | 319 | 90.1% | 133 | 50.8% | 171 | 44.5% | 0.000 | X2 |
| (+) | 35 | 9.9% | 129 | 49.2% | 213 | 55.5% | |||
| Chroid plexus | (−) | 313 | 88.4% | 99 | 37.8% | 67 | 17.4% | 0.000 | X2 |
| (+) | 41 | 11.6% | 163 | 62.2% | 317 | 82.6% | |||
| Habenular | (−) | 310 | 87.6% | 148 | 56.5% | 207 | 53.9% | 0.000 | X2 |
| (+) | 44 | 12.4% | 114 | 43.5% | 177 | 46.1% | |||
| Petroclinoid Ligament | (−) | 345 | 97.5% | 180 | 68.7% | 257 | 66.9% | 0.000 | X2 |
| (+) | 9 | 2.5% | 82 | 31.3% | 127 | 33.1% | |||
| Basal ganglia | (−) | 354 | 100.0% | 262 | 100.0% | 378 | 98.4% | P < 0.05 | X2 |
| (+) | 0 | 0.0% | 0 | 0.0% | 6 | 1.6% | |||
| Falx cerebri | (−) | 353 | 99.7% | 252 | 96.2% | 333 | 86.7% | 0.000 | X2 |
| (+) | 1 | 0.3% | 10 | 3.8% | 51 | 13.3% | |||
| Tentorium Cerebelli | (−) | 354 | 100% | 262 | 100% | 382 | 99.5% | P > 0.05 | X2 |
| (+) | 0 | 0.0% | 0 | 0.0% | 2 | 0.5% | |||
X2Chi-Square test (Fischer test).
Discussion
The accumulation of brain calcification often involve calcium hydroxylapatite (Ca10[PO4]6[OH]2) as the main element; other elements may be zinc, iron, and magnesium [9, 10]. The mechanism of calcification and the causes for the selective sensitivity of the basal ganglia to calcium accumulation are not fully understood [8]. But, injury to the intima-media of cerebral vessels may result in increased vascular permeability and leakage of plasma proteins into the extravascular space. The accumulation of electron-dense calcium bodies in the capillary walls and parenchyma causes calcification [11, 12].
In this conducted study, the most common areas of ICs were the following: 37.7% pineal calcification, 52.1% choroid plexus calcification, 33.5% habenular calcification, 21.8% petroclinoid calcification, 0.6% basal ganglia calcification, 6.2% falx cerebri calcification and 0.2% tentorium cerebelli calcification. The incidence and co-existence of ICs were significantly higher in females than in males. Pineal, choroid plexus, petroclinoid ligament calcifications were significantly higher in females than in males. The incidence and co-existence of ICs increased with age except Tentorium Cerebelli calcification.
In a study by Sedghizadeh et al. [1], the prevalence of IC was reported as 35.2%. Most of the calcifications were seen in the pineal/habenular region (80%), followed bilaterally in the choroid plexus region (12%) and bilaterally in the petroclinoid ligament region (8%). In this study, choroid plexus calcification was the most common. While the mean age of the cases in their study was 52, this value is lower in our study (30.6). The difference in results may be related to this. In their studies, pineal calcification did not separate from habenular calcification. We attribute the high incidence of pineal/habenular calcification to this situation.
In the study of Bayrak et al. [5], IC was found with a rate of 33.1%. 19.2% of the cases were habenular, 2.7% petroclinoid ligament and 2.4% choroid plexus calcification. 38.2% of females and 29.3% of males had IC. No statistically significant relationship was found between age, gender and calcifications. Differently, in this study, there was significant relationship between age, gender and ICs. 74.9% of females and 58.7% of males had calcification. The percentages reported in the study of Bayrak et al. [5] were quite low compared to our study. We attribute the lower percentages because of studying with younger population (mean age: 19.36) and using cone beam computed tomography that has low contrast resolution compared to CT.
In the study of Yalcin et al. [7], choroid plexus calcification was found in 70.2% of the cases, pineal calcification in 71.6%, habenular calcification in 19.2%, basal ganglia calcification in 1.3%. There was male predominance in all IC types except basal ganglia calcifications. The prevalence of basal ganglion calcifications did not relatively change with age. 54.4% of the study population had both pineal and choroid plexus calcifications. The prevalence of pineal calcification in individuals with habenular calcification was as high as 93.9%. Up to 82.6% of basal ganglia calcifications also had pineal calcification. In this study, the incidence of habenular calcification was found to be high, however, the incidence of pineal and basal ganglia calcification was found to be lower than the study of Yalcin et al. [7]. Differently, in this study, the incidence of IC was significantly higher in females than in males. Basal ganglia calcification increased with age. Co-existence of duplicate ICs was most common (25.2%). The difference in calcification incidences can be attributed to the fact that Yalcin et al. evaluated a very high number of subjects in their study.
In the study of Kiraz [13], the IC areas were as follows: the pineal gland (59.25%) followed by the choroid plexus (55.19%), habenular commissure (22.65%), and basal ganglia (3.07%). It was reported that there was a statistically significant increase in the frequency of calcifications of the pineal gland, choroid plexus, habenular commissure, and basal ganglia with age. The calcification rates of the choroid plexus, pineal gland and habenular commissure were found to be statistically significantly higher in males than in females. Similarly, choroid plexus calcification was observed most frequently in this study (52.1%) and calcifications increased with age. Differently, the incidence of IC was significantly higher in females than in males.
In the study of Daghighi et al. [14], 71.0% of cases had pineal calcification, 66.2% had choroid plexus calcification, 20.1% had habenular calcification, 7.3% had tentorium cerebelli, sagittal sinus or falx cerebri calcification, 0.8% had basal ganglia calcification. The frequency of ICs was higher in males than females, and these defined calcification types increase in older ages. Co-existence of pineal and choroid plexus calcifications was most common in females, while co-existence of pineal and habenular calcifications was most common in males. In the present study, choroid plexus calcification was most frequently observed in this study. While the incidence of pineal (37.7%) and habenular (33.5%) calcifications was lower, the incidence of basal ganglia calcification (0.6%) was consistent with the study of Daghighi et al. [14]. Duplicate ICs are more common in females (30.6%) than males (21.2%).
In a study by Ghorbanlou et al. [15], 89.8% of subjects had IC. The areas of IC were reported as pineal gland (75.0%), habenula (36.4%), right lateral ventricular choroid plexus (67.7%), left lateral ventricular choroid plexus (62.7%), falx cerebri (26.8%), petroclinoid ligament (13.2%), tentorium cerebelli (6.8%), basal ganglia (0.9%). In this study, the percentage of ICs was found to be lower, except for petroclinoid ligament calcification. The higher incidence reported by Ghorbanlou et al. [15] can be attributed to their study on a lower number of subjects.
Similar to our study, Uduma et al. [16] reported that choroid plexus calcification was most frequently observed, constituting 56.82% of the cases, followed by pineal calcification (46.21%). Differently, it has been reported that with increasing age, choroid plexus/pineal calcifications show equal predominance, and females tend to have increased pineal calcifications compared to males and falx calcification was more common in males. In the present study, pineal calcifications were significantly higher in females than in males and falx cerebri calcification did not differ significantly between males and females.
Orcan et al. [17] reported that 69.3% of the cases had choroid plexus, 66.1% had pineal, 35.2% had habenular commissure calcification, 25.2% had other (basal ganglia, dura and arachnoid) calcifications. 51.9%, 28.7% and 28.4% of the cases had pineal gland and choroid plexus, pineal gland and habenular commissure, and choroid plexus and habenular commissure calcification co-existence, respectively. There was significant increase in the prevalence of the pineal gland, choroid plexus and habenular commissure calcifications with increased age. In this study, the incidence of ICs was found to be lower in general. 25.2% of the cases had duplicate calcifications. Except for habenular calcification, our study was consistent with this study.
In the study of Kwak et al. [18, 19], IC was demonstrated in 67.7% of the pineal region, 57.6% in the choroid plexus of the lateral ventricles and 7.5% in the basal ganglia. They reported that the incidence of IC in patients aged 20–79 years was significantly higher in males than in females. In this study, although the incidence of choroid plexus was close to the study of Kwak et al. [18, 19], the incidence of pineal and basal ganglia calcification was found to be lower. The incidence of IC in the age group >35 was significantly higher than the younger groups and was significantly higher in females than in males.
There are differences in the frequency of ICs in the literature. Reasons for the different results reported were considered to be: ethnic differences, differences in sample size and age range, and differences in imaging device used.
Some studies hypothesize that pineal calcifications found in patients greater than 1 cm or less than 9 years of age should require further investigations as they may indicate underlying neoplasms [20, 21]. Therefore, suspicious calcifications should be investigated further with glandular volume assessment and clinical and biochemical investigations [22]. Atypical locations of choroid plexus calcifications such as the glomerular level, lateral ventricular bodies, roof of the third ventricle, and foramen of Monro raise suspicion for an underlying pathology [20]. The habenula is structurally connected to several deep regions of the brain and therefore serves as a transmission and processing center that affects dopamine and serotonin production. Therefore, habenular calcifications are among the common findings in patients with schizophrenia [23]. Brain calcinosis syndrome is generally known as bilateral calcium deposition in the brain parenchyma, most frequently in the basal ganglia. There are some causes of pathological basal ganglia calcification such as metabolic disorders, infectious and genetic diseases. Hypoparathyroidism and pseudohypoparathyroidism are the most frequent reasons of pathological basal ganglia calcification. Multiple and asymmetric IC is a result of infections such as toxoplasmosis, rubella, cytomegalovirus, cysticercosis, AIDS. Symmetrical, bilateral basal ganglia calcifications not associated with metabolic disorders can be seen as a result of hereditary and neurodegenerative diseases. More than 50 reported clinical situations have been associated with brain calcinosis syndrome, including sporadic entities and inherited conditions [24].
Conclusions
It is important for clinicians to distinguish physiological calcifications from pathological ones, in the differentiation of pathological lesions with calcifications. In terms of compression of IC on important structures and complications that may occur during surgery, it is important to know this formation well.
There are studies evaluating the frequency of ICs in the literature. However, this study is important as it draws attention to the incidence of ICs and their co-existences in the Hatay region. In addition, to the best of our knowledge, although there are few studies on the frequency of duplicate calcifications in the literature, no study evaluating the frequency of multiple co-existence of calcifications has been found. For this reason, we think that this study will be a guide for future researches in terms of determining the co-existence of up to 5 calcification types, which have not been found in the literature, and will be an important resource for researchers who want to work on this subject.
Authors’ contribution
Mehmet Serindere developed the protocol, performed the measurements and analysis, and wrote the first draft of the manuscript. Gokhan Polat contributed to protocol design. All authors contributed to the analysis of results and reviewed and approved the final version of the manuscript for submission.
Ethical Statement
Our work was approved by the local Ethical Committee, approval number 19. The study submitted to IMAGING have been conducted in accordance with the Declaration of Helsinki and according to requirements of all applicable local and international standards.
Funding sources
No financial support was received for this study.
Conflict of interests
The authors have no conflict of interest to disclose.
References
- [1]↑
Sedghizadeh PP, Nguyen M, Enciso R: Intracranial physiological calcifications evaluated with cone beam CT. Dentomaxillofacial Radiology 2012; 41: 675–678.
- [2]↑
Kieffer SA, Gold LH: Intracranial physiologic calcifications. Seminars in Roentgenology 1974; 2: 151–162.
- [3]↑
William SD: Radiology review manual. Philadelphia, PA: Lippincott Williams & Wilkins 2003; Vol. 5: 230.
- [4]↑
Deepak S, Jayakumar B: Intracranial calcifications. Journal of Association Physicians India 2005; 53: 948.
- [5]↑
Bayrak S, Göller Bulut D, Kurşun Çakmak EŞ, Orhan K: Cone beam computed tomographic evaluation of intracranial physiologic calcifications. Journal of Craniofacial Surgery 2019 Mar/Apr; 30(2): 510–513.
- [6]↑
Cederberg RA, Benson BW, Nunn M, English JD: Calcification of the interclinoid and petroclinoid ligaments of sella turcica: A radiographic study of the prevalence. Orthodontics and Craniofacial Research 2003 Nov; 6(4): 227–232.
- [7]↑
Yalcin A, Ceylan M, Bayraktutan OF, Sonkaya AR, Yuce I: Age and gender related prevalence of intracranial calcifications in CT imaging; data from 12,000 healthy subjects. Journal of Chemical Neuroanatomy 2016 Dec; 78: 20–24.
- [8]↑
Deng H, Zheng W, Jankovic J: Genetics and molecular biology of brain calcification. Ageing Research Reviews 2015 Jul; 22: 20–38.
- [9]↑
Beall SS, Patten BM, Mallette L, Jankovic J: Abnormal systemic metabolism of iron, porphyrin, and calcium in Fahr's syndrome. Annals of Neurology 1989 Oct; 26(4): 569–575.
- [10]↑
Duckett S, Galle P, Escourolle R, Poirier J, Hauw JJ: Presence of zinc, aluminum, magnesium in striopalledodentate (SPD) calcifications (Fahr's disease): electron probe study. Acta Neuropathologica 1977 Apr 29; 38(1): 7–10.
- [11]↑
Tsuchiya Y, Ubara Y, Anzai M, Hiramatsu R, Suwabe T, Hoshino J, et al.: A case of idiopathic basal ganglia calcification associated with membranoproliferative glomerulonephritis. Internal Medicine 2011; 50(20): 2351–2356.
- [12]↑
Yamada M, Asano T, Okamoto K, Hayashi Y, Kanematsu M, Hoshi H, et al.: High frequency of calcification in basal ganglia on brain computed tomography images in Japanese older adults. Geriatrics and Gerontology International 2013 Jul; 13(3): 706–710.
- [13]↑
Kiraz M: The relationship with age and gender of intracranial physiological calcifications: a study from Corum, Turkey. Annals of Medical and Research 2021; 28(9): 1775–1780.
- [14]↑
Daghighi MH, Rezaei V, Zarrintan S, Pourfathi H: Intracranial physiological calcifications in adults on computed tomography in Tabriz, Iran. Folia Morphologica (Warsaw) 2007 May; 66(2): 115–119.
- [15]↑
Ghorbanlou M, Moradi F, Mehdizadeh M: Frequency, shape, and estimated volume of intracranial physiologic calcification in different age groups investigated by brain computed tomography scan: a retrospective study. Anatomical Cellular Biology 2022 Mar 31; 55(1): 63–71.
- [16]↑
Uduma FU, Pius F, Mathieu M: Computed tomographic pattern of physiological intracranial calcifications in a city in central Africa. Global Journal of Health Sciences 2011 Dec 29; 4(1): 184–191.
- [17]↑
Orcan CG, Nas OF, Çavusoğlu G, Alan O, Kılıç H, Uyguç AU, et al.: Kraniyal bilgisayarlı tomografide saptanan fizyolojik pineal gland, koroid pleksus ve habenular komissür kalsifikasyonlarının görülme oranları ve birliktelikleri. The Medical Bulletin of Sisli Etfal Hospital 2010; 44: 22–26.
- [18]↑
Kwak R, Takeuchi F, Ito S, Kadoya S: Intracranial physiological calcification on computed tomography (Part 1): calcification of the pineal region. No To Shinkei 1988; 40: 569–574.
- [19]↑
Kwak R, Takeuchi F, Yamamoto N, Nakamura T, Kadoya S: Intracranial physiological calcification on computed tomography (Part 2): calcification in the choroid plexus of the lateral ventricles. No To Shinkei 1988; 40: 707–711.
- [20]↑
Grech R, Grech S, Mizzi A: Intracranial calcifications. A pictorial review. The Neuroradiology Journal 2012 Sep; 25(4): 427–451.
- [21]↑
Kiroglu Y, Çalli C, Karabulut N, Oncel C: Intracranial calcifications on CT. Diagnostic and Interventional Radiology 2010 Dec 1; 16(4): 263.
- [22]↑
Saade C, Najem E, Asmar K, Salman R, El Achkar B, Naffaa L: Intracranial calcifications on CT: an updated review. Journal of Radiology Case Reports 2019; 13(8): 1–18.
- [23]↑
Whitehead MT, Oh C, Raju A, Choudhri AF: Physiologic pineal region, choroid plexus, and dural calcifications in the first decade of life. AJNR (American Journal of Neuroradiology) 2015; 36: 575–580.
- [24]↑
Basak RC: A case report of Basal Ganglia calcification – a rare finding of hypoparathyroidism. Oman Medical Journal 2009 Jul; 24(3): 220–222.
