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.

中文翻译：

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如何在患有神经系统疾病的儿童中寻找颅内钙化：CT、MRI 或两者兼而有之？

背景

颅内钙化（ICC）是儿科神经病学的重要诊断线索。考虑到与计算机断层扫描 (CT) 相关的辐射诱发的癌症风险，我们旨在与 CT 扫描相比，确定对顺磁性/反磁性物质敏感的磁共振成像 (MRI) 序列在检测 ICC 中的诊断价值。

材料和方法

我们选择了在 2005 年至 2018 年间转诊至参与中心的受与 ICC 相关的神经系统疾病影响的儿童进行的 MRI 和 CT 扫描。纳入标准是神经放射学检查的年龄 < 18 岁、可获得钙化的高质量 CT 阳性以及 MRI 扫描包括 GE 或/和 SWI 序列，间隔不超过 6 个月。

结果

81 名患者被纳入研究。CT 和 MRI 扫描经过共识审查。MRI 未能在 14% 的病例中检测到 ICC。磁敏感加权成像 (SWI) 是在这种情况下使用的最佳 MRI 序列，其次是梯度回波成像。在 19% 的病例中，CT 可以避免，因为对患者的临床管理不需要识别或监测 ICC。

结论

在原因不明的儿科发病神经系统疾病的诊断检查中，寻找 ICC 的第一步应该是包括 SWI 和 GE 序列的 MRI。如果 MRI 上没有 ICC，应至少进行一次脑 CT 扫描。当 ICC 的识别或监测不太可能增加对患者随访或治疗有用的信息时，我们建议不要进行 CT 扫描。