Davide Tonduti1, Anna Pichiecchio2,3, Cecilia Parazzini4, Luisa Chiapparini5, Carla Uggetti6, Stefania Maria Bova7, Simona Orcesi3,8. 1. Child Neurology, Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy. davidetondu@hotmail.com. 2. Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy. 3. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 4. Paediatric Radiology and Neuroradiology Department - COALA (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milan, Italy. 5. Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 6. Neuroradiology Unit, Department of Radiology, ASST Santi Paolo E Carlo, Milan, Italy. 7. Child Neurology, Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy. 8. Child and Adolescent Neurology Department, IRCCS Mondino Foundation, Pavia, Italy.
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.
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.
Authors: Andreas Brunklaus; Liam Dorris; Rachael Ellis; Eleanor Reavey; Elizabeth Lee; Gordon Forbes; Richard Appleton; J Helen Cross; Colin Ferrie; Imelda Hughes; Alice Jollands; Mary D King; John Livingston; Bryan Lynch; Sunny Philip; Ingrid E Scheffer; Ruth Williams; Sameer M Zuberi Journal: Dev Med Child Neurol Date: 2012-11-20 Impact factor: 5.449