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Significance of basal ganglia calcification on computed tomography in children
A Legido1, R A Zimmerman, R J Packer
1Division of Neurology, Children's Hospital, Philadelphia, Pa.
Insights
Basal ganglia calcification (BGC) in children often follows cancer treatment or indicates generalized neurological dysfunction. While developmental delays are common, BGC itself doesn't correlate with specific neurological issues, acting as a marker for broader brain damage.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Child Neurology
Background:
- Basal ganglia calcification (BGC) is an uncommon finding in pediatric head computed tomography (CT) scans.
- Understanding the underlying causes and implications of BGC in children is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the prevalence, associated conditions, and clinical significance of basal ganglia calcification (BGC) in a pediatric population.
Main Methods:
- Retrospective review of 6,428 head CT scans from 4,283 children over a 3-year period.
- Analysis of patient demographics, medical conditions, treatment history (including radiation therapy doses), and neurological symptoms.
- Evaluation of calcium and phosphorus metabolism in a subset of patients.
Main Results:
- Basal ganglia calcification (BGC) was identified in 48 (1.1%) children.
- The most frequent associations were cancer treatment (16 patients), tuberous sclerosis or congenital infections (14 patients), and other medical conditions (18 patients).
- Calcifications appeared a median of 10 months post-radiation therapy in cancer patients; neurological symptoms were common but not directly correlated with BGC.
Conclusions:
- Childhood basal ganglia calcification (BGC) is predominantly linked to cancer treatment or generalized neurological dysfunction.
- BGC may serve as an indicator of more extensive brain damage rather than being directly related to specific neurological deficits.
- Developmental delays are observed in many children with BGC, highlighting its significance as a marker.
Abstract:
We reviewed 6,428 head computed tomography (CT) scans performed on 4,283 children at our institution over a 3-year period and found basal ganglia calcification (BGC) in 48 (1.1%) of the patients. Their mean age at the time of detection was 5.3 years (range: 0.5-20 years); 16 (33%) patients had cancer, 14 (29%) had tuberous sclerosis or congenital infection and 18 (38%) had other medical conditions. All patients with cancer had been treated with radiation therapy, receiving a mean dose of 4,583 cGy (range: 1,800-5,500 cGy) to the diencephalon, and calcifications first became apparent at a median of 10 months after treatment. Other medical conditions included neonatal asphyxia (3), metabolic disease (3) (Kearns Sayre, MELAS, Krabbe's), congenital anomalies (3), meningitis (2), Fahr's disease (1) and others (6). Neurologic symptoms were common in children of all groups, but could not be correlated to BGC changes. Calcium and phosphorus metabolism was evaluated in 19 patients and was abnormal in 1. We conclude that BGC on CT in childhood occur primarily as an aftermath of the cancer treatment or in children with generalized neurologic dysfunction. Many children with BGC are delayed in their development, but calcifications are not directly related to specific forms of neurologic dysfunction. Rather, ther appear to serve as markers for more extensive brain damage.