Vascular Calcification(s)
Gregory L. Katzman, MD, MBA
DIFFERENTIAL DIAGNOSIS
Common
Physiologic Calcification, Vascular
Atherosclerosis, Intracranial
Diabetes
Saccular Aneurysm
Fusiform Aneurysm, ASVD
Less Common
Chronic Renal Failure
Cavernous Malformation
Arteriovenous Malformation
Calcified Plaque Embolus
Hyperparathyroidism
Rare but Important
Mineralizing Microangiopathy
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Atherosclerotic, diabetic, & renal failure calcifications are often comorbidities in the same patient
Helpful Clues for Common Diagnoses
Physiologic Calcification, Vascular
Barely discernible mural calcifications without narrowing
Unaccompanied by evidence of disease
Only in medial layer; assoc. w/elastin
Atherosclerosis, Intracranial
Eccentric mural calcifications with focal lumenal narrowing
Mostly in intimal layer; assoc. w/collagen
Diabetes
Concentric nature in contrast to eccentric calcified atherosclerotic plaque
Saccular Aneurysm
Chunky or curvilinear mural calcifications
May appear as hypointense rim on MR
Fusiform Aneurysm, ASVD
Long segment irregular fusiform dilatation
Mural calcifications common
Helpful Clues for Less Common Diagnoses
Chronic Renal Failure
Vascular calcification & arterial stiffness occurs due to disturbances of calcium metabolism
Cavernous Malformation
“Popcorn” appearance with hypointense hemosiderin rim on T2WI MR
Arteriovenous Malformation
Calcifications in 25-30%
Calcified Plaque Embolus
Calcified cerebral emboli change in site, size, & attenuation with time
Not a contraindication to thrombolysis
Hyperparathyroidism
Subsequent hypercalcemia can lead to vascular, soft tissue, & joint calcifications
Helpful Clues for Rare Diagnoses
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