Learning objectives
To identify normal variants on brain imaging
To enlist the disease entities they may mimic and to distinguish normal variants from pathological conditions,
To discuss the further management of aforementioned incidental findings, if indicated.
Background
Advancement in neuroimaging and advent of more efficient modalities has led to detection of lesions and pathologies which were not easily detected previously. In addition to pathologies, a wide spectrum of normal findings are also encountered in our daily practice.
It is important to recognise these normal variant findings, establish their significance and differentiate them from pathologies having similar appearance in some cases. The reporting radiologist if not aware, may overestimate the implication of these findings.
Findings and procedure details
We can broadly divide such findings into normal (age-related) intracranial calcification, normal cystic variants, vascular variants and normal meningeal/calvarial variants.
A. Normal intracranial calcifications: Occur as part of normal ageing of brain, without a pathological cause. As expected, they are more prevalent in older age groups.
The common locations involving such calcifications include:
Pineal gland [1] (fig.1) [Fig 1]
Most common ( ~ 71% ).
Morphology varies with age- young children showing single and punctate calcification while bigger and relatively coarse calcification in older individuals....
Conclusion
The aforementioned normal variants must be distinguished from their disease counterparts, as indeterminate descriptions can lead to unnecessary interventions, and patient apprehension and morbidity. Their significance should be clearly mentioned in the radiological report, and appropriate further imaging should be used to resolve doubtful cases.
Personal information and conflict of interest
S. Sharma:
Nothing to disclose
S. Mahal:
Nothing to disclose
S. Tiwari:
Nothing to disclose
T. Yadav:
Nothing to disclose
P. K. Garg:
Nothing to disclose
B. Sureka:
Nothing to disclose
P. S. Khera:
Nothing to disclose
References
[1] Whitehead MT, Oh C, Raju A, Choudhri AF. Physiologic pineal region, choroid plexus, and dural calcifications in the first decade of life. American Journal of Neuroradiology. 2015 Mar 1;36(3):575-80.
[2] Hegde AN, Mohan S, Lath N, Lim CT. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. 2011 Jan;31(1):5-30.
[3] Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics. 2007 Jul;27(4):1071-86.
[4] Vernooij M.W., Yousry T.A. (2019) Incidental Findings on Neuroimaging and Normal Variants That May Mimic Disease. In: Barkhof...