Calcified cerebral metastases are uncommon and can either occur spontaneously in the setting of certain specific primary malignancies or secondarily, following treatment with radiotherapy 1.
A wide range to primary malignancies can result in calcified cerebral metastases 1:
adenocarcinoma (e.g. breast cancer, lung) - most common
squamous cell carcinoma (e.g. lung, cervix)
sarcomas (e.g. osteosarcoma, mediastinal sarcoma)
mucinous adenocarcinomas (e.g. colorectal, ovarian)
Radiographic features
CT
CT is the most easily interpreted modality for the presence of calcifications. They a morphologically heterogeneous with punctate, coarse, peripheral and linear patterns all observed 1.
MRI
Identifying calcifications on MRI can be more challenging than with CT. Susceptibility-weighted imaging will usually demonstrate signal loss, and the phase images can be used to distinguish calcifications from blood products; this is, however, not always straight forward.
Differential diagnosis
Other calcified lesions:
primary tumors (e.g. oligodendroglioma)
cerebral cavernous venous malformations (cavernomas)
cerebral granulomas (e.g. neurocysticercosis or tuberculosis)
meningioma (could be confused with a peripheral/cortical metastasis)
degenerative/dystrophic calcifications (e.g. Fahr disease)
Hyperdense but not calcified:
highly cellular lesions (e.g. lymphoma)
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