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PubMed1990

CT demonstration of calcification in carcinoma of the lung.

Radiologic visualization of calcification within lung cancer is uncommon and may cause confusion and misdiagnosis. For this reason, we reviewed CT records of 353 patients undergoing initial evaluation of lung cancer for the presence of calcification within the tumor, both to document this finding and to estimate its prevalence. Twenty patients (6%) whose records indicated that CT showed calcification were identified, and their chest radiographs and CT scans were analyzed. Patients were included in the study if calcium was seen within the tumor on noncontrast pretreatment CT scans and if pathologic data were available. There were 15 lung and five mediastinal tumors. Fourteen were 5 cm or greater in diameter; three were between 3 and 5 cm, and three were 2 cm or smaller. Cell types of the tumors included small-cell carcinoma (eight patients), squamous cell carcinoma (seven patients), adenocarcinoma (four patients), and undifferentiated carcinoma (one patient). Patterns of calcification were amorphous (eight patients), punctate (10 patients), and reticular (two patients). Extent of tumor calcification and distribution (central, peripheral, or diffuse) did not correlate with cell type or size of the lesion. The visualization of calcium on chest radiographs and CT scans does not alone exclude the diagnosis of bronchogenic carcinoma.

Adenocarcinoma↗
PubMed1991

Calcification of the ligamentum arteriosum in children: a normal finding on CT.

Calcification of the ligamentum arteriosum is a rare finding on plain radiographs. We commonly have seen the calcification on unenhanced CT scans of the chest, a finding not previously reported. A retrospective review of unenhanced CT scans of the chest was undertaken to determine the frequency of the described finding. Seven (13%) of 53 patients had a well-demarcated focus of calcification in the region of the ligamentum arteriosum. None of these patients had evidence of a patent ductus arteriosum. Calcification within the ligamentum arteriosum was seen in 13% of routine CT examinations of the chest in children and should not be confused with a pathologic process producing mediastinal calcifications.

Adolescent↗
PubMed1993

Coronary artery calcification: clinical significance and current methods of detection.

Coronary artery disease affects 1,500,000 Americans each year; 500,000 of these will die. The earliest detectable lesion of coronary atherosclerosis is the fatty streak. Later, crescent-shaped lipid plaques occur, which may rupture and produce either progressive stenosis or sudden occlusion with myocardial infarction. Calcium is deposited early in the formation of the atherosclerotic plaque, and calcification can be used as a marker of the atherosclerotic process. Many imaging techniques can be used to detect calcification of coronary arteries. The most promising are fluoroscopy, ultrafast CT, and intravascular sonography. Detection of calcification is most valuable in persons less than 40 years old in whom modification of risk factors may be important. In addition, the progression and possible regression of calcification can be used as an indicator of the atherosclerotic process. The absence of calcification in coronary arteries may diminish the need for further testing.

Calcinosis↗
PubMed2001

Portal and mesenteric venous calcification in patients with advanced cirrhosis.

OBJECTIVE: The incidence of calcification in the portal and mesenteric venous system was studied in patients with advanced cirrhosis undergoing evaluation for liver transplantation. The significance of portal and mesenteric calcification on liver transplantation was also investigated. CONCLUSION: An 11% incidence of portal and mesenteric venous calcification was found in patients with cirrhosis, which was much higher than anticipated. Two (29%) of seven patients who had calcification present on CT and underwent liver transplantation died at surgery as a result of portal venous thrombosis. Thus, venous calcification seen on CT is a significant finding in patients undergoing liver transplantation.

Adult↗
PubMed2003

Osseous involvement in calcific tendinitis: a retrospective review of 50 cases.

OBJECTIVE: The purpose of this study was to describe the spectrum of radiologic and pathologic manifestations of calcific tendinitis involving bone. MATERIALS AND METHODS: We retrospectively reviewed 50 cases of calcific tendinitis involving underlying bone. Clinical data reviewed included patient age and sex and lesion location. Images reviewed included radiographs (n = 44), CT scans (n = 13), MRIs (n = 16), and bone scintigrams (n = 13). Radiologic examinations were evaluated for the presence of cortical erosion, periosteal reaction, and marrow extension. Pathology confirmation was available in 37 cases. RESULTS: The average age of patients was 50 years (range, 16-82 years), with 29 female patients (58%). Calcific tendinitis with associated bone involvement was seen most commonly in the femur (40%) and the humerus (40%). Concretions were most commonly solid-appearing (50%). Cortical erosion was the most common manifestation of osseous involvement (78% of cases). Marrow involvement was shown in 18 (36%) of 50 cases. Marrow extension was most commonly seen in the lesser and greater tuberosities of the humerus, which accounted for 61% (11/18) of cases. Focal increased radionuclide uptake was seen in 13 (100%) of 13 cases. CONCLUSION: Calcific tendinitis presenting with osseous destruction, marrow changes, and soft-tissue calcifications may be confused with neoplasm both radiologically and pathologically. Recognition of the atypical presentation of this common disease may prevent unnecessary biopsy.

Adolescent↗
PubMed2003

Metallic marker placement after stereotactic core biopsy of breast calcifications: comparison of two clips and deployment techniques.

OBJECTIVE: Two methods of deployment of metallic clips at the site of stereotactic core biopsy for breast calcifications are compared retrospectively. MATERIALS AND METHODS: One hundred nineteen clips deployed through an 11-gauge vacuum-assisted biopsy probe at core biopsy sites were compared with 109 vascular ligating clips deployed at biopsy sites using an 18-gauge spinal needle. The distance of each clip from the position of the target calcification was assessed using stereotactic coordinates in 52 sequential cases and was measured on mammograms before and after biopsy in 108 clips deployed through an 11-gauge probe and 98 clips deployed using an 18-gauge needle. Variance in clip position between postbiopsy and follow-up mammograms was measured in 43 clips placed with an 11-gauge probe and in 44 clips placed with an 18-gauge needle. Comparable measurements of variance in position of fat necrosis calcifications between screening mammograms were used as controls. RESULTS: Ninety-seven percent of the clips placed with an 11-gauge probe and 98% of the clips placed using an 18-gauge needle were within 1 cm of the target calcifications using stereotactic coordinates. On mammograms obtained after biopsy, 70% of the clips placed with an 11-gauge probe and 63% of the clips placed using an 18-gauge needle were within 1 cm of the target calcifications, and the position of 91% of the clips placed with an 11-gauge probe and 90% of the clips placed using an 18-gauge needle varied less than 15 mm on follow-up mammograms. Both clips provided accurate targets for wire-localized excisions. The cost of the 11-gauge needle and clip is $320. The 14-gauge probe, vascular clip, and 18-gauge spinal needle cost $191.58. CONCLUSION: A vascular ligating clip delivered to a stereotactic core biopsy site by an 18-gauge spinal needle is comparable in apparent accuracy and stability to a clip deployed through an 11-gauge probe. This technique allows core biopsies to be performed with instruments smaller than 11-gauge and at a 40% savings in equipment cost.

Biopsy, Needle↗
PubMed2006

Uremic vascular calcification.

Recent evidence suggests that uremic vascular calcification is an active, cell-mediated process resembling osteogenesis in bone rather than passive precipitation. We identified increased expression of bone-associated proteins (osteopontin, bone sialoprotein, alkaline phosphatase, type I collagen) and the bone-specific transcription factor core-binding factor alpha(1) (Cbfalpha(1)) in histologic sections of inferior epigastric arteries obtained from patients with stage V chronic kidney disease or calcific uremic arteriolopathy. In in vitro experiments, the addition of uremic serum to cultured vascular smooth muscle cells up-regulated osteopontin and Cbfalpha(1) expression and accelerated mineralization. This implies that the uremic mileau may lead to dedifferentiation of vascular smooth muscle cells, with subsequent mineralization. However, a lack of inhibitors of calcification may also be important. Dialysis patients with low levels of serum fetuin A, a circulating inhibitor of mineralization, have increased coronary artery calcification, and fetuin A can inhibit mineralization of vascular smooth muscle cells in vitro. Further understanding of the pathophysiology of uremic vascular calcification is needed to design effective therapeutic strategies to intervene with this devastating condition in patients with stage V chronic kidney disease.

Animals↗
PubMed2006

Mechanisms of focal calcification in rabbit aortas: role of calcifying vesicles.

BACKGROUND: We previously demonstrated that calcification in rabbit thoracic aortas is initiated in the lower zone of the extensively thickened plaques (LZP) adjacent to the media. Whether osteogenesis or a local increase in calcifying vesicles underlies the focal calcification remains to be established. METHODS: To determine that focal calcification is related to osteogenesis, an obligatory osteogenic biomarker, alkaline phosphatase (ALP) activity, was evaluated in the unfixed thoracic aorta sections of rabbits fed a supplemental cholesterol diet and of humans with advanced atherosclerosis. To determine whether blood shortage to the smooth muscle cells (SMCs) imposed by intima thickening may increase calcifying vesicles, the effect of serum deprivation on the biogenesis of calcifying vesicles in cultured SMCs was investigated. RESULTS: (1) In contrast to positive rabbit kidney cross sections and consistent with the activity in various isolated subcellular fractions of aortas, ALP activity was absent in the media, adventitia, lesions, and LZP of rabbit aortas or in the fibrointima of human aortas. (2) Histologic assessments of the lesions indicate the absence of bone cells or osteoid. (3) Depletion of the serum from culture media caused a twofold increase in the levels of ALP-deficient and adenosine triphosphatase-rich calcifying vesicles, which were released from the cells by treatment with 0.05% trypsin-0.02% ethylenediaminetetraacetic acid for 15 minutes. CONCLUSIONS: (1) Focal calcification in rabbit aortas and diffuse mineralization in human fibrointima are not associated with osteogenesis, and (2) blockade of the blood supply to SMCs may trigger the cells to produce more calcifying vesicles, thereby leading to site-specific calcification in rabbit aortas.

Alkaline Phosphatase↗
PubMed1994

The relationship of pineal calcification to cerebral atrophy on CT scan in multiple sclerosis.

Calcification is a known morphological feature of the pineal gland. The mechanisms underlying the development of pineal calcification (PC) are elusive although there is experimental evidence that calcification may be a marker of the past secretory activity of the gland and/or of degeneration. The increased incidence of PC with aging suggests that it may reflect cerebral degenerative changes as well. In a recent Editorial in this Journal it was proposed that the pineal gland is implicated in the pathogenesis of multiple sclerosis (MS). Cerebral atrophy, which can be demonstrated on CT scan, is a common feature of MS resulting from demyelination and gliosis. If PC is a marker of a cerebral degenerative process, then one would expect a higher incidence of calcification of the gland in patients with cerebral atrophy compared to those without cerebral atrophy. To test this hypothesis, we studied the incidence of PC on CT scan in a cohort of 48 MS patients, 21 of whom had cerebral atrophy. For the purpose of comparison, we also assessed the incidence of choroid plexus calcification (CPC) in relation to cerebral atrophy. PC was found in 42 patients (87.5%) and its incidence in patients with cerebral atrophy was significantly higher compared to the incidence in patients without cerebral atrophy (100% vs. 77.7%; p < .025). In contrast, CPC was unrelated to cerebral atrophy or to PC thus supporting the notion of a specific association between the pineal gland and the pathogenesis of MS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Differences between heart valve allografts and xenografts in the incidence and initiation of dystrophic calcification.

Following surgical removal because of primary tissue failure, 30 antibiotic-sterilized human aortic valve allografts and 27 glutaraldehyde-treated porcine aortic valve xenografts were examined for macroscopic and microscopic evidence of dystrophic calcification. These grafts had been mounted on stents and used for from 34 to 166 months to replace diseased mitral valves. After explantation the grafts were carefully examined then prepared for light microscopy, for transmission electron microscopy and for energy dispersive X-ray microanalysis. Gross calcification occurred significantly (p = 0.002) more frequently in xenografts (89%), and was more extensive than in allografts (53%). Calcification usually appeared as nodular excrescences on the cusps, although occasionally it formed plates within them. This reduced tissue pliability and was usually associated with either valvular stenosis or regurgitation. The calcified deposits contained calcium and phosphate in ratios approaching those of hydroxyapatite. In xenograft valves the smallest discrete deposits of calcification were spherical and usually associated with membranous debris of porcine donor fibroblasts, but allografts did not contain donor cell remnants and early calcification was linearly arranged along collagen fibres.

Adolescent↗
PubMed1995

Incidental asymptomatic orbital calcifications.

OBJECTIVE: To use modern computed tomography (CT) imaging to quantify the incidence of asymptomatic incidental orbital calcifications and describe their histological features. MATERIALS AND METHODS: One hundred orbital CT scans were reviewed. In addition, patients who had orbital calcification(s) detected on a brain CT scan were examined by the ophthalmology service. RESULTS: Of the orbital CT scans, 2% had bilateral drusen of the optic nerve head, 3% had calcified scleral plaques anterior to the medial or lateral rectus muscles, and 3% had bilateral ossification of the trochlear apparatus. Routine brain CT scans detected asymptomatic calcifications of the sclera and dura surrounding the proximal optic nerves. CONCLUSION: Incidental asymptomatic orbital calcifications are commonly encountered on modern high-resolution CT images of the brain and orbit. This article should help the clinician to confidently distinguish these densities from foreign bodies or pathological calcifications.

Adolescent↗
PubMedDate not supplied

Detection of calcifications in breast biopsies by scanning electron microscopy.

The identification of microcalcifications in breast biopsy specimens is a common and important task for the surgical pathologist that may sometimes be problematic. Although visualized by preoperative mammographic and operative specimen radiography, some cases may fail to reveal calcifications by histopathologic examination or occasion laborious and time-consuming study to confirm sparse calcifications. The present study demonstrates how conventional bright-field and polariscopic light microscopy did require considerable effort to confirm rare calcification. On the other hand, scanning electron microscopy was employed directly on a routine slide and provided definitive visual and physical proof, e.g., by means of energy dispersive x-ray microanalysis of a rare calcification on a slide previously judged to be negative for calcium and in a short period of time. Recent instrument advances in high voltage beam stabilization and in the ability to vary the pressure of the scanning electron microscope in the vicinity of the specimen now allow complete insertion of a diagnostic glass slide with only trivial preparation. The report, although brief, raises important questions regarding the extent and prevalence of breast calcifications.

Adult↗
PubMed2000

Covalently bonded heparin to alter the pericardial calcification.

Calcification is the leading cause of failure of a wide spectrum of cardiovascular and non-cardiovascular medical devices. In this study our aim was to immobilize polyethylene glycol (PEG) and heparin on multiple crosslinked bovine pericardium with Glutaraldehyde (GA) and carbodiimide. Grafting of PEG and heparin through an intermediate tissue bound substrate containing aldehyde and imide functional groups showed reduction in calcification. In this experimental protocol, we used Golomb and Wagner's in vitro model for studying pericardial calcification and a diffusion cell with two compartments for evaluating the diffusion of calcium across the BP. The results showed that heparin immobilization on the surface reduces calcification independent of its concentration in the incubating medium. It is conceivable that inactivation of unpaired aldehydic moieties present in pericardium after exposure to GA act as potential site for PEG grafting and imide functionalities of EDC can covalently bind heparin, would be the key step in the prevention of calcification. It is well-established fact that heparin has a potent antithrombotic effect. But the exact role of heparin in the anticalcification process of bioprostheses still remain elusive.

Animals↗
PubMedDate not supplied

In utero development of pulmonary artery calcification in monochorionic twins: a report of three cases and discussion of the possible etiology.

Pulmonary artery (PA) calcification is unusual in children, reportedly occurring only in conjunction with severe underlying valvular disease. Three newborns were found by chest X-ray study to have thin calcified rings of the PA. Two were pump twins in twin reversed arterial perfusion (TRAP) sequences, each with an acardiac cotwin, and the third was the recipient in a twin transfusion syndrome (TTS). Both twin pairs with TRAP sequence were premature, each pump twin presenting with cardiac decompensation. One remained well at 5 months of age, the other died at 5 1/2 months of age. The third, the premature recipient of twins with TTS, died at 24 h of age, and the donor cotwin died at 2 h of age. The two hearts were structurally normal at autopsy. Subtle intimal wrinkling was seen above the pulmonary valve leaflets, and the media was yellow and granular on cut section. Hyperplasia of the intima and media with disruption and calcification of the elastic fibers of the media was seen microscopically. These three cases of PA calcification occurring in utero were not related to structural valvular abnormalities but were presumably due to increased cardiac output in utero as each occurred in the volume-overloaded twin of the twin pair. Comparison of the weight differences between these three twin pairs with PA calcification suggests a relationship between the presence of PA calcification and the severity of the cardiac volume overload. In utero cardiac damage may contribute to the high morbidity and mortality rate seen in infants with TRAP sequence and TTS.

Adult↗
PubMed1989

[Ectopic calcification of the abdominal aorta and bone mineral content of vertebrae].

The relationship between the ectopic calcification of abdominal aorta and the de-calcification of bone in 137 elderly patients was investigated by quantitative computed tomography. We calculated the index (CAI) of the calcification volume to the aorta volume in the lower abdominal aorta, and simultaneously estimated the bone mineral content (BMC) of the vertebral body using a calibration phantom. The CAI increased and the BMC decreased progressively in proportion to aging. There was a significant negative correlation between the CAI and the MBC in females in the eighth and ninth decades (eighth decade: n = 37, r = -0.400; p less than 0.01, ninth decade: n = 37, r = -0.334; p less than 0.05). These results suggested that in elderly females, abdominal aortic calcification is closely related to de-calcification from the vertebral body.

Aged↗
PubMed1992

[The relation between bone calcium metabolism and senile aortic valve calcification].

The authors assessed the affect of bone calcium metabolism on aortic valve calcification (AVC) in 189 septua- and octogenarians (49 males and 140 females, 81.0 +/- 4.4 yrs). Both AVC and mitral annular calcification (MAC) were evaluated by two-dimensional echocardiography, and then the degree of AVC was classified into three categories; C-1: calcification seen in one cusp of the aortic valve, C-2: calcification in two cusps, and C-3: calcification in three cusps. Bone mineral content (BMC) of three lumbar vertebral bodies was obtained by quantitative computed tomography using a calibrated phantom. Serum calcium, phosphate, parathyroid hormone, calcitonin, and osteocalcin were also examined within a month. The patients were classified into age-matched five groups in both sexes; Group-C: MAC (-) and AVC (-) (n = 79); Group-A1: MAC (-) and AVC (+) with C-1 (n = 35); Group-A2: MAC (-) and AVC (+) with C-2 (n = 19); Group-A3: MAC (-) and AVC (+) with C-3 (n = 15); and Group-AM: MAC (+) and AVC (+) in any cusp (n = 42). In males, BMC decreased in the order of Groups-A3 (83 +/- 27 mg/cm3), -C (67 +/- 50), -AM (62 +/- 62), -A2 (61 +/- 38), and -A1 (59 +/- 58), but there was no significant difference between any of the five groups. In females, the BMC in Group-AM (29 +/- 24) was significantly less than that in Group-C (48 +/- 35) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Calcification comparison of polymers for vascular graft.

Polytetrafluoroethylene (PTFE), polyurethane (PU) and silicone are widely known biocompatible polymers which are commonly used for vascular grafts. However, in vitro and in vivo calcifications of these polymers have been found to seriously compromise their quality as biomaterials. In consideration of this problem, the present study compared the calcification rate and extent of PTFE, PU and silicone. Using the in vitro flow-type method, PTFE, PU and silicone films were tested for 1, 4, 7, 10, 14 and 21 days. After 21 days of in vitro calcification test, the calcium levels on PTFE, PU and silicone were 35.89 +/- 5.01 microg/cm2, 23.73 +/- 0.68 microg/cm2 and 19.86 +/- 5.28 microg/cm2, respectively. The higher observed calcium level for PTFE may be due to the effect of the rough surface of PTFE in accumulating calcium ions on the polymer surface. From the 7th day of test, the [Ca]/[P] molar ratio started to decrease over time, and PTFE showed a faster calcification process. This decreasing [Ca]/[P] molar ratio demonstrated the typical calcification mechanism consisting of phosphorus ion accumulation following calcium ion accumulation. This study concluded that PU and silicone are less calcified than PTFE film, a finding in good agreement with previously published studies.

Biocompatible Materials↗
PubMed2005

Serious cardiac and pulmonary calcification in a young peritoneal dialysis patient: potential role of continuous correction of acidosis.

We describe a 40-month-old male infant with renal failure, treated with peritoneal dialysis, who developed massive calcification of soft tissues including the heart and lungs with subsequent cardiopulmonary insufficiency. A diagnosis of Jeune syndrome was made. After starting peritoneal dialysis, the patient exhibited an intractable metabolic acidosis of unknown etiology necessitating treatment with intravenous or oral sodium bicarbonate. Myocardial calcification was first detected by 2-dimensional echocardiography performed 3 months after starting dialysis. The patient was not suitable for renal transplantation because of his cardiac dysfunction and died of cardiac and respiratory failure at the age of 6 years. Although the patient exhibited a variety of risk factors for ectopic calcification including hyperphosphatemia, hyperparathyroidism, high calcium-phosphate product and treatment with vitamin D, the early and massive soft tissue calcification may have been accelerated by correction of the metabolic acidosis. Therefore, the use of sodium bicarbonate may be involved in the etiology of the myocardial calcification.

Acidosis↗