Two Cases of Caseous Calcification of the Mitral Annulus

변경민,박승우,최진오,양지현,한혜진,손관협,김윤정 대한심장학회 2009 Korean Circulation Journal Vol.39 No.2

Caseous mitral annular calcification describes a heavy calcification of the mitral annulus with central liquefaction. This rare variant of mitral annular calcification may resemble an intracardiac tumor, abscess, vegetation, or thrombus, a resemblance that often leads to unnecessary surgery. Typical echocardiographic findings include a large, round, bright echogenic mass with a central echolucent area. It is known to have a benign clinical outcome, and it is thus managed conservatively. Because this entity is not well known and has only rarely been described, we report two cases of mitral annular calcification encountered at our institution. The first patient was an elderly woman with exertional dyspnea who was found to have a solitary pulmonary nodule on plain chest radiography. This was determined to represent caseous calcification of the mitral annulus. The other patient was an elderly woman who had a history of cerebral embolic infarction. She did not have an intracardiac thrombus, but she did have caseous mitral annular calcification. Both patients were managed conservatively. Caseous mitral annular calcification describes a heavy calcification of the mitral annulus with central liquefaction. This rare variant of mitral annular calcification may resemble an intracardiac tumor, abscess, vegetation, or thrombus, a resemblance that often leads to unnecessary surgery. Typical echocardiographic findings include a large, round, bright echogenic mass with a central echolucent area. It is known to have a benign clinical outcome, and it is thus managed conservatively. Because this entity is not well known and has only rarely been described, we report two cases of mitral annular calcification encountered at our institution. The first patient was an elderly woman with exertional dyspnea who was found to have a solitary pulmonary nodule on plain chest radiography. This was determined to represent caseous calcification of the mitral annulus. The other patient was an elderly woman who had a history of cerebral embolic infarction. She did not have an intracardiac thrombus, but she did have caseous mitral annular calcification. Both patients were managed conservatively.

Age-Related Prevalence of Periodontoid Calcification and Its Associations with Acute Cervical Pain

Takashi Kobayashi,Naohisa Miyakoshi,Norikazu Konno,Yoshinori Ishikawa,Hideaki Noguchi,Yoichi Shimada 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.6

Study Design: Prospective study. Purpose: To assess the prevalence of periodontoid calcification and its associations with acute cervical pain. Overview of Literature: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a common rheumatological disorder that occurs especially in elderly patients. Although CPPD crystals induce acute arthritis, these crystals are not usually symptomatic. Calcification surrounding the odontoid process (periodontoid calcification) has been reported to induce inflammation, resulting in acute neck pain. This disease is called crowned dens syndrome. Whether calcification induces inflammation or whether the crystals are symptomatic remains unclear. Methods: The prevalence of periodontoid calcification at the atlas transverse ligament was examined by computed tomography of the upper cervical spine in patients suspected of brain disease but no cervical pain (control group, n=296), patients with pseudogout of the peripheral joints but no cervical pain (arthritis group, n=41), and patients with acute neck pain (neck pain group, n=22). Next, the correlation between the prevalence of periodontoid calcification and symptoms was analyzed. Results: In the control group, 40 patients (13.5%) showed periodontoid calcification with no significant difference in the prevalence with gender. The prevalence of calcification increased significantly with age (p =0.002). In the arthritis group, 26 patients (63.4%) reported periodontoid calcification. In the neck pain group, 14 patients (63.6%) reported periodontoid calcification. Multiple logistic regression analysis by age and group revealed that higher age, inclusion in the arthritis group, and inclusion in the neck pain group significantly affected the prevalence of calcification. Conclusions: Our results cumulatively suggest that periodontoid calcification is an aging-related reaction and that calcification per se does not always cause neck pain. Periodontoid calcification was observed more frequently in patients with pseudogout of the peripheral joints and in those with acute neck pain than in asymptomatic control patients.

Calcified Thyroid Nodules: Review of the Significance of Peripheral Calcifications

김아영,박성빈,이용석,최희석,김경아,곽범석,황재철 대한초음파의학회 2009 ULTRASONOGRAPHY Vol.28 No.2

Thyroid calcification may occur in both benign and malignant thyroid disease, but previous literature reports have indicated that calcification is more common in malignant lesions than it is in benign ones. Various patterns of calcification are seen, including microcalcification, coarse dense macrocalcification, and peripheral calcification. Microcalcification and coarse dense macrocalcification are two of the most specific features of thyroid malignancy. However, to date, the clinical significance of peripheral calcification remains unclear and therefore controversial. In this pictorial review, we describe the ultrasonographic features of calcified thyroid nodules and seek to delineate the spectrum and determine the clinical significance of peripheral calcification by correlating it with pathologic results. A broad spectrum of benign to malignant tumors is associated with peripheral calcification. Peripheral calcification in a thyroid nodule should be considered to indicate an indeterminate lesion, and ultrasonography-guided FNAB or core biopsy should be performed in order to exclude malignancy. Thyroid calcification may occur in both benign and malignant thyroid disease, but previous literature reports have indicated that calcification is more common in malignant lesions than it is in benign ones. Various patterns of calcification are seen, including microcalcification, coarse dense macrocalcification, and peripheral calcification. Microcalcification and coarse dense macrocalcification are two of the most specific features of thyroid malignancy. However, to date, the clinical significance of peripheral calcification remains unclear and therefore controversial. In this pictorial review, we describe the ultrasonographic features of calcified thyroid nodules and seek to delineate the spectrum and determine the clinical significance of peripheral calcification by correlating it with pathologic results. A broad spectrum of benign to malignant tumors is associated with peripheral calcification. Peripheral calcification in a thyroid nodule should be considered to indicate an indeterminate lesion, and ultrasonography-guided FNAB or core biopsy should be performed in order to exclude malignancy.

갑상선 종물 내 석회화 양상과 유두상암과의 연관성

이남훈,최현진,허세형,이창희,진성민,이상혁 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.11

Backgraound and Objectives Thyroid calcification is widely known as a highly specific sign of malignancy. However, there are few studies on the correlation between the calcification and papillary thyroid cancer (PTC). The aim of this study was to describe the features of calcification in thyroid mass, and determine the relationship between thyroid calcification and PTC. Subjects and Methods Patients (116) who underwent surgery for thyroid mass during the period of March 2006 to December 2008 were reviewed retrospectively. Each patient underwent preoperative sonography (n=96) and computed tomography (CT)(n=110) to evaluate the thyroid lesion. We subdivided the calcification according to characteristic features and compared the pathologic results. The association between the type of calcification and PTC was verified through the Chi-square test or likelihood ratio. Results Of 96 patients who underwent sonography, 41 (42.7%) had calcification, of which 23 had microcalcificaiton, 15 had focal calcification, and three had rim calcification. Of 41 calcified lesions, 34 (82.9%) were PTC. Incidence of cancer from thyroid which had no calcified lesion was 30.9%. Three (6.7%) of 45 benign lesions had microcalcification, and 20 (39.2%) of 51 were PTC. We found statistically significant correlation between the presence of calcification, especially microcalcification, on sonography and PTC. Thirty of 110 patients (27.3%) who underwent neck CT had calcification, and among them, 20 patients (66.7%) were diagnosed as PTC. There was no statistical significance in relationship between calcification on CT and malignancy. Conclusion This study suggests that microcalcification which is shown by sonography were more specific for PTC than other calcified lesions.

석회화된 기저세포암의 석회화 관련 인자의 발현

도미옥 ( Mi Ok Do ),김소영 ( So Young Kim ),최유원 ( You Won Choi ),명기범 ( Ki Bum Myung ),최혜영 ( Hae Young Choi ) 대한피부과학회 2007 大韓皮膚科學會誌 Vol.45 No.7

Background: Although basal cell carcinoma (BCC) is the most common human skin tumor, with calcification reportedly taking place in about 20% of all BCC cases, the pathogenesis of calcification in BCC has not yet been studied. Objective: The purpose of this study was to evaluate factors related to the pathogenesis of calcification in BCC. Methods: We performed immunohistochemical staining for β-catenin, frizzled-2, BMP-4, osteopontin, osteocalcin, and osteonectin using frozen skin tissue from 15 cases of BCC with calcification and 11 cases of BCC without calcification. Results: The expression of β-catenin showed positive in 14 of the 15 cases in BCC with calcification, but negative in all 11 cases of BCC without calcification. The expression of frizzled-2 was observed in 14 of the 15 cases in BCC with calcification, and in 10 of the 11 cases in BCC without calcification. The difference did not reach statistical significance (p=0.236). The expression of BMP-4 was observed in all 26 samples of BCC, but the intensity of expression did not reach statistical significance between the two groups (p=0.293). Furthermore, osteopontin and osteocalcin showed no statistical significance between two the groups (p=0.567, p=0.401). The expression of osteonectin was observed in all of the BCC cases, and was stronger in BCC with calcification than in BCC without calcification (p=0.042). Conclusion: We suggest that the calcification in BCC might be related to the increase of β-catenin expression and that osteonectin might also influence the process of calcification in BCC. (Korean J Dermatol 2007;45(7):666∼672)

Calcification Remodeling Index Characterized by Cardiac CT as a Novel Parameter to Predict the Use of Rotational Atherectomy for Coronary Intervention of Lesions with Moderate to Severe Calcification

Mengmeng Yu,Yuehua Li,Wenbin Li,Zhigang Lu,Meng Wei,Jiayin Zhang 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.5

Objective: To assess the feasibility of calcification characterization by coronary computed tomography angiography (CCTA) to predict the use of rotational atherectomy (RA) for coronary intervention of lesions with moderate to severe calcification. Materials and Methods: Patients with calcified lesions treated by percutaneous coronary intervention (PCI) who underwent both CCTA and invasive coronary angiography were retrospectively included in this study. Calcification remodeling index was calculated as the ratio of the smallest vessel cross-sectional area of the lesion to the proximal reference luminal area. Other parameters such as calcium volume, regional Agatston score, calcification length, and involved calcium arc quadrant were also recorded. Results: A total of 223 patients with 241 calcified lesions were finally included. Lesions with RA tended to have larger calcium volume, higher regional Agatston score, more involved calcium arc quadrants, and significantly smaller calcification remodeling index than lesions without RA. Receiver operating characteristic curve analysis revealed that the best cutoff value of calcification remodeling index was 0.84 (area under curve = 0.847, p < 0.001). Calcification remodeling index ≤ 0.84 was the strongest independent predictor (odds ratio: 251.47, p < 0.001) for using RA. Conclusion: Calcification remodeling index was significantly correlated with the incidence of using RA to aid PCI. Calcification remodeling index ≤ 0.84 was the strongest independent predictor for using RA prior to stent implantation.

석회화의 종류와 농도에 따른 CT와 MRI 분석

최영칠,신현준,최진영 대한신경과학회 2009 대한신경과학회지 Vol.27 No.2

Background: High-density calcifications on CT images can appear as high signals on T1-weighted MR images, but with differing extents and degrees. This study investigated CT and MR images of calcifications of various types and concentrations. Methods: We analyzed CT and MR images of two cases of bilateral basal ganglia calcifications and experimental suspensions of calcifications of different types and concentrations. Results: The density of CT calcifications increased in proportion to their concentration regardless of their type. However, the MR signals differed with the types and concentrations of calcification. A high signal was one of the most noticeable signs on T1-weighted MR images for calcium phosphate, and it increased for concentrations up to 0.2 g/mL before leveling off. The signal for all types of calcification decreased on T2-weighted and especially fluid-attenuated inversion recovery (FLAIR) images. Conclusions: High signals are characteristic of calcification on T1-weighted MR images, and are often stronger than those on CT images. A low signal appears consistently on FLAIR MR images regardless of the calcification type. These findings might be helpful in evaluating calcifications apparent in MR images. Background: High-density calcifications on CT images can appear as high signals on T1-weighted MR images, but with differing extents and degrees. This study investigated CT and MR images of calcifications of various types and concentrations. Methods: We analyzed CT and MR images of two cases of bilateral basal ganglia calcifications and experimental suspensions of calcifications of different types and concentrations. Results: The density of CT calcifications increased in proportion to their concentration regardless of their type. However, the MR signals differed with the types and concentrations of calcification. A high signal was one of the most noticeable signs on T1-weighted MR images for calcium phosphate, and it increased for concentrations up to 0.2 g/mL before leveling off. The signal for all types of calcification decreased on T2-weighted and especially fluid-attenuated inversion recovery (FLAIR) images. Conclusions: High signals are characteristic of calcification on T1-weighted MR images, and are often stronger than those on CT images. A low signal appears consistently on FLAIR MR images regardless of the calcification type. These findings might be helpful in evaluating calcifications apparent in MR images.

Role of Inflammation in Arterial Calcification

Hae-Young Lee,Soyeon Lim,박성하 대한심장학회 2021 Korean Circulation Journal Vol.51 No.2

Arterial calcification, characterized by calcium phosphate deposition in the arteries, can be divided into intimal calcification and medial calcification. The former is the predominant form of calcification in coronary artery plaques; the latter mostly affects peripheral arteries and aortas. Both forms of arterial calcification have strong correlations with adverse cardiovascular events. Intimal microcalcification is associated with increased risk of plaque disruption while the degree of burden of coronary calcification, measured by coronary calcium score, is a marker of overall plaque burden. Continuous research on vascular calcification has been performed during the past few decades, and several cellular and molecular mechanisms and therapeutic targets were identified. However, despite clinical trials to evaluate the efficacy of drug therapies to treat vascular calcification, none have been shown to have efficacy until the present. Therefore, more extensive research is necessary to develop appropriate therapeutic strategies based on a thorough understanding of vascular calcification. In this review, we mainly focus on intimal calcification, namely the pathobiology of arterial calcification, and its clinical implications.

Estrogen-Related Receptor γ Plays a Key Role in Vascular Calcification Through the Upregulation of BMP2 Expression

Kim, Ji-Hyun,Choi, Yeon-Kyung,Do, Ji-Yeon,Choi, Young-Keun,Ha, Chae-Myeong,Lee, Sun Joo,Jeon, Jae-Han,Lee, Won-Kee,Choi, Hueng-Sik,Park, Keun-Gyu,Lee, In-Kyu American Heart Association 2015 Arteriosclerosis, thrombosis, and vascular biology Vol.35 No.11

<P>Objective Vascular calcification which refers to ectopic mineralization in vascular cells is associated with several conditions, such as chronic kidney disease, atherosclerosis, and diabetes mellitus. Estrogen-related receptor (ERR) is a member of the orphan nuclear receptor superfamily, which plays diverse roles in regulating homeostatic and metabolic processes. However, the role of ERR in vascular calcification has not been investigated to date. The aim of the present study was to examine the role of ERR in vascular calcification. Approach and Results Vascular calcification was induced by treating rat aortic vascular smooth muscle cells with calcification medium. ERR expression in vascular smooth muscle cells was induced during calcification medium-induced vascular calcification. Adenovirus-mediated overexpression of ERR in vascular smooth muscle cells resulted in the upregulation of the expression of osteogenic genes, including runt-related transcription factor 2, osteopontin, and Msx2, and the downregulation of -smooth muscle actin. Adenovirus-mediated overexpression of ERR induced bone morphogenetic protein 2 (BMP2) expression, leading to increased phosphorylation of the intracellular BMP2 effector proteins SMAD1/5/8. Collectively, these data suggested that ERR promotes dedifferentiation of vascular smooth muscle cells to an osteogenic phenotype during the vascular calcification process. Inhibition of endogenous ERR expression or activity using a specific siRNA or the selective inverse agonist GSK5182 attenuated vascular calcification and osteogenic gene expression in vitro and in vivo. Conclusions The present results indicate that ERR plays a key role in vascular calcification by upregulating the BMP2 signaling pathway, suggesting that inhibition of ERR is a potential therapeutic strategy for the prevention of vascular calcification.</P>

Intracranial Arterial Calcificationes Can Reflect Cerebral Atherosclerosis Burden

김정민,박광열,배재한,한수현,정해봉,정다은 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.1

Background and Purpose We investigated whether the intracranial arterial calcification status reflects the overall cerebral atherosclerosis burden. Methods Patients with acute cerebral infarction who were admitted to a single university hospital stroke center and underwent brain computed tomography angiography (CTA) between May 2011 and December 2015 were included. We reviewed their demographic, clinical, and imaging data. Cerebral artery calcification was assessed from the cavernous portion of both internal carotid arteries, and patients were categorized into three groups according to the calcification status. The cerebral atherosclerosis score was calculated as the sum of the degree of stenosis of the major intracranial and extracranial arteries on brain CTA. Results In total, 1,161 patients were included (age=67±13 years, mean±standard deviation), of which 517 were female. Intracranial arterial calcification and atherosclerosis were detected in 921 patients. The cerebral atherosclerosis score tended to increase with the calcification status (no calcification=2.0±3.0, mild=3.8±3.8, severe=6.5±4.8; p<0.001 in analysis of variance followed by the Bonferroni test). Multivariable logistic regression analysis including age, sex, vascular risk factors, body mass index, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and calcification status showed that intracranial calcification was independently associated with an advanced cerebral atherosclerosis burden in a dose-dependent manner (compared to no calcification: odds ratio=2.0 and 95% confidence interval= 1.1–3.4 for mild calcification, and odds ratio=4.7 and 95% confidence interval=2.7–8.3 for severe calcification). Conclusions This study found that the calcification status of the cavernous portion of an internal carotid artery can reflect the overall cerebral atherosclerosis burden