Fat within the falx: MR demonstration of falcine bony metaplasia with marrow formation

Falcine bony metaplasia frequently is incorrectly labeled "dense calcification" on brain CT and conventional radiography. Of 3,000 brain magnetic resonance (MR) scans reviewed, 12 demonstrated a central area of increased signal intensity on T1 and T2 weighted images with a smooth peripheral rim of diminished signal intensity within the region of the falx. The central area of increased signal intensity corresponded to fat in the medullary cavity and the peripheral area of low signal intensity corresponded to cortical bone. The CT scans, available in nine of 12 patients, were compared with the MR scans and revealed dense mineralization in the corresponding region of the falx. A postmortem specimen of densely "calcified" falx cerebri was examined that revealed cortical bone and a medullary cavity complete with bony trabeculae and marrow. The MR findings of falx ossification should not be confused with other entities of greater clinical significance.