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The brain in children: is contrast enhancement really needed after obtaining normal unenhanced CT results?

Abstract：

PURPOSE:To retrospectively determine and compare the sensitivity and specificity of unenhanced and contrast material-enhanced computed tomography (CT) (reference standard) in the diagnosis of brain abnormalities and to evaluate any change in diagnosis that resulted from the contrast-enhanced study. MATERIALS AND METHODS:This study was approved by the local research ethics board; the requirement for informed consent was waived. The authors reviewed the unenhanced and contrast-enhanced CT scans of the brain obtained in 353 children for indications other than trauma. There were 196 boys and 157 girls aged 0 months to 17.8 years. Scans were read independently by two pediatric neuroradiologists who were blinded to clinical information. The diagnosis for each scan was recorded according to the anatomic section (supratentorial, infratentorial, ventricles, and skull). The final diagnosis was classified as normal, abnormal, or equivocal. kappa Statistics, with 95% confidence intervals, were reported, and the sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS:Interreader agreement for different anatomic regions varied between good (kappa coefficient, 0.63) and very good (kappa coefficient, 0.88) for unenhanced and contrast-enhanced scans. Sensitivity, specificity, positive predictive value, and negative predictive value for unenhanced scans were 97%, 89%, 87%, and 97%, respectively. The use of contrast material led to a change in the original normal or equivocal diagnosis to an abnormal diagnosis for only five (2.7%) of the 183 normal unenhanced scans. CONCLUSION:Unenhanced CT of developing brains has high sensitivity and specificity in the diagnosis of pathologic findings. The use of intravenous contrast material after unenhanced CT of the brain in children did not change the diagnosis frequently.

journal_name

Radiology

journal_title

Radiology

authors

Branson HM,Doria AS,Moineddin R,Shroff MM

doi

10.1148/radiol.2443051785

subject

Has Abstract

pub_date

2007-09-01 00:00:00

pages

838-44

issue

eissn

0033-8419

issn

1527-1315

pii

2443051785

journal_volume

244

pub_type

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The brain in children: is contrast enhancement really needed after obtaining normal unenhanced CT results?