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The Brain in Children: Is Contrast Enhancement Really Needed after Obtaining Normal Unenhanced CT Results?¹

¹ From the Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8 (H.M.B., A.S.D., M.M.S.); and Department of Public Health, Family and Community Medicine, University of Toronto, Ontario, Canada (R.M.). Received November 8, 2005; revision requested January 4, 2006; revision received March 24; accepted April 20; final version accepted January 8, 2007. Supported in part by a research award from the Department of Medical Imaging, University of Toronto. Address correspondence to M.M.S. (e-mail: manohar.shroff{at}sickkids.ca).

View larger version (92K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Change in the clinical diagnosis for brain CT scan obtained in 1-year-old girl from normal to abnormal after administration of contrast material. (a) Unenhanced transverse CT scan reported as normal. (b) Corresponding contrast-enhanced transverse CT scan demonstrates right cerebellar developmental venous anomaly (arrow). (c) Unenhanced transverse CT scan obtained near the vertex reported as normal; however, in retrospect, the patient's superior sagittal sinus (arrow) had low attenuation. (d) Corresponding contrast-enhanced transverse CT scan demonstrates filling defect in posterior sagittal sinus (arrow), which most likely represents an incidental arachnoid granulation.

View larger version (76K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Change in the clinical diagnosis for brain CT scan obtained in 1-year-old girl from normal to abnormal after administration of contrast material. (a) Unenhanced transverse CT scan reported as normal. (b) Corresponding contrast-enhanced transverse CT scan demonstrates right cerebellar developmental venous anomaly (arrow). (c) Unenhanced transverse CT scan obtained near the vertex reported as normal; however, in retrospect, the patient's superior sagittal sinus (arrow) had low attenuation. (d) Corresponding contrast-enhanced transverse CT scan demonstrates filling defect in posterior sagittal sinus (arrow), which most likely represents an incidental arachnoid granulation.

View larger version (75K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Change in the clinical diagnosis for brain CT scan obtained in 1-year-old girl from normal to abnormal after administration of contrast material. (a) Unenhanced transverse CT scan reported as normal. (b) Corresponding contrast-enhanced transverse CT scan demonstrates right cerebellar developmental venous anomaly (arrow). (c) Unenhanced transverse CT scan obtained near the vertex reported as normal; however, in retrospect, the patient's superior sagittal sinus (arrow) had low attenuation. (d) Corresponding contrast-enhanced transverse CT scan demonstrates filling defect in posterior sagittal sinus (arrow), which most likely represents an incidental arachnoid granulation.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Change in the clinical diagnosis for brain CT scan obtained in 1-year-old girl from normal to abnormal after administration of contrast material. (a) Unenhanced transverse CT scan reported as normal. (b) Corresponding contrast-enhanced transverse CT scan demonstrates right cerebellar developmental venous anomaly (arrow). (c) Unenhanced transverse CT scan obtained near the vertex reported as normal; however, in retrospect, the patient's superior sagittal sinus (arrow) had low attenuation. (d) Corresponding contrast-enhanced transverse CT scan demonstrates filling defect in posterior sagittal sinus (arrow), which most likely represents an incidental arachnoid granulation.

View larger version (110K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Transverse CT images illustrate changes in the clinical diagnosis for a brain CT scan from normal to abnormal. (a) Unenhanced scan obtained in 6-day-old girl reported as normal. (b) Corresponding contrast-enhanced scan demonstrates white matter edema (arrows).

View larger version (46K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Transverse CT images illustrate changes in the clinical diagnosis for a brain CT scan from normal to abnormal. (a) Unenhanced scan obtained in 6-day-old girl reported as normal. (b) Corresponding contrast-enhanced scan demonstrates white matter edema (arrows).

View larger version (99K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: (a) Unenhanced transverse CT scan in 2-month-old girl shows slightly enlarged ventricles and subarachnoid spaces (arrows), which were reported as abnormal. (b) Corresponding contrast-enhanced CT scan shows "filling-in" of these spaces with normal vessels (arrows), a finding that prompted a change in the diagnosis to normal.

View larger version (97K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: (a) Unenhanced transverse CT scan in 2-month-old girl shows slightly enlarged ventricles and subarachnoid spaces (arrows), which were reported as abnormal. (b) Corresponding contrast-enhanced CT scan shows "filling-in" of these spaces with normal vessels (arrows), a finding that prompted a change in the diagnosis to normal.