Sensitivity and Specificity of Non-Enhanced CT-Brain: A Single-Centre Cross-Sectional Study
DOI:
https://doi.org/10.31674/mjmr.2023.v07i04.001Abstract
Aim: This study aims to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of non-enhanced CT (NECT) brain and contrast-enhanced computed tomography (CECT) as the reference standard in diagnosing brain abnormalities and to assess changes in diagnosis (if any) after reviewing the contrast-enhanced study. Methods: This is a descriptive retrospective cross-sectional study done by reviewing CT-scans performed at Universiti Kebangsaan Malaysia Medical Centre from January to December 2015. NECT and its corresponding CECT brain scans were evaluated by a radiologist and a radiology resident independently on separate occasions. The final diagnosis was categorized as normal and abnormal. The sensitivity, specificity, PPV and NPV of NECT compared to CECT were calculated. Results: NECT and CECT brain scans obtained in 158 patients for indications other than trauma were reviewed. 50.63% (n=80) and 49.37% (n=78) of them are male and female respectively. Both paediatric and adult patients were included in this study, with a mean age of 49.33 (range=6 months to 92 years old). The sensitivity, specificity, PPV and NPV of NECT brain were found to be 95 %, 100 %, 100% and 86.7 % respectively. Conclusion: NECT brain demonstrated high sensitivity, specificity and PPV. 6 out of 158 (3.8%) NECT brain failed to identify brain abnormality which were then seen on CECT. CECT following normal NECT should be limited to patient who i) has positive neurological sign after exclusion of stroke, ii) is a known case of primary tumor, iii) has inflammatory/infective disease i.e tuberculosis.
Keywords:
CT Brain , Normal and Abnormal CT Brain, Non-Enhanced CT Brain, Contrasted CT BrainDownloads
References
Bernard, M. S., Hourihan, M. D., & Adams, H. (1991). Computed tomography of the brain: Does contrast enhancement really help? Clinical Radiology, 44(3), 161-164. https://doi.org/10.1016/S0009-9260(05)80860-8
Branson, H. M., Doria, A. S., Moineddin, R., & Shroff, M. M. (2007). The brain in children: is contrast enhancement really needed after obtaining normal unenhanced CT results? Radiology, 244(3), 838-844. https://doi.org/10.1148/radiol.2443051785
Cabral, D. A., Flodmark, O., Farrell, K., & Speert, D. P. (1987). Prospective study of computed tomography in acute bacterial meningitis. The Journal of Pediatrics, 111(2), 201-205. https://doi.org/10.1016/S0022-3476(87)80067-7
Cartwright, K., Reilly, S., White, D., & Stuart, J. (1992). Early treatment with parenteral penicillin in meningococcal disease. British Medical Journal, 305(6846), 143-147. https://doi.org/10.1136/bmj.305.6846.143
Chishti, F. A., Al Saeed, O. M., Al-Khawari, H., & Shaikh, M. (2003). Contrast-enhanced cranial computed tomography in magnetic resonance imaging era. Medical Principles and Practice, 12(4), 248-251. https://doi.org/10.1159/000072292
Demaerel, P., Buelens, C., Wilms, G., & Baert, A. L. (1998). Cranial CT revisited: do we really need contrast enhancement? European Radiology, 8, 1447-1451. https://doi.org/10.1007/s003300050572
European Society of Radiology (2004) Risk management in radiology in Europe IV. Available from: https://www.myesr.org/sites/default/files/ESR_brochure_04_2.pdf [Accessed 20 March 2023].
Greenberg, H., Chandler, W.F., Sandler, H.M. (1999) Brain tumors. Oxford University Press, USA. ISBN:019512958X.
Huckman, M. S. (1975). Clinical experience with the intravenous infusion of iodinated contrast material as an adjunct to computed tomography. Surgical Neurology, 4(3), 297-318. PMID: 170696
Ibrahim, R., Samian, S. D., Mazli, M. Z., Amrizal, M. N., & Aljunid, S. M. (2012). Cost of magnetic resonance imaging (MRI) and computed tomography (CT) scan in UKMMC. BMC Health Services Research, 12(1), 1-2. https://doi.org/10.1186/1472-6963-12-S1-P11
Kocak, M. (2022) Computed Tomography (CT). MSD Manual Professional Edition. Available from: https://www.msdmanuals.com/professional/special-subjects/principles-of-radiologic-imaging/computed-tomography [Accessed 20 Feb 2023]
Minné, C., Kisansa, M. E., Ebrahim, N., Suleman, F. E., & Makhanya, N. Z. (2014). The prevalence of undiagnosed abnormalities on non-contrast-enhanced computed tomography compared to contrast-enhanced computed tomography of the brain. SA Journal of Radiology, 18(1), 1-7. http://dx.doi.org/10.4102/sajr.v18i1.598
Nagra, I., Wee, B., Short, J., & Banerjee, A. K. (2011). The role of cranial CT in the investigation of meningitis. JRSM Short Reports, 2(3), 1-9. https://doi.org/10.1258/shorts.2011.010113
Namasivayam, S., Kalra, M. K., Torres, W. E., & Small, W. C. (2006). Adverse reactions to intravenous iodinated contrast media: an update. Current Problems in Diagnostic Radiology, 35(4), 164-169. https://doi.org/10.1067/j.cpradiol.2006.04.001
Pearce, M. S., Salotti, J. A., Little, M. P., McHugh, K., Lee, C., Kim, K. P., & de González, A. B. (2012). CT scans in childhood and risk of leukaemia and brain tumours–Authors' reply. The Lancet, 380(9855), 1736-1737. https://doi.org/10.1016/S0140-6736(12)60815-0
Rawson, J. V., & Pelletier, A. L. (2013). When to order contrast-enhanced CT. American Family Physician, 88(5), 312-316.
Royal College of Radiologists (1995). Risk Management in Clinical Radiology. London: Royal College of Radiologists.
Shah, N. B., & Platt, S. L. (2008). ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children. Current Opinion in Pediatrics, 20(3), 243-247. https://doi.org/10.1097/MOP.0b013e3282ffafd2
Strang, J. R., & Pugh, E. J. (1992). Meningococcal infections: reducing the case fatality rate by giving penicillin before admission to hospital. British Medical Journal, 305(6846), 141-143. https://doi.org/10.1136/bmj.305.6846.141
Talan, D. A., Guterman, J. J., Overturf, G. D., Singer, C., Hoffman, J. R., & Lambert, B. (1989). Analysis of emergency department management of suspected bacterial meningitis. Annals of Emergency Medicine, 18(8), 856-862. https://doi.org/10.1016/S0196-0644(89)80213-6
Wood, L. P., Parisi, M., & Finch, I. J. (1990). Value of contrast enhanced CT scanning in the non-trauma emergency room patient. Neuroradiology, 32(4), 261-264. https://doi.org/10.1007/BF00593043
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Malaysian Journal of Medical Research (MJMR)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
