Pitfalls in Neuroimaging of Headache: A Case Report and Review of the Literature

Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.

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The contrast-enhanced CT scan in the diagnosis of isodense subdural hematoma

Journal of Neurosurgery ◽

10.3171/jns.1979.50.1.0064 ◽

1979 ◽

Vol 50 (1) ◽

pp. 64-69 ◽

Cited By ~ 22

Author(s):

Fong Y. Tsai ◽

James E. Huprich ◽

Hervey D. Segall ◽

James S. Teal

Keyword(s):

Cerebral Cortex ◽

Ct Scan ◽

Subdural Hematoma ◽

Correct Diagnosis ◽

Content Type ◽

Subdural Hematomas ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Fine Print

✓ The authors review 29 cases of surgically-proven isodense subdural hematomas examined by non-contrast and contrast-enhanced computerized tomography scans. Three types of isodense collections were noted: homogeneous isodense collections, mixed-density collections, and gravitational layering within subdural collections. Contrast enhancement within the cerebral cortex, cortical vessels, and subdural membranes led to the correct diagnosis in each case. Contrast-enhanced scans are essential for the evaluation of isodense subdural hematomas.

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Abdominal case of the day. Focal liver enhancement on contrast-enhanced CT scan caused by obstruction of the superior vena cava (SVC).

American Journal of Roentgenology ◽

10.2214/ajr.169.1.9207535 ◽

1997 ◽

Vol 169 (1) ◽

pp. 250-250 ◽

Cited By ~ 2

Author(s):

T E Herbener ◽

V Basile ◽

D Nakamoto ◽

H E Butler ◽

S P Pickering

Keyword(s):

Ct Scan ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

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Is CT Angiogram of the Abdominal Vessels Needed following the Diagnosis of Ischemic Colitis? A Multicenter Community Study

ISRN Gastroenterology ◽

10.1155/2014/756926 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Muhammed Sherid ◽

Salih Samo ◽

Samian Sulaiman ◽

Husein Husein ◽

Sankara N. Sethuraman ◽

...

Keyword(s):

Ct Scan ◽

Ischemic Colitis ◽

Celiac Trunk ◽

Ct Angiogram ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Group 3 ◽

Group 5 ◽

Atherosclerotic Changes

Background. CT angiogram is frequently obtained after diagnosis of ischemic colitis (IC). Aims. To investigate the vascular findings of CT angiogram as compared to contrast-enhanced CT scan and whether this modality changes the management or prognosis of IC. Methods. We conducted a retrospective analysis of patients with IC from 2007 to 2013. Results. CT angiogram was performed in 34 patients (28.81%), whereas contrast-enhanced CT scan was performed in 54 patients (45.76%). In CT angiogram group, 8 patients (23.5%) had atherosclerotic changes. Stenosis was found in 12 patients (35.3%) (9: celiac trunk, 3: SMA). Among this group, one patient underwent colectomy and another underwent angioplasty of the celiac trunk who died within 30 days. Among contrast-enhanced CT scan group, 5 patients (9.3%) had atherosclerotic changes. Stenosis was found in 5 patients (9.3%) (3: celiac trunk, 1: SMA, and 1: IMA). Among this group, 3 patients had colectomy and one died within 30 days. There was no statistical difference between both groups in all vascular findings except the stenosis which was higher in CT angiogram group (P=0.0025). Neither the need for surgery nor all-cause mortality was different between both groups. Conclusion. CT angiogram did not provide any useful findings that altered the management or the prognosis of IC.

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Contrast enhanced CT scan 1-year after admission. The bifurcated surgical graft of the abdominal aorta with visceral sidegrafts is seen

ASVIDE ◽

10.21037/asvide.2018.292 ◽

2018 ◽

Vol 5 ◽

pp. 292-292

Author(s):

Paul Schoenhagen

Keyword(s):

Ct Scan ◽

Abdominal Aorta ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

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Delayed response to proton beam treatment of hepatocellular carcinoma

BJR|case reports ◽

10.1259/bjrcr.20180125 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20180125

Author(s):

Chee-Wai Cheng ◽

Mitchell Machtay ◽

Jennifer Dorth ◽

Olga Sergeeva ◽

Hangsheng Xia ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Ct Scan ◽

Proton Beam ◽

Arterial Phase ◽

Delayed Response ◽

Data Set ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Imaging Response

Hepatocellular carcinoma (HCC) has become one of the leading causes of cancer death worldwide. There has been anecdotal report regarding the effectiveness of proton beam treatment for HCC. In this pre-clinical investigation, the woodchuck model of viral hepatitis infection-induced HCC was used for proton beam treatment experiment. The radiopaque fiducial markers that are biodegradable were injected around the tumor under ultrasound guidance to facilitate positioning in sequential treatments. An α cradle mode was used to ensure reproducibility of animal positioning on the treatment couch. A CT scan was performed first for contouring by a radiation oncologist. The CT data set with contours was then exported for dose planning. Three fractionations, each 750 CcGyE, were applied every other day with a Mevion S250 passive scattering proton therapy system. Multiphase contrast-enhanced CT scans were performed after the treatment and at later times for follow-ups. 3 weeks post-treatment, shrinking of the HCC nodule was detected and constituted to a partial response (30% reduction along the long axis). By week nine after treatment, the nodule disappeared during the arterial phase of multiphase contrast-enhanced CT scan. Pathological evaluation corroborated with this imaging response. A delayed, but complete imaging response to proton beam treatment applied to HCC was achieved with this unique and clinically relevant animal model of HCC.

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