CSF enhancement on post-contrast fluid-attenuated inversion recovery images; a systematic review
Whitney M. FreezeMerel M. van der ThielJeroen de BresserCatharina J.M. KlijnEllis S. van EttenJacobus F.A. JansenLouise van der WeerdHeidi I.L. JacobsWalter H. BackesSusanne J. van Veluw
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Abstract:
Cerebrospinal fluid (CSF) enhancement on T2-weighted post-contrast fluid-attenuated inversion recovery (pcT2wFLAIR) images is a relatively unknown neuroradiological marker for gadolinium-based contrast agent extravasation due to blood–brain barrier (BBB) disruption. We systematically reviewed human studies reporting on CSF enhancement on pcT2wFLAIR images to provide a comprehensive overview of prevalence of this new biomarker in healthy and diseased populations as well as its etiology and optimal detection methodology. We extracted information on the prevalence of CSF enhancement, its vascular risk factor and neuroimaging correlates, and methodological attributes of each study. Forty-four eligible studies were identified. By pooling data, we found that the prevalence of CSF enhancement was 82% (95% confidence interval (CI) 80–89) in meningitis (4 studies, 65 patients), 73% (95%CI 62–81) in cases with (post-) acute intracerebral hemorrhage (2 studies, 77 cases), 64% (95% CI 54–73) in cases who underwent surgery for aneurysm treatment (2 studies, 99 patients), 40% (95% CI 30–51) in cases who underwent surgery for carotid artery disease treatment (3 studies, 76 patients), 27% (95% CI 25–30) in cases with acute ischemic stroke (9 studies, 1148 patients), 21% (95% CI 17–23) in multiple sclerosis (6 studies, 897 patients), and 13% (95% CI 7–21) in adult controls (4 studies, 112 cases). Presence of CSF enhancement was associated with higher age in eleven studies, with lobar cerebral microbleeds in one study, and with cerebral atrophy in four studies. PcT2wFLAIR imaging represents a promising method that can provide novel perspectives on BBB leakage into CSF compartments, with the potential to reveal important new insights into the pathophysiological mechanisms of varying neurological diseases.Keywords:
Fluid-attenuated inversion recovery
Etiology
Objective:To evaluate the clinical application of FLAIR sequences in low field MRI of the brain.Methods:247 patients with brain diseases were studied with MR FSE-T 2WI and FLAIR technique.The detectable abilities of lesions with FLAIR and FSE-T 2WI were compared.Results:516 lesions were identified with MRI in 247 patients. The FLAIR imaging showed 508 lesions(98.44%), but the FSE-T 2WI only showed 436 lesions (84.50%).The difference is statistically significant (P0.01).280 lesions were clear with FLAIR in demonstrating the intrinsic structure and border of lesions, and 120 ones with FSE-T 2WI. Therefore, the FLAIR imagings were superior to FSE-T 2WI in demonstrating the intrinsic structure and border of lesions (P0.01).Conclusion:In low field MR of the brain, FLAIR was superior to conventional FSE-T 2 weighted sequence for patients with brain diseases. It is useful to improve the detection of the lesions and demonstrate the intrinsic structure and border of lesions clearly. FLAIR can be used as a conventional sequence of the examination in MRI of the brain.
Fluid-attenuated inversion recovery
T2 weighted
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Objective: To evaluate the application of fluid-attenuated inversion-recovery (FLAIR) sequence to cerebral infarction in low field MR. Methods:75 cases with cerebral infarction were examined with MR FSE-T 2WI and FLAIR techniques.The detectable abilities of focus with FLAIR and FSE-T 2WI were compared.Results: 302 infarction foci were identified with MRI in 75 patients. FLAIR detected more foci than FSE (300 versus 242), its sensitivity was greater than FSE (99.34% versus 88.13%, P0.01).FLAIR was better than FSE for cortical, subcortical and periventrical foci both in sensitivity and in focus conspicuity. FLAIR displayed the foci of acute and subacute cerebral infarctions more clearly.Chronic infarctions demonstrated hypointensive center with hyperintensive rim or hypointensive plaque in FLAIR images.Conclusion:FLAIR sequence was superior to conventional FSE sequences to detect cortical, subcortical and periventrical cerebral infarctions;and also helpful to differentiate the acute infartions from chronic ones.FLAIR should become a conventional sequence in the diagnosis of cerebral infarction.
Fluid-attenuated inversion recovery
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Objective To evaluate the application of flow attenuated inversion recovery( FLAIR)sequence in cerebral disease.Methods 63 cases with varied brain disease were studied with FLAIR sequence and FSE MR imaging. The images of these sequences in the detection of cerebral diseases were analysed and compared.Results There were 106 lesions on T 2 -weighted images while 147 lesions were detected on FLAIR images (including 41 lesions only could be seen on FLAIR images).The inter-structure and border of 95 lesions on FLAIR images were showed better than on T 2 -weighted images.Conclusion FLAIR is superior to T 2 -weighted image for detecting the border extent and inter-structure of cerebral lesions.
Fluid-attenuated inversion recovery
Brain disease
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Background The diagnostic value of a contrast‐enhanced T2‐weighted FLAIR sequence (ce FLAIR ) in brain imaging is unclear. Hypothesis/Objectives That the number of brain lesions detected with ce FLAIR would be no greater than the sum of lesions detected with n FLAIR and ceT1W sequence. Animals One hundred and twenty‐nine animals (108 dogs and 21 cats) undergoing magnetic resonance imaging ( MRI ) of the head between July 2010 and October 2011 were included in the study. Methods A transverse ce FLAIR was added to a standard brain MRI protocol. Presence and number of lesions were determined based on all available MRI sequences by 3 examiners in consensus and lesion visibility was evaluated for n FLAIR , ce FLAIR , and ceT1W sequences. Results Eighty‐three lesions (58 intra‐axial and 25 extra‐axial) were identified in 51 patients. Five lesions were detected with n FLAIR alone, 2 with ceT1W alone, and 1 with ce FLAIR alone. Significantly higher numbers of lesions were detected using ce FLAIR than n FLAIR (76 versus 67 lesions; P = 0.04), in particular for lesions also detected with ceT1W images (53 versus 40; P =.01). There was no significant difference between the number of lesions detected with combined n FLAIR and ceT1W sequences compared to those detected with ce FLAIR (82 versus 76; P =.25). Conclusion and Clinical Importance Use of ce FLAIR as a complementary sequence to n FLAIR and ceT1W sequences did not improve the detection of brain lesions and cannot be recommended as part of a routine brain MRI protocol in dogs and cats with suspected brain lesions.
Fluid-attenuated inversion recovery
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Objective: To evaluate the value of fluid-attenuated inversion-recovery(FLAIR) sequences in cerebral tumor with low field strength MRI.Methods: 50 patients with cerebral tumor were studied with MR FSE-T2WI and FLAIR technique.The detectable abilities of lesions with FLAIR and FSE-T2WI were compared.Results: The FLAIR image showed 64 lesions(100%),but the FSE-T2WI only showed 56 lesions(87.5%).46 lesions(71.88%)were clear with FLAIR in demonstrating the intrinsic structure and border of lesions,and 27 ones(42.19%)with FSE-T2WI.Therefore,the FLAIR images were superior to FSE-T2WI in demonstrating the intrinsic structure and border of lesions(P0.01).Conclusion: In low field MR of the brain,FLAIR sequence was helpful to differentiate the tumor from edema,visualize the intrinsic structure of lesions.Therefore,FLAIR should become a conventional sequence in the diagnosis of cerebral tumor.
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Fluid-attenuated inversion recovery (FLAIR) images are magnetic resonance (MR) images obtained with an inversion recovery sequence having a long inversion time (T 1) and a long echo time (TE). The purpose of this study was to evaluate the utility of FLAIR images in brain check-up. 320 healthy adults (229 males, 91 females) were examined with FLAIR sequences of several types having repetitive time (TR) of 7000 msec, inversion times of 1700 msec and echo times (TE) of 110 msec. All studies were performed on a SHIMAZU MAGNEX 100 HP 1.0 T imaging system. FLAIR images were useful in detecting cortical and subcortical lesions near the brain surface, which were unclear in the conventional T 2 weighted images. FLAIR images were useful in evaluation of periventricular hyperintensity area (PVH). Frequency and degree of PVH were increased in aging. FLAIR images were useful in the differential diagnosis of lacuna and perivascular space. In conclusion, FLAIR images were very sensitive for the detection of brain lesions in brain check-up.
Fluid-attenuated inversion recovery
Echo time
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Objective: We performed fluid attenuated inversion recovery(FLAIR)and turboSE pulse sequences brain MRI to evaluate their characteristics and clinical application. Materials and Methods: 65 Patients with brain diseases were examined with both FLAIR(TR/TI/TE: 9000/2500/110ms) and turbeSE (T1W: 650/14ms; T2W: 5217/110ms) sequences. The signal of CSF in FLAIR images is lower than that of parenchyma with Parameter 9000/2500/100. Results: FLAIR detected more lesions in total than turboSE(1306 versus 1164). Its sensitivity is greater than turboSE(98% versus 88% . P＜0. 05). FLAIR is better than turboSE for subeortical/cortical, cerebral hemisphere and periventricular lesions both in sensitivity and in lesion conspicuousness. But for lesions at basal ganglia and posterior fossa, turboSE is more sensitive than FLAIR. Conclusion: FLAIR sequence shows its advantages. But for certain areas, it is less sensitive than turboSE. We consider that FLAIR should be a complementing modality to turboSE in brain MRI.
Fluid-attenuated inversion recovery
Posterior fossa
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Satisfactory magnetic resonance imaging (MRI) of those patients with involuntary head motion due to brain diseases is essential in avoiding missed diagnosis and guiding treatment.To investigate the clinical feasibility of artificial intelligence-assisted compressed sensing single-shot fluid-attenuated inversion recovery (ACS-SS-FLAIR) in evaluating patients with involuntary head motion due to brain diseases, compared with the conventional T2-FLAIR with parallel imaging (PI-FLAIR).A total of 33 uncooperative patients with brain disease were prospectively enrolled. Two readers independently reviewed images acquired with ACS-SS-FLAIR and PI-FLAIR at a 3.0-T MR scanner. In the aspects of qualitative evaluation of image quality, overall image quality and lesion conspicuity of ACS-SS-FLAIR and PI-FLAIR were assessed and then statistically compared by paired Wilcoxon rank-sum test. For quantitative evaluation, the relative contrast of lesion-to-cerebral parenchyma were calculated and compared.Overall image quality scores of ACS-SS-FLAIR evaluated by two readers were 2.94 ± 0.24 and 2.91 ± 0.29, respectively, both of which were significantly higher than that of PI-FLAIR, respectively (P < 0.001 and <0.001). Lesion conspicuity scores of were 2.74 ± 0.47 and 2.79 ± 0.44, both of which were significantly higher than that of PI-FLAIR, respectively (P < 0.001 and <0.001). In the quantitative evaluation for image quality, the relative contrast of lesion-to-cerebral parenchyma was 0.34 ± 0.09 in the ACS-SS-FLAIR sequence, significantly larger than that in the PI-FLAIR sequence (P = 0.001).The ACS-SS-FLAIR sequence is clinically feasible in the MRI workup of those patients with involuntary head motion due to brain diseases, showing shorter image acquisition time and better image quality compared with conventional PI-FLAIR.
Fluid-attenuated inversion recovery
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Early diagnosis of infectious meningitis is essential due to high morbidity and mortality of this disease. Contrast enhanced (CE) magnetic resonance imaging (MRI) has been increasingly used as a non-invasive diagnostic tool and it is also recommended as a first line diagnostic examination in brain infections. Leptomeningeal disease can be more easily visualized on CE fluid-attenuated inversion recovery (FLAIR) images than on CE T1-weighted images because FLAIR imaging allows a clearer distinction between enhancing meninges and enhancing cortical veins, resulting the latter hypointense on CE-FLAIR images. CE-FLAIR sequence should be included as a routine sequence in suspected cases of meningitis.
Fluid-attenuated inversion recovery
Meninges
Brain disease
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Purpose: Fluid-attenuated inversion recovery images (FLAIR) are highly sensitive for subarachnoid hemorrhages (SAH). Yet, cerebrospinal fluid (CSF) flow artifacts on conventional FLAIR result in false positive results. Here, we compared two-dimensional (2D) and three-dimensional (3D) FLAIR-sequences concerning their proneness to these artifacts, and their sensitivity and specificity for SAHs.
Fluid-attenuated inversion recovery
Subarachnoid space
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