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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:553-559, March 2005
© 2005 American Society of Neuroradiology

BRAIN

Intracranial Meningeal Disease: Comparison of Contrast-Enhanced MR Imaging with Fluid-Attenuated Inversion Recovery and Fat-Suppressed T1-Weighted Sequences

Waneerat Galassi^a, Warinthorn Phuttharak^a, John R. Hesselink^a, John F. Healy^a, Rosalind B. Dietrich^a and Steven G. Imbesi^a

^a From the Department of Radiology, University of California, San Diego, Medical Center, San Diego, California

Address correspondence to John R. Hesselink, MD, Department of Radiology, UCSD Medical Center, 200 West Arbor Drive, Mail Code #8756, San Diego, CA 92103-8756

BACKGROUND AND PURPOSE: Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) imaging has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MR imaging. The purpose of this study was to compare contrast-enhanced T1-weighted MR images with fat suppression to contrast-enhanced FLAIR images to determine which sequence was superior for depicting meningeal disease.

METHODS: We reviewed MR images of 24 patients (35 studies) with a variety of meningeal diseases. The MR imaging protocol included contrast-enhanced T1-weighted MR images with fat suppression (FS) and contrast-enhanced fluid-attenuated inversion recovery (FLAIR) images that were reviewed by three neuroradiologists and were assigned a rating of positive, equivocal, or negative for abnormal meningeal enhancement. The two sequences were compared side by side to determine which better depicted meningeal disease.

RESULTS: Abnormal meningeal enhancement was positive in 35 contrast-enhanced T1-weighted MR images with FS and in 33 contrast-enhanced FLAIR studies. In the first group, which had the T1-weighted sequence acquired first (21 of 33 studies), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in 11 studies (52%), inferior contrast enhancement in six studies (29%), and equal contrast enhancement in four studies (19%) compared with the contrast-enhanced FLAIR images. In the second group, which had the FLAIR sequence acquired first (12 of 33), contrast-enhanced T1-weighted images with FS showed superior contrast enhancement in seven studies (58%), inferior contrast enhancement in two studies (17%), and equal contrast enhancement in three studies (25%).

CONCLUSION: Contrast-enhanced T1-weighted MR imaging with FS is superior to contrast-enhanced FLAIR imaging in most cases for depicting intracranial meningeal diseases.