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Appearance of normal brain maturation on fluid-attenuated inversion-recovery (FLAIR) MR images
1Department of Radiology, Kinki University School of Medicine, Osaka, Japan.
Background And Purpose:
Fluid-attenuated inversion-recovery (FLAIR) MR imaging is widely accepted for brain diagnoses, though to our knowledge no description of the MR FLAIR appearance of the normal infantile brain has been published. The purpose of this study was to investigate the appearance of normal infantile brain maturation on FLAIR MR images.
Methods:
FLAIR images were obtained in 52 children between the ages of 1 day and 4 years who had clinically suspected brain disease but no neurologic abnormality or growth retardation. T1- and T2-weighted images were also obtained in all the children, and these images were compared with the FLAIR sequences for the appearance of brain maturation. A grading system for the differences in signal intensity between gray and white matter on FLAIR images was introduced to make detailed profiles of maturation in each brain region, including the posterior limb of the internal capsule, the cerebellar peduncle, the frontal deep white matter, the occipital deep white matter, and the centrum semiovale. These grades were plotted against patients' ages.
Results:
On the FLAIR images, the myelinated white matter, including the cerebellar peduncle and the posterior limb of the internal capsule, showed high signal intensity relative to gray matter at birth. Thereafter, the white matter lost signal intensity with time and showed low signal intensity at 50 weeks and beyond. The unmyelinated white matter, including the frontal deep white matter, the occipital deep white matter, and the centrum semiovale, showed low signal intensity at birth. The white matter showed high signal intensity at 20 to 30 weeks, and low signal intensity again at 100 to 160 weeks and after.
Conclusion:
The dynamics of brain myelination can be accurately delineated and evaluated on FLAIR images without other spin-echo (SE) sequences. The FLAIR appearance of infantile white matter can be divided into two phases, reflecting development of the myelination process: the first phase is similar to that seen on SE T1-weighted images and the second phase is similar to that seen on SE T2-weighted images.
Insights
This study describes the normal appearance of infantile brain maturation using Fluid-attenuated inversion-recovery (FLAIR) MR imaging. FLAIR imaging effectively shows myelination dynamics in infants, aiding in brain development assessments.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Fluid-attenuated inversion-recovery (FLAIR) MR imaging is crucial for brain diagnoses.
- No prior studies have detailed the MR FLAIR appearance of the normal infantile brain.
Purpose of the Study:
- To investigate and describe the appearance of normal infantile brain maturation on FLAIR MR images.
- To establish a baseline for infantile brain development using FLAIR sequences.
Main Methods:
- FLAIR, T1-, and T2-weighted MR images were acquired in 52 infants (1 day to 4 years).
- A grading system assessed signal intensity differences between gray and white matter in key brain regions.
- Grades were correlated with patient age to profile maturation.
Main Results:
- Myelinated white matter (e.g., cerebellar peduncle) showed high signal intensity at birth, decreasing over time.
- Unmyelinated white matter (e.g., centrum semiovale) showed low signal intensity at birth, increasing then decreasing.
- FLAIR signal intensity patterns reflect myelination stages.
Conclusions:
- FLAIR MR imaging accurately visualizes infantile white matter maturation dynamics.
- FLAIR sequences alone are sufficient for evaluating myelination, without needing other spin-echo sequences.
- Infantile white matter FLAIR appearance exhibits two phases linked to myelination development.