MRI findings in 32 consecutive lipomas using conventional and advanced sequences

Intracranial lipomas are histologically benign and usually incidental magnetic resonance imaging findings that must be differentiated from ominous lesions. The authors describe 32 lipomas in 30 patients using conventional spin-echo (CSE) T1-weighted images (T1WI), CSE proton density (PDWI), CSE T2-weighted images (T2WI), fast spin-echo (FSE) T2WI, and FSE fluid-attenuated inversion recovery (FLAIR). Lipomas occurred most commonly in the trigonal choroid plexus, cerebral convexity, pericallosal, and quadrigeminal cistern regions. Lipomas were hyperintense on CSE T1WI and of variable appearance on CSE PDWI and CSE T2WI. Lipomas were isointense to hyperintense on FSE T2WI and hyperintense on FLAIR. Chemical shift artifact (CSA) usually was present on either CSE PDWI or CSE T2WI but was not seen on FSE images. One patient had intracranial hypotension associated with a large convexity lipoma. The authors conclude that lipomas appear different on CSE T2WI than on FSE T2WI. CSE PDWI and CSE T2WI are complementary in detecting CSA. The lack of CSA being detected in lipomas on FSE images most likely relates to inherent bandwidth differences compared with those of CSE. The hyperintense appearance of lipomas on FSE FLAIR and FSE T2WI may be confused with subacute hematomas. The authors recommend that if CSE technique by itself is used to exclude lipomas (in centers that are not using FSE), then T1WI, PDWI, and T2WI usually are sufficient. For centers using FSE routinely, fat saturation or CSE sequences also may be needed to exclude lipomas. Finally, the authors' series suggests that intracranial lipomas may occur in lateral locations more frequently than reported previously.