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Serial FLAIR imaging after Gd-DTPA contrast: pitfalls in stroke trial magnetic resonance imaging

Helmut Rumpel1, Ling Ling Chan

  • 1Department of Diagnostic Radiology, Singapore General Hospital, Outram Rd, Singapore 169608. helmut.rumpel@pacific.net.sg

Stroke
|March 8, 2003
PubMed
Abstract

Insights

Fluid-attenuated inversion-recovery (FLAIR) MRI in acute stroke trials can be affected by gadolinium (Gd-DTPA) contrast. Chronic infarcts may appear hyperintense on second FLAIR scans due to T1 effects.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Standard stroke trial MRI protocols often use two sequential fluid-attenuated inversion-recovery (FLAIR) sequences.
  • The first FLAIR scan is acquired before gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast administration, and the second is performed during the contrast clearance phase.

Observation:

  • A case involving a 68-year-old male with both acute and chronic infarcts is presented.
  • The chronic infarct showed a notable change from hypointense to hyperintense on the second FLAIR image.
  • This hyperintensity mimicked acute-on-chronic infarction or hemorrhage.

Findings:

  • The observed hyperintensity in the chronic infarct on the second FLAIR scan was not due to acute infarction or hemorrhage, as confirmed by diffusion-weighted imaging (DWI) and computed tomography (CT).
  • This phenomenon suggests that T1 effects from Gd-DTPA can influence image contrast in chronic infarcts within acute stroke trial imaging protocols.

Implications:

  • Findings highlight the potential for Gd-DTPA T1 effects to cause misleading hyperintensities in chronic infarcts on serial FLAIR MRI.
  • This necessitates careful interpretation of FLAIR images in stroke trials, especially when evaluating chronic lesions alongside acute findings.
  • Consideration of contrast agent properties is crucial for accurate stroke diagnosis and trial data analysis.

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