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Published on: August 14, 2019
Contrast-enhanced FLAIR (fluid-attenuated inversion recovery) for evaluating mild traumatic brain injury
Soo Chin Kim1, Sun-Won Park1, Inseon Ryoo2
1Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae medical center, Seoul, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Purpose:
To evaluate whether adding a contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence to routine magnetic resonance imaging (MRI) can detect additional abnormalities in the brains of symptomatic patients with mild traumatic brain injury.
Materials And Methods:
Fifty-four patients with persistent symptoms following mild closed head injury were included in our retrospective study (M ∶ F = 32 ∶ 22, mean age: 59.8 ± 16.4, age range: 26-84 years). All MRI examinations were obtained within 14 days after head trauma (mean: 3.2 ± 4.1 days, range: 0.2-14 days). Two neuroradiologists recorded (1) the presence of traumatic brain lesions on MR images with and without contrast-enhanced FLAIR images and (2) the pattern and location of meningeal enhancement depicted on contrast-enhanced FLAIR images. The number of additional traumatic brain lesions diagnosed with contrast-enhanced FLAIR was recorded. Correlations between meningeal enhancement and clinical findings were also evaluated.
Results:
Traumatic brain lesions were detected on routine image sequences in 25 patients. Three additional cases of brain abnormality were detected with the contrast-enhanced FLAIR images. Meningeal enhancement was identified on contrast-enhanced FLAIR images in 9 cases while the other routine image sequences showed no findings of traumatic brain injury. Overall, the additional contrast-enhanced FLAIR images revealed more extensive abnormalities than routine imaging in 37 cases (p<0.001). In multivariate logistic regression analysis, subdural hematoma and posttraumatic loss of consciousness showed a significant association with meningeal enhancement on contrast-enhanced FLAIR images, with odds ratios 13.068 (95% confidence interval 2.037 to 83.852), and 15.487 (95% confidence interval 2.545 to 94.228), respectively.
Conclusion:
Meningeal enhancement on contrast-enhanced FLAIR images can help detect traumatic brain lesions as well as additional abnormalities not identified on routine unenhanced MRI. Therefore contrast-enhanced FLAIR MR imaging is recommended when a contrast MR study is indicated in a patient with a symptomatic prior closed mild head injury.
Insights
Adding contrast-enhanced FLAIR MRI sequences to routine imaging detects more brain abnormalities in patients with mild traumatic brain injury. This advanced MRI technique aids in identifying subtle lesions and meningeal enhancement, improving diagnostic accuracy for head injuries.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Mild traumatic brain injury (mTBI) can cause persistent symptoms.
- Routine MRI may miss subtle abnormalities in mTBI patients.
- Contrast-enhanced MRI techniques can improve lesion detection.
Purpose of the Study:
- To determine if adding contrast-enhanced FLAIR MRI sequences to routine MRI protocols can detect additional brain abnormalities in symptomatic mTBI patients.
- To evaluate the utility of contrast-enhanced FLAIR in identifying meningeal enhancement post-head injury.
Main Methods:
- Retrospective study of 54 patients with persistent symptoms after mild closed head injury.
- MRI examinations performed within 14 days of trauma.
- Two neuroradiologists reviewed MR images with and without contrast-enhanced FLAIR sequences to identify traumatic brain lesions and meningeal enhancement.
Main Results:
- Routine MRI detected lesions in 25 patients; contrast-enhanced FLAIR identified 3 additional abnormalities.
- Meningeal enhancement was observed in 9 cases solely on contrast-enhanced FLAIR.
- Contrast-enhanced FLAIR revealed more extensive abnormalities in 37 cases compared to routine imaging (p<0.001).
- Subdural hematoma and posttraumatic loss of consciousness were significantly associated with meningeal enhancement.
Conclusions:
- Contrast-enhanced FLAIR MRI is valuable for detecting traumatic brain lesions and additional abnormalities missed by routine unenhanced MRI.
- This advanced imaging technique is recommended for symptomatic patients with prior mild head injuries when contrast MRI is indicated.
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