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FLAIR hyperintensity in the subarachnoid space: Main differentials

J Miranda Bautista1, I Garrido Morro1, P Fernández García1

  • 1Servicio de Radiodiagnóstico, HGU Gregorio Marañón, Madrid, Spain.

Radiologia
|February 16, 2024
PubMed

Insights

Fluid-attenuated inversion recovery (FLAIR) MRI sequences can show hyperintensity in the arachnoid space. This finding may indicate disease or be caused by artifacts, potentially leading to diagnostic errors.

Area of Science:

  • Neuroimaging
  • Radiology
  • Medical Diagnostics

Background:

  • Fluid-attenuated inversion recovery (FLAIR) is a crucial brain MRI sequence.
  • FLAIR suppresses cerebrospinal fluid signal, aiding subarachnoid space disease detection.
  • Hyperintensity in the arachnoid space on FLAIR can be pathological or artifactual.

Purpose of the Study:

  • To differentiate between pathological and artifactual causes of arachnoid space hyperintensity on FLAIR MRI.
  • To highlight the potential for diagnostic errors due to non-pathological FLAIR findings.
  • To provide a comprehensive overview of conditions causing FLAIR hyperintensity.

Main Methods:

  • Review of existing literature on FLAIR MRI findings.
  • Analysis of cases presenting with arachnoid space hyperintensity.
  • Categorization of hyperintensity causes into disease-related and artifact-related.

Main Results:

  • Known causes of hyperintensity include tumors, inflammation, vascular disease, and CSF cellularity.
  • Numerous non-pathological conditions, primarily artifacts, also cause hyperintensity.
  • Artifacts represent a significant source of potential misdiagnosis.

Conclusions:

  • Understanding the differential diagnosis of FLAIR hyperintensity is critical.
  • Distinguishing between true pathology and artifacts is essential for accurate brain MRI interpretation.
  • Awareness of artifactual causes can prevent unnecessary patient anxiety and interventions.
Keywords:
Cerebrospinal fluidEspacio subaracnoideoFLAIR sequenceHiperintensidadHyperintensityLíquido cefalorraquídeoMagnetic resonance imagingResonancia magnéticaSecuencia FLAIRSubarachnoid space

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