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Updated: Aug 6, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Fluid-attenuated inversion recovery (FLAIR) for assessment of cerebral infarction. Initial clinical experience in 50
M Brant-Zawadzki1, D Atkinson, M Detrick
1Hoag Memorial Hospital, Newport Beach, California 92658-6100, USA.
Background And Purpose:
Our aim was to evaluate fluid-attenuated inversion recovery (FLAIR) sequence in the diagnosis of cerebral infarction with MRI.
Methods:
A retrospective review was undertaken of 50 consecutive MRI studies ordered for suspected cerebrovascular accident. All studies included FLAIR and rapid acquisition with relaxation enhancement (RARE) T2-weighted spin-echo sequences. The two sequences were compared independently by four observers at two different institutions. Detectability of lesions and image quality were scored.
Results:
Overall, FLAIR sequences proved superior in 10 patients, detecting acute cortical infarcts missed with RARE spin-echo technique in five patients. In five additional patients, improved characterization of chronic infarction and improved detection of microangiopathic deep hemispheric changes were observed. One brain stem infarct was missed with the FLAIR sequence.
Conclusions:
FLAIR offers advantages in detection of acute infarcts affecting the cortical ribbon, is a useful, rapid adjunct to conventional T2-weighted spin-echo sequences, and has the potential to replace these in the future.
Insights
Fluid-attenuated inversion recovery (FLAIR) MRI sequences are superior for detecting acute cerebral infarction, especially cortical lesions, compared to traditional T2-weighted spin-echo methods. FLAIR enhances diagnosis and may replace older techniques.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurology
Background:
- Cerebral infarction diagnosis relies on Magnetic Resonance Imaging (MRI).
- Conventional T2-weighted spin-echo sequences are standard for detecting infarcts.
- Evaluating advanced MRI techniques is crucial for improving diagnostic accuracy.
Purpose of the Study:
- To assess the diagnostic efficacy of fluid-attenuated inversion recovery (FLAIR) sequences in identifying cerebral infarction using MRI.
- To compare FLAIR sequence performance against T2-weighted spin-echo sequences.
Main Methods:
- Retrospective analysis of 50 MRI studies for suspected cerebrovascular accident.
- Inclusion of both FLAIR and rapid acquisition with relaxation enhancement (RARE) T2-weighted spin-echo sequences.
- Independent review and scoring of lesion detectability and image quality by four observers at two institutions.
Main Results:
- FLAIR sequences demonstrated superiority in 10 patients.
- Acute cortical infarcts missed by RARE spin-echo were detected by FLAIR in five patients.
- Improved characterization of chronic infarcts and detection of microangiopathic changes were noted; one brainstem infarct was missed by FLAIR.
Conclusions:
- FLAIR sequences offer significant advantages for detecting acute infarcts, particularly those in the cortical ribbon.
- FLAIR serves as a valuable and rapid adjunct to conventional T2-weighted spin-echo sequences.
- FLAIR holds potential to supersede conventional T2-weighted sequences in future clinical practice.
