Serial FLAIR imaging after Gd-DTPA contrast: pitfalls in stroke trial magnetic resonance imaging.
BACKGROUND
Most MRI protocols for stroke trials comprise 2 successive fluid-attenuated inversion-recovery (FLAIR) imaging acquisitions in which the first scan is done pre-Gd-DTPA contrast while the second is within the contrast clearance window.


METHODS
A 68-year-old male was diagnosed as having hyperacute right middle cerebral artery infarct and a subacute chronic small left occipital cortical infarct. The latter turned from hypointense to strikingly hyperintense on the second FLAIR image, resembling the picture of an acute-on-chronic infarction or hemorrhage. However, the second DWI and CT refuted either of these.


CONCLUSIONS
Image contrast using FLAIR in acute stroke trial imaging may also be affected by T1 effects of Gd-DTPA in chronic infarcts.
Rumpel
Helmut
H
Department of Diagnostic Radiology, Singapore General Hospital, Outram Rd, Singapore 169608. helmut.rumpel@pacific.net.sg
Chan
Ling Ling
LL
D000208:Acute Disease; D000368:Aged; D016477:Artifacts; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D019786:Gadolinium DTPA / Q000493:pharmacokinetics*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008657:Metabolic Clearance Rate; D020521:Stroke / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D019786:Gadolinium DTPA