title: 3D fluid-attenuated inversion recovery imaging: reduced CSF artifacts and enhanced sensitivity and specificity for subarachnoid hemorrhage.
abstract: OBJECTIVE
  FLAIR images are highly sensitive for SAH. However, CSF flow artifacts caused by conventional FLAIR can produce false-positive results. Here, we compare 3D and 3D FLAIR sequences, focusing on their potential for containing these artifacts and their sensitivity and specificity for detection of SAHs.
  
  
  METHODS
  We evaluated the following 4 FLAIR sequences: 1) 2D FLAIR at 1.5T, 2) 2D FLAIR, 3) 2D PROPELLER-FLAIR, and 4) 3D Cube-FLAIR at 3T. All sequences were performed in 5 healthy volunteers; sequences 2 and 4 were also performed under routine conditions in 10 patients with focal epilepsy and in 10 patients with SAH. Two neuroradiologists independently conducted the analysis. The presence of flow artifacts in the ventricles and cisterns of healthy volunteers and patients with epilepsy was evaluated and scored on a 4-point scale. Mean values were calculated and compared by using paired t tests. Sensitivity and specificity for SAH detection in sequences 2 and 4 were determined.
  
  
  RESULTS
  Cube-FLAIR showed almost no CSF artifacts in the volunteers and the patients with epilepsy; therefore, it was superior to any other FLAIR (P < .001). Sensitivity and specificity of SAH detection by 3T FLAIR were 58.3% and 89.4%, respectively, whereas Cube-FLAIR had a sensitivity of 95% and a specificity of 100%.
  
  
  CONCLUSIONS
  Cube-FLAIR allows FLAIR imaging with almost no CSF artifacts and is, thus, particularly useful for SAH detection.
authors.affiliation: Department of Neuroradiology, University of Munich, Munich, Germany. nina.lummel@med.uni-muenchen.de
authors.forename: N
authors.initials: N
authors.lastname: Lummel
authors.forename: V
authors.initials: V
authors.lastname: Schoepf
authors.forename: M
authors.initials: M
authors.lastname: Burke
authors.forename: H
authors.initials: H
authors.lastname: Brueckmann
authors.forename: J
authors.initials: J
authors.lastname: Linn
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016477:Artifacts; D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid / Q000166:cytology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000473:pathology*; D013382:Subtraction Technique; D055815:Young Adult