title: Contrast-enhanced FLAIR (fluid-attenuated inversion recovery) for evaluating mild traumatic brain injury.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae medical center, Seoul, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Soo Chin
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae medical center, Seoul, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sun-Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Inseon
authors.initials: I
authors.lastname: Ryoo
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Asan Medical Center, Seoul, Korea.
authors.forename: Seung Chai
authors.initials: SC
authors.lastname: Jung
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Yun
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji-hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chul-Ho
authors.initials: CH
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008578:Meninges / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media