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Hyperintensity in the Subarachnoid Space on FLAIR MRI

¹ Department of Radiology, Princess Alexandra Hospital, Ipswich Rd., Woolloongabba, Queensland, Australia 4102.
² Department of Radiology, Christchurch Hospital, Christchurch, New Zealand.
³ Department of Radiology, The Wesley Hospital, Auchenflower, Queensland, Australia.
⁴ Department of Radiology, The Alfred Hospital, Prahran, Victoria, Australia.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —41-year-old man 3 days after traumatic subarachnoid hemorrhage. Axial FLAIR MR image shows posttraumatic subarachnoid hemorrhage (arrows) overlying temporal lobes.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —41-year-old man 3 days after traumatic subarachnoid hemorrhage. CT scan corresponding to A shows subarachnoid hemorrhage overlying temporal lobe is more difficult to appreciate owing to beam-hardening artifact (arrows) from adjacent calvarium.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —21-year-old man with meningitis. Axial T1-weighted contrast-enhanced MR image shows prominent leptomeningeal and vascular enhancement over both cerebral hemispheres.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —21-year-old man with meningitis. Unenhanced axial FLAIR MR image corresponding to A shows subtle areas of abnormal hyperintensity (arrows) in subarachnoid space.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —21-year-old man with meningitis. Contrast-enhanced FLAIR MR image shows intense diffuse leptomeningeal enhancement. Some vessels enhanced in A are not enhanced.

View larger version (163K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —29-year-old man with leptomeningeal metastasis of medulloblastoma. Axial contrast-enhanced T1-weighted MR image shows widespread leptomeningeal metastatic lesions (arrows) involving surfaces of cerebellum and cerebral hemispheres.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —29-year-old man with leptomeningeal metastasis of medulloblastoma. Axial FLAIR MR image shows mild subarachnoid hyperintensity and nodularity over cerebellar and cerebral surfaces in keeping with presence of widespread leptomeningeal metastatic lesions (arrows).

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —60-year-old man with non-Hodgkin's lymphoma. Axial contrast-enhanced MR image obtained with FLAIR sequence shows bilateral intense enhancement (arrow) of internal auditory canals and adjacent seventh cranial nerves within temporal bone secondary to lymphomatous infiltration.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —60-year-old man with non-Hodgkin's lymphoma. Contrast-enhanced axial T1-weighted MR image corresponding to A shows less conspicuous meningeal enhancement (arrow) of internal auditory canals.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —34-year-old woman with neurocutaneous melanosis and melanocytic tumor of leptomeninges. (Courtesy of Brazier D, Sydney, Australia) FLAIR MR image shows extensive sulcal hyperintensity.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —34-year-old woman with neurocutaneous melanosis and melanocytic tumor of leptomeninges. (Courtesy of Brazier D, Sydney, Australia) Contrast-enhanced T1-weighted MR image shows extensive conspicuous sulcal hyperintensity and enhancement.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —57-year-old man with old right posterior circulation infarct. Axial T1-weighted MR image shows small focus of hyperintensity (arrow) due to lipoma at right cerebellopontine angle.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —57-year-old man with old right posterior circulation infarct. Axial FLAIR MR image corresponding to A shows lipoma (arrow) at right cerebellopontine angle.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —31-year-old woman with recurrent headache after resection of ruptured dermoid. Preoperative axial T1-weighted MR image shows left parasellar T1-weighted hyperintense dermoid (arrow).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —31-year-old woman with recurrent headache after resection of ruptured dermoid. Axial T1-weighted MR image shows high-signal-intensity fat droplets (arrows) in subarachnoid space in keeping with dermoid rupture.

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —31-year-old woman with recurrent headache after resection of ruptured dermoid. Axial FLAIR MR image shows focal subtle hyperintense fat droplets (arrows) in subarachnoid space.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —57-year-old woman with right cerebral infarct. Axial FLAIR MR image obtained soon after onset of neurologic symptoms shows hyperintensity (arrow) due to thrombotic occlusion or slow flow in right middle cerebral artery.

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —57-year-old woman with right cerebral infarct. Time-of-flight MR angiogram shows occlusion of M1 segment of right middle cerebral artery.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —57-year-old woman with right cerebral infarct. Axial diffusion-weighted MR image shows acute right lenticulostriate infarct (arrow) in perforator territory but no established infarct in rest of right middle cerebral artery territory. Perfusion imaging was not performed. Further ischemia-related diffusion abnormality is evident in left periventricular white matter.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —25-year-old woman with moyamoya disease. Axial FLAIR MR image shows vascular hyperintensity (arrows) in subarachnoid space most likely due to slow or retrograde flow.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —36-year-old intubated man with meningioma undergoing follow-up imaging. Axial FLAIR MR image shows diffuse hyperintensity (arrows) in subarachnoid space thought to be caused by supplemental oxygen.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11 —55-year-old man with left sensorineural hearing loss. Axial FLAIR MR image shows focal increased signal intensity (arrow) due to CSF flow artifact in right aspect of prepontine cistern.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —39-year-old man with right sensorineural hearing loss. Axial FLAIR MR image shows vascular pulsation artifact (arrow) from left transverse sinus that can be mistaken for hyperintensity in subarachnoid space. Phase-encoding direction is anteroposterior, whereas in most FLAIR examinations phase encoding is left to right.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —33-year-old woman with left sensorineural hearing loss. Axial FLAIR MR image shows hyperintensity (arrow) close to subarachnoid space (in phase-encoding direction) due to ghosting artifact from eye movement. Phase-encoding direction is anteroposterior, whereas in most FLAIR examinations phase encoding is left to right.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14A —44-year-old man after resection of cavernous hemangioma. FLAIR MR image shows magnetic susceptibility artifact due to metallic clips (arrow) from craniotomy performed 2 years earlier.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14B —44-year-old man after resection of cavernous hemangioma. FLAIR MR image shows subtle artifactual hyperintensity (arrow) in subarachnoid space overlying superior aspect of right temporal lobe.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 15 —81-year-old woman with delirium. FLAIR MR image shows area of artifactual hyperintensity (arrow) in subarachnoid space due to marked head motion.

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