Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging Associated with the Clearance Dynamics of Gadolinium Chelate: A Potential Diagnostic Pitfall

Abstract

BACKGROUND AND PURPOSE:Hyperintense CSF in the subarachnoid space (SAS) on fluid-attenuated inversion recovery (FLAIR) imaging has been reported in numerous pathologic conditions, including subarachnoid hemorrhage, meningitis, meningeal carcinomatosis, superior sagittal thrombosis, adjacent tumors, status epilepticus, and stroke. It has also been reported in otherwise healthy patients undergoing anesthesia with supplemental oxygen. We present a series of 11 patients with hyperintense CSF signal intensity in the SAS on FLAIR imaging after previous administration of gadolinium chelate.

Differentiation of Leptomeningeal and Vascular Enhancement on Post-contrast FLAIR MRI Sequence: Role in Early Detection of Infectious Meningitis

“…This is responsible for unequivocal visual appreciation of meningeal enhancement on PCFLAIR as observed qualitatively. It was also substantiated that in tubercular meningitis, the average basal enhancement was significantly more than leptomeningeal enhancement as reported previously [3,22].…”

“…Using a lower TE in our study eliminated these shortcomings and shortened the duration of study. Occasionally, the high signal in subarachnoid space is found in different conditions other than meningitis like subarachnoid hemorrhage, stroke, in patients who have received supplemental oxygen, gadolinium or iodinated contrast in the previous week or general anesthesia [15,16,[22][23][24]. Such cases were excluded from our study and can even be ruled out by appropriate clinical evaluation.…”

Flat Detector Angio-CT following Intra-Arterial Therapy of Acute Ischemic Stroke: Identification of Hemorrhage and Distinction from Contrast Accumulation due to Blood-Brain Barrier Disruption

“…8,9,[23][24][25] Such findings, which are believed to result from some degree of BBB disruption or a change in vascular permeability, can mimic SAH, intraventricular hemorrhage, or socalled hyperintense acute reperfusion marker on fluid-attenuated inversion recovery MR imaging [25][26][27] and may cause unnecessary delay in anticoagulant/antiaggregant treatment. After apparently uneventful endovascular coiling of intracranial aneurysms, a sig- True-positive 7 7 2 2 6 6 8 10 True-negative 51 53 58 64 61 57 53 50 False-positive 10 8 8 2 4 8 8 11 False-negative 5 5 5 5 2 2 4 2 Note:-BBBD indicates blood-brain barrier disruption.…”

Neurocritical Care for Patients with Kidney Dysfunction

“…The study of BBB permeability via brain MRI with contrast is relatively contraindicated in patients with CKD due to concerns of nephrogenic systemic fibrosis [98]. Nevertheless, there are a few reports showing leakage of gadolinium into the CSF in patients with CKD after contrast brain MRI [99,100]. Extravasation of contrast from the capillary bed suggests disruption of BBB integrity in these patients.…”