Relationship between contrast enhancement on fluid-attenuated inversion recovery MR sequences and signal intensity on T2-weighted MR images: Visual evaluation of brain tumors

Purpose: To investigate the relationship between the degree of contrast enhancement in fluid-attenuated inversion recovery (FLAIR) sequences and tumor signal intensity on T2-weighted images. Materials and Methods: A total of 96 patients suspected of having brain tumors were examined by MR imaging, and whenever a brain tumor with an enhancing part larger than the slice thickness was demonstrated on postcontrast T1-weighted images, postcontrast FLAIR images were additionally acquired. The tumor signal intensity on the T2-weighted images was visually classified as follows: equal or lower compared with normal cerebral cortex (group 1), higher than normal cortex (group 2), and as high as cerebrospinal fluid (CSF) (group 3). When a lesion contained several parts with different signal intensities on T2-weighted images, we assessed each part separately. In each group, we visually compared pre- and postcontrast FLAIR images and assessed whether tumor contrast enhancement was present. When contrast enhancement was present on FLAIR sequence, the degree of contrast enhancement in T1-weighted and FLAIR sequences was visually compared. Results: Postcontrast T1-weighted images showed 46 enhancing lesions, including 48 parts, in 31 MR examinations. FLAIR images of the lesion-parts in group 1 (N = 18) did not show significant contrast enhancement. In group 2 (N = 12), all the parts were enhanced in FLAIR sequences, and three parts were enhanced more clearly in the FLAIR sequences than in the T1-weighted sequences. In group 3 (N = 18), all the parts were enhanced equally or more clearly in the FLAIR sequences than in the T1-weighted sequences. Conclusion: The signal intensity in FLAIR sequences is largely influenced by both T1 and T2 relaxation time; there is a close relationship between the signal intensity of brain tumors on T2-weighted images and the degree of contrast enhancement on FLAIR sequences. When tumors have higher signal intensity than normal cortex on T2-weighted images, additional postcontrast FLAIR imaging may improve their depiction.