Role of contrast-enhanced FLAIR MRI in diagnosis of intracranial lesions

Background MR imaging plays a significant role in detection and characterization of different brain diseases. The role of the post-contrast T1-weighted image magnetic resonance imaging (T1W MRI) sequence has been widely established in previous studies and clinical practice. In this study, we aim to share our experience as regards the added value of contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) sequence in the diagnosis of various intracranial pathological conditions and evaluate its usefulness in comparison with post-contrast T1W images. Results Based on the final radiological diagnosis, the total cases were subdivided into three categories, and the majority of our cases were tumors (81.2%), followed by multiple sclerosis (11.8%), and the least was central nervous system infection (7.1%). CE-FLAIR showed superior enhancement in 35 cases (50.7) and equal enhancement in 25 cases (36.3%). However, it showed less enhancement than post-contrast T1W images in 9 cases (13%). Excellent inter-observer agreement (97.65%) was noted. Regarding lesion conspicuity, good delineation was found in the majority of cases (64.7%), fair delineation in 12.9%, and no delineation in 22.4%. A statistically significant difference was found in signal intensity of lesion between pre- and post-contrast FLAIR sequences. Contrast to background ratio was statistically significant in CE FLAIR images in comparison to CE T1 images. Conclusion CE-FLAIR imaging should be used as a routine or adjunctive sequence to CE-T1WI to enhance early detection and increase the diagnostic confidence in MRI examination of different brain pathological conditions.