Published Online
on February 6, 2003

A more recent version of this article appeared on March 1, 2003

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Submitted on September 11, 2002
Accepted on September 19, 2002

Serial FLAIR Imaging After Gd-DTPA Contrast. Pitfalls in Stroke Trial Magnetic Resonance Imaging

Helmut Rumpel PhD^* and Ling Ling Chan MD

From the Department of Diagnostic Radiology, Singapore General Hospital, Singapore.

^* To whom correspondence should be addressed. E-mail: helmut.rumpel{at}pacific.net.sg.

Background--Most MRI protocols for stroke trials comprise 2 successive fluid-attenuated inversion-recovery (FLAIR) imaging acquisitions in which the first scan is done pre-Gd-DTPA contrast while the second is within the contrast clearance window.

Summary of Report--A 68-year-old male was diagnosed as having hyperacute right middle cerebral artery infarct and a subacute chronic small left occipital cortical infarct. The latter turned from hypointense to strikingly hyperintense on the second FLAIR image, resembling the picture of an acute-on-chronic infarction or hemorrhage. However, the second DWI and CT refuted either of these.

Conclusions--Image contrast using FLAIR in acute stroke trial imaging may also be affected by T1 effects of Gd-DTPA in chronic infarcts.

Key words: contrast media • magnetic resonance imaging • stroke, acute • thrombolytic therapy

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