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Differential diagnosis of hyperintense cerebrospinal fluid on fluid-attenuated inversion recovery images of the brain. Part I: pathological conditions

Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Correspondence: Khin Khin Tha, Department of Radiology, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan. E-mail: kktha{at}med.hokudai.ac.jp

The fluid-attenuated inversion recovery imaging sequence is a widely used MRI sequence of the brain. It is an inversion recovery pulse sequence, designed to suppress signals from the cerebrospinal fluid. It is highly sensitive in detection of lesions adjacent to or within the cerebrospinal fluid associated with T₂ prolongation or T₁ shortening. The term "hyperintense cerebrospinal fluid" is used to describe failed suppression, or hyperintensity, of cerebrospinal fluid on fluid-attenuated inversion recovery imaging of the brain. It is often encountered in many important pathological conditions, including subarachnoid haemorrhage, meningitis and leptomeningeal metastasis. However, certain non-pathological states in which there is no definite cerebrospinal fluid abnormality can also present with hyperintense cerebrospinal fluid. Correct interpretation of abnormalities is important to arrive at an appropriate diagnosis. This pictorial review provides fluid-attenuated inversion recovery images of hyperintense cerebrospinal fluid of the brain and describes distinguishing features. Part I features pathological conditions whereas Part II focuses on non-pathological conditions.