Fast fluid‐attenuated inversion‐recovery (FLAIR) MRI in the assessment of intraaxial brain tumors

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Abstract
This study demonstrates the value of a fast fluid‐attenuated inversion‐recovery (FLAIR) technique in the assessment of primary intraaxial brain tumors. Twenty‐one patients with primary intraaxial brain tumors were examined by T2‐weighted, proton‐density‐weighted fast spin echo, fast FLAIR, and contrast‐enhanced T1‐weighted spin echo using identical slice parameters. The images were evaluated using quantitative and qualitative criteria. Quantitative criteria were tumor‐to‐background and tumor‐to‐cerebrospinal fluid (CSF) contrast and contrast‐to‐noise ratio (CNR). The qualitative evaluation was performed as a multi‐reader analysis concerning lesion detection, lesion delineation, and image artifacts. In the qualitative evaluation, all readers found the fast FLAIR to be superior to fast spin echo in the exact delineation of intraaxial brain tumors (P < .001) and the delineation of enhancing and nonenhancing tumor parts. Fast FLAIR was superior in the delineation of cortically located and small lesions but was limited in lesions adjacent to the ventricles. Fast FLAIR provided a significantly better tumor‐to‐CSF contrast and tumor‐to‐CSF CNR (P < .001). The tumor‐to‐background contrast and tumor‐to‐background CNR of the fast FLAIR images were lower than those of T2‐weighted spin‐echo images but higher than those of proton‐density‐weighted spin‐echo images. FLAIR images had more image artifacts influencing the image interpretation in only two patients. Signal hyperintensities at the ventricular border were present in 92% of the patients. They are common findings in fast FLAIR and should be included into the image interpretation.