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<meta name="DC.Title" content="Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea" />
<meta name="DC.Date" content="2004-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) constitutes an important neurologic emergency. Some authors have suggested that fluid-attenuated inversion recovery (FLAIR) MR imaging can detect SAH that may not be apparent on CT scans but may be revealed by lumbar puncture. We sought to determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings and positive lumbar puncture results.

METHODS: The CT scans and FLAIR MR images of all patients with suspected SAH during a 3-year interval (2000–2002) were retrospectively reviewed by a blinded reader. Among these cases, we identified 12 with CT findings that were negative for SAH, lumbar puncture results that were positive for SAH, and FLAIR MR imaging findings that were available for review. Eleven of the 12 patients had undergone FLAIR MR imaging within 2 days of CT and lumbar puncture. The 12 patients with negative CT findings were comprised of six male and six female patients with an age range of 7 to 69 years. We evaluated the true and false negative and positive FLAIR MR imaging findings for SAH by using the lumbar puncture results as the gold standard. The FLAIR MR imaging findings of 12 additional patients without SAH (as revealed by lumbar puncture) were used as control data for a blinded reading.

RESULTS: For all 12 control cases without SAH, the FLAIR MR imaging findings were interpreted correctly. Of the 12 cases that had positive lumbar puncture results but false-negative CT findings for SAH, FLAIR MR imaging findings were true-positive in only two cases and were false-negative in 10. One of the two true-positive cases had the highest concentration of RBC in the series (365 k/cc), and the other had the second highest value of RBC (65 k/cc).

CONCLUSION: FLAIR MR imaging cannot replace lumbar puncture to detect the presence of SAH. FLAIR MR imaging findings are infrequently positive (16.7%) when CT findings are negative for SAH. This is likely because there is a minimum concentration of RBC/cc that must be exceeded for CSF to become hyperintense on FLAIR MR images." />
<meta name="DC.Contributor" content="Mona Mohamed" />
<meta name="DC.Contributor" content="D. Cressler Heasely" />
<meta name="DC.Contributor" content="Banu Yagmurlu" />
<meta name="DC.Contributor" content="David M. Yousem" />
<meta name="article:published_time" content="2004-04-01" />
<meta name="article:section" content="BRAIN" />
<meta name="citation_title" content="Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; Subarachnoid hemorrhage (SAH) constitutes an important neurologic emergency. Some authors have suggested that fluid-attenuated inversion recovery (FLAIR) MR imaging can detect SAH that may not be apparent on CT scans but may be revealed by lumbar puncture. We sought to determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings and positive lumbar puncture results.&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; The CT scans and FLAIR MR images of all patients with suspected SAH during a 3-year interval (2000–2002) were retrospectively reviewed by a blinded reader. Among these cases, we identified 12 with CT findings that were negative for SAH, lumbar puncture results that were positive for SAH, and FLAIR MR imaging findings that were available for review. Eleven of the 12 patients had undergone FLAIR MR imaging within 2 days of CT and lumbar puncture. The 12 patients with negative CT findings were comprised of six male and six female patients with an age range of 7 to 69 years. We evaluated the true and false negative and positive FLAIR MR imaging findings for SAH by using the lumbar puncture results as the gold standard. The FLAIR MR imaging findings of 12 additional patients without SAH (as revealed by lumbar puncture) were used as control data for a blinded reading.&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; For all 12 control cases without SAH, the FLAIR MR imaging findings were interpreted correctly. Of the 12 cases that had positive lumbar puncture results but false-negative CT findings for SAH, FLAIR MR imaging findings were true-positive in only two cases and were false-negative in 10. One of the two true-positive cases had the highest concentration of RBC in the series (365 k/cc), and the other had the second highest value of RBC (65 k/cc).&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; FLAIR MR imaging cannot replace lumbar puncture to detect the presence of SAH. FLAIR MR imaging findings are infrequently positive (16.7%) when CT findings are negative for SAH. This is likely because there is a minimum concentration of RBC/cc that must be exceeded for CSF to become hyperintense on FLAIR MR images.&lt;/p&gt;" />
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<meta name="citation_author" content="Mona Mohamed" />
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<meta name="citation_author" content="Banu Yagmurlu" />
<meta name="citation_author" content="David M. Yousem" />
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<meta name="twitter:title" content="Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) constitutes an important neurologic emergency. Some authors have suggested that fluid-attenuated inversion recovery (FLAIR) MR imaging can detect SAH that may not be apparent on CT scans but may be revealed by lumbar puncture. We sought to determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings and positive lumbar puncture results.

METHODS: The CT scans and FLAIR MR images of all patients with suspected SAH during a 3-year interval (2000–2002) were retrospectively reviewed by a blinded reader. Among these cases, we identified 12 with CT findings that were negative for SAH, lumbar puncture results that were positive for SAH, and FLAIR MR imaging findings that were available for review. Eleven of the 12 patients had undergone FLAIR MR imaging within 2 days of CT and lumbar puncture. The 12 patients with negative CT findings were comprised of six male and six female patients with an age range of 7 to 69 years. We evaluated the true and false negative and positive FLAIR MR imaging findings for SAH by using the lumbar puncture results as the gold standard. The FLAIR MR imaging findings of 12 additional patients without SAH (as revealed by lumbar puncture) were used as control data for a blinded reading.

RESULTS: For all 12 control cases without SAH, the FLAIR MR imaging findings were interpreted correctly. Of the 12 cases that had positive lumbar puncture results but false-negative CT findings for SAH, FLAIR MR imaging findings were true-positive in only two cases and were false-negative in 10. One of the two true-positive cases had the highest concentration of RBC in the series (365 k/cc), and the other had the second highest value of RBC (65 k/cc).

CONCLUSION: FLAIR MR imaging cannot replace lumbar puncture to detect the presence of SAH. FLAIR MR imaging findings are infrequently positive (16.7%) when CT findings are negative for SAH. This is likely because there is a minimum concentration of RBC/cc that must be exceeded for CSF to become hyperintense on FLAIR MR images." />
<meta name="og-title" property="og:title" content="Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea" />
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<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) constitutes an important neurologic emergency. Some authors have suggested that fluid-attenuated inversion recovery (FLAIR) MR imaging can detect SAH that may not be apparent on CT scans but may be revealed by lumbar puncture. We sought to determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings and positive lumbar puncture results.

METHODS: The CT scans and FLAIR MR images of all patients with suspected SAH during a 3-year interval (2000–2002) were retrospectively reviewed by a blinded reader. Among these cases, we identified 12 with CT findings that were negative for SAH, lumbar puncture results that were positive for SAH, and FLAIR MR imaging findings that were available for review. Eleven of the 12 patients had undergone FLAIR MR imaging within 2 days of CT and lumbar puncture. The 12 patients with negative CT findings were comprised of six male and six female patients with an age range of 7 to 69 years. We evaluated the true and false negative and positive FLAIR MR imaging findings for SAH by using the lumbar puncture results as the gold standard. The FLAIR MR imaging findings of 12 additional patients without SAH (as revealed by lumbar puncture) were used as control data for a blinded reading.

RESULTS: For all 12 control cases without SAH, the FLAIR MR imaging findings were interpreted correctly. Of the 12 cases that had positive lumbar puncture results but false-negative CT findings for SAH, FLAIR MR imaging findings were true-positive in only two cases and were false-negative in 10. One of the two true-positive cases had the highest concentration of RBC in the series (365 k/cc), and the other had the second highest value of RBC (65 k/cc).

CONCLUSION: FLAIR MR imaging cannot replace lumbar puncture to detect the presence of SAH. FLAIR MR imaging findings are infrequently positive (16.7%) when CT findings are negative for SAH. This is likely because there is a minimum concentration of RBC/cc that must be exceeded for CSF to become hyperintense on FLAIR MR images." />
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      <h1 class="highwire-cite-title" id="page-title">Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Mona Mohamed</span>, <span class="highwire-citation-author" data-delta="1">D. Cressler Heasely</span>, <span class="highwire-citation-author" data-delta="2">Banu Yagmurlu</span> and <span class="highwire-citation-author" data-delta="3">David M. Yousem</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2004,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">25 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">545-550; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-10468--61061933206" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Mona Mohamed </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Mona%2BMohamed%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mohamed%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMona%2BMohamed%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D. Cressler Heasely </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BCressler%2BHeasely%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Heasely%20DC&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.%2BCressler%2BHeasely%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Banu Yagmurlu </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Banu%2BYagmurlu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yagmurlu%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ABanu%2BYagmurlu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">David M. Yousem </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=David%2BM.%2BYousem%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yousem%20DM&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADavid%2BM.%2BYousem%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="messages highwire-corrections highwire-correction-type-correction"><h3 class="highwire-corrections-title">This article has a correction. Please see:</h3><ul class="highwire-corrections-list"><li class="relation-481 first last"><a href="/content/25/5/904.1" class="" data-icon-position="" data-hide-link-title="0">Errata - May 01, 2004</a></li></ul></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 25</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2004 </div></div>
      
      
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      <div class="highwire-cite-title">Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea</div>  
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      <div class="highwire-cite-title">Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea</div>  
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