Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

A Potential Diagnostic Pitfall in the Differentiation of Hemorrhagic and Fatty Lesions Using Short Inversion Time Inversion Recovery: a Case Report

  • Kim, Jee Hye (Department of Radiology, Chungbuk National University Hospital) ;
  • Kang, Woo Young (Department of Radiology, Chungbuk National University Hospital) ;
  • Cho, Bum Sang (Department of Radiology, Chungbuk National University Hospital) ;
  • Yi, Kyung Sik (Department of Radiology, Chungbuk National University Hospital)
  • Received : 2016.06.21
  • Accepted : 2016.08.24
  • Published : 2016.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Short inversion time inversion recovery (STIR) is widely used for spinal magnetic resonance imaging (MRI) because the pulse sequence of STIR is insensitive to magnetic field inhomogeneity and can be used to scan a large field of view. In this case report, we present a case of spinal epidural hematoma with unexpected signal decrease on a STIR image. The MRI showed an epidural mass that appeared with high signal intensity on both T1- and T2-weighted images. However, a signal decrease was encountered on the STIR image. This nonspecific decrease of signal in tissue with a short T1 relaxation time that is similar to that of fat (i.e., hemorrhage) could lead to a diagnostic pitfall; one could falsely diagnose this decrease of signal as fat instead of hemorrhage. Awareness of the nonselective signal suppression achieved with STIR pulse sequences may avert an erroneous diagnosis in image interpretation.

Keywords

References

  1. Lovblad KO, Baumgartner RW, Zambaz BD, Remonda L, Ozdoba C, Schroth G. Nontraumatic spinal epidural hematomas. MR features. Acta Radiol 1997;38:8-13
  2. Krinsky G, Rofsky NM, Weinreb JC. Nonspecificity of short inversion time inversion recovery (STIR) as a technique of fat suppression: pitfalls in image interpretation. AJR Am J Roentgenol 1996;166:523-526 https://doi.org/10.2214/ajr.166.3.8623620
  3. Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X, Cotten A. Fat suppression in MR imaging: techniques and pitfalls. Radiographics 1999;19:373-382
  4. Bradley WG Jr. MR appearance of hemorrhage in the brain. Radiology 1993;189:15-26 https://doi.org/10.1148/radiology.189.1.8372185
  5. Froehlich JM, Metens T, Chilla B, Hauser N, Hohl MK, Kubik-Huch RA. MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery. Eur J Radiol 2012;81:598-602 https://doi.org/10.1016/j.ejrad.2011.01.062
  6. Khaladkar SM, Kamal A, Kamal V, Kumar S, Singh G, Kalra R. Pitfall in differentiation of hemorrhagic vs. fatty lesions in female pelvis using fat saturated sequences with inversion recovery - role of T1 FATSAT sequence - a case report with radiological review. IOSR-JDMS 2015;14:86-90
  7. Lee YS, Kwon ST, Kim JO, Choi ES. Serial MR imaging of intramuscular hematoma: experimental study in a rat model with the pathologic correlation. Korean J Radiol 2011;12:66-77
  8. Wu J, Lu L-Q, Gu J-P, Yin X-D. The application of fatsuppression MR pulse sequence in the diagnosis of bonejoint disease. Int J Med Phys, Clin Eng and Radiat Oncol 2012;1:88-94 https://doi.org/10.4236/ijmpcero.2012.13012