Investig Magn Reson Imaging.  2016 Sep;20(3):181-184. 10.13104/imri.2016.20.3.181.

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

• Kim JH
• Kang WY
• Cho BS
• Yi KS

• KMID: 2354799
• DOI: http://doi.org/10.13104/imri.2016.20.3.181

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.

Keyword

Epidural hematoma; Spine; Fat; Short inversion time inversion recovery (STIR)

MeSH Terms

Diagnosis
Hematoma, Epidural, Spinal
Hemorrhage
Magnetic Fields
Magnetic Resonance Imaging
Relaxation
Spine

Figure

• 

  Fig. 1 A magnetic resonance image of the lumbar spine. (a) The sagittal T2-weighted image shows a hyperintense epidural mass at the L4 level, indicating compressing cauda equina syndrome. (b) This image shows hyperintensity on the T1-weighted image. (c) On the STIR image, the lesion shows dark signal intensity. (d) Intense enhancement was observed after contrast infusion. (e) On the axial T2-weighted image the lesion appears as an extradural intraspinal mass at the right posterior aspect of the spinal canal (arrows). (f) The gradient echo image shows relative hyperintensity at the central portion and hypointensity at the peripheral portion (arrows).

• 

  Fig. 2 A computed tomography image of the patient's abdomen and pelvis. (a) The precontrast image shows a subtle high-density lesion at L4 (arrow). (b) The postcontrast image shows no gross fatty lesion or a peripheral enhancing lesion (arrow). (c) The coronal image shows a peripheral enhancing lesion at L4 (arrow).

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