Evaluation of the usefulness of post-contrast T2-FLAIR sequence MRI in the diagnosis of intracranial pathology

Abstract Background To demonstrate the diagnostic value of CE-T2 FLAIR sequence in addition to CE-T1WI in MR imaging of intracranial pathologies. The CE-T2 FLAIR sequence is not widely utilised, but if included in standard MR acquisition protocols, it might enhance patient care by increasing diagnostic sensitivity and facilitating early diagnosis before an invasive CSF sample is obtained. Methods A total of 64 patients underwent Gadolinium contrast-enhanced MRI of the brain on uMR Omega 3.0 T. A hospital-based diagnostic validity study was conducted for one year, from 2024 to 2025, at a tertiary care teaching hospital. Intravenous contrast was given in the form of Gadolinium dimeglumine (0.5 mmol/ml). All patients who were referred for a contrast-enhanced brain MRI to rule out meningeal or parenchymal pathology were included in the study. Result A mean age of 43.14 years with a standard deviation of 20.84 years, reflecting a broad age distribution, was considered in the study. On T1WI, hypointense (60.9%) and isointense (20.3%) findings were the most frequent. On T2WI, heterogeneous (29.7%) and hyperintense (65.6%) findings were the most frequent. 73.4% of lesions had post-contrast enhancement on T1WI. 90.6% of the lesions showed enhancement on the post-contrast T2 FLAIR sequence, with superior background-lesion contrast and distinctive perilesional oedema in the latter sequence. Conclusion Post-contrast T2 FLAIR, as a more sensitive imaging sequence, was supported by its superior ability to detect modest enhancement and define lesion borders. CE T2 FLAIR might improve diagnostic accuracy and facilitate prompt clinical decision-making if included in standard neuroimaging protocols.