Pitfalls in pediatric radiology: Focus on sulcus hyperintensity on fluid-attenuated inversion recovery

Abstract

Fluid-attenuated inversion recovery (FLAIR) has become a routine sequence for head imaging in many facilities in daily clinical practice. FLAIR uses inversion pulses to suppress the signals of physiological water components in the cranial cavity, making it easier to detect T2 prolongation lesions. However, various factors can cause high signals in the cerebral sulci on FLAIR images. The main factors include increased protein concentration, presence of hemorrhagic components, elevated cellular components (including tumor and inflammatory cells), and artifacts, which leads to a wide range of differential diagnoses. When evaluating FLAIR images, it is important to consider these factors and to incorporate clinical information into the diagnostic process.