对比T2FLAIR序列与增强T1WI序列在诊断脑转移瘤过程中的诊断价值

目的：比较增强T1WI及增强T2FLAIR两种序列对脑转移瘤的诊断价值。方法：回顾分析本院2008年9月～2010年3月34例经临床和影像检查确诊为脑转移瘤的患者资料,所有病例均行常规MRI平扫及SET1WI和T2FLAIR增强扫描,比较两种序列上转移瘤的数目、大小和部位以及转移瘤的强化显著性、病变强化区的边界等,并分析两者间偏差的原因。结果：34个病例,MRI平扫共检出129个病灶,增强T1WI发现194个病灶,而增强后T2WI FLAIR共发现185个病灶,4例增强后T2FLAIR较增强后T1WI显示的病灶多,6例增强后T2FLAIR显示的病灶少于增强后T1WI,25例两者显示的病灶相同,增强后T1WI因为脑浅表层血管混淆而漏诊误诊7个病灶,在对比增强后T2FLAIR均可明确诊断。大多数转移瘤在T1WI的强化程度高于T2FLAIR序列。转移瘤的肿瘤与灰质、肿瘤与白质的CR（对比率）以FLAIR序列为高,而转移瘤的肿瘤与灰质、肿瘤与白质的CNR（对比噪声比）以T1WI为高,两者有显著性差异（P〈0.01）。结论：增强后T2FLAIR序列可以有效显示脑转移灶,很好地鉴别大脑浅表部位的血管和转移瘤,增强T1WI序列能更明显地显示转移瘤的强化,两者同时使用,可以提高转移瘤的检出率与诊断准确性。     

增强FLAIR序列和磁化传递对比在脑转移瘤的应用价值

目的 探讨增强液体衰减反转恢复(FLAIR)和磁化传递对比(MTC)两种序列对脑转移瘤的显示价值.资料与方法 对60例拟诊脑转移瘤的患者行MR常规扫描后采用T1WI、FLAIR、MTC序列再行增强扫描,并分别统计三种序列各自显示的病灶位置和个数及三种序列上转移瘤的病灶/正常组织信号强度比.结果 60例患者中42例发现脑转移瘤,共计131个病灶,增强后常规T1WI显示112个,FLAIR显示126个,MTC显示125个,三种序列上转移瘤的病灶/正常组织信号强度比差异有统计学意义.结论 增强后FLAIR序列和MTC对部分脑转移瘤的显示和诊断具有特殊意义,联合使用能提高脑转移瘤的诊断准确率.     

CUBE T_2 FLAIR序列在脑内微小转移瘤诊断中的应用

目的 :探讨CUBE T2FLAIR序列对脑内微小转移瘤的临床应用价值。方法:对35例脑转移瘤患者行常规扫描后再行3D T1WI序列和CUBE T2FLAIR序列增强扫描,统计并比较2种序列显示转移瘤的数目、大小、位置等。结果:35例共129个病灶,CUBE T2FLAIR显示124个病灶,显示率98.4%;3D T1WI序列显示112个病灶,显示率86.8%,两者比较差异有统计学意义(P=0.014)。结论:在显示脑内微小转移瘤方面,CUBE T2FLAIR序列比3D T1WI序列更敏感。     

FLAIR增强扫描在脑转移瘤诊断中的价值

目的通过与平扫液体衰减反转恢复(FLAIR)及增强T1WI的比较研究,探讨增强FLAIR序列在脑转移瘤诊断中的价值。资料与方法20例脑转移瘤患者行增强前后T1WI和FLAIR成像,计数两种序列上转移瘤的数目,测量肿瘤强化程度、强化百分比和肿瘤体积,计算肿瘤与白质、肿瘤与脑脊液的对比率(CR)和对比噪声比(CNR)。结果20例中1例仅增强T1WI发现3个点状强化灶,余19例共327个转移灶中平扫FLAIR序列发现100个,增强T1WI发现292个,两者共发现298个;增强FLAIR序列发现181个。与增强T1WI相比,仅增强FLAIR序列显示的35个转移灶中,26个位于皮层或皮层下;2个小脑半球灶直径达14mm,余33个直径均<5mm。受血管结构的影响,增强T1WI上7个病灶假阳性,9个为假阴性,而在增强FLAIR序列上均明确诊断。在T1WI上肿瘤的强化程度和强化百分比高于FLAIR序列,而肿瘤与白质、肿瘤与脑脊液的CR和CNR则以FLAIR序列为高,增强T1WI和增强FLAIR序列上的转移瘤体积平均为(4.2±6.2)cm3和(4.0±6.5)cm3,两者差异无统计学意义。结论增强FLAIR序列在脑转移瘤的诊断中有一定的价值,尤其是对位于皮层表面的病灶,其与增强T1WI具有很好的互补性。     

增强FLAIR和磁化传递对比对脑转移瘤的诊断价值

目的:对照分析增强液体衰减反转恢复(FLAIR)和磁化传递对比(MTC)两种序列对脑转移瘤的诊断价值.方法:27例患有原发性肺癌且临床怀疑有脑转移的患者,比较增强后T1WI、MTC以及FLAIR显示脑转移病变的数目、位置及强化程度,并分析三者之间偏差的原因.结果:27例患者中,共计发现168个转移灶.增强后MTC显示166个病灶(98.8%),增强后FLAIR显示162个病灶(96.4%),增强T1 WI显示病灶最少,为148个(88.1%).大部分病灶强化程度与扫描延迟时间有关.增强后T1WI及MTC因与脑表面小血管混淆而致误判2枚病灶,在对比增强FLAIR均可明确诊断.结论:增强后FLAIR在脑转移瘤诊断中有一定价值,与MTC联合应用能提高脑转移瘤的诊断准确率.     

颅内柔脑膜转移瘤：低场MRI FLAIR序列与T1WI增强扫描对比分析

目的:评估低场MR液体衰减反转恢复(FLAIR)序列诊断颅内柔脑膜转移瘤的价值.材料和方法:回顾性分析30例颅内柔脑膜转移瘤的FLAIR序列平扫与T1WI常规剂量增强扫描的表现.结果:T1WI增强扫描检出柔脑膜转移瘤128个,而FLAIR检出117个,T1WI增强扫描检出病灶较FLAIR序列敏感(P<0.05);T1WI增强扫描明确所有病灶边界,而FLAIR序列对所有病灶的边界显示不清.结论:对于颅内柔脑膜转移瘤的低场MR诊断,T1WI增强扫描优于FLAIR序列.     

三维快速自旋回波序列调制反转角成像技术检出脑转移瘤的价值

该研究回顾分析了河南省肿瘤医院病理确诊为恶性肿瘤且经手术及临床随访确诊存在脑转移病灶的28例患者的临床及影像资料。所有患者均接受头颅动态增强MRI(CE-MRI)的5 mm层厚液体衰减反转恢复序列(FLAIR)T1WI(5 mm-T1 FLAIR)、CE-MRI的1 mm层厚FLAIR T1WI(1 mm-T1 FLAIR)和CE-MRI的1 mm层厚三维快速自旋回波序列调制反转角序列成像(1 mm-MATRIX)。在5 mm-T1 FLAIR、1 mm-T1 FLAIR和1 mm-MATRIX序列图像上分别检出604个、656个和752个脑转移病灶, 差异有统计学意义(P<0.001);两两比较显示5 mm-T1 FLAIR与1 mm-MATRIX检出病灶差异有统计学意义(P<0.001);1 mm-T1 FLAIR与1 mm-MATRIX比较差异有统计学意义(P=0.008)。对于病灶长径<3 mm的脑转移病灶, 1 mm-MATRIX序列检出数多于5 mm-T1 FLAIR序列及1 mm-T1 FLAIR序列, 差异有统计学意义(P值分别为0.001、0.001...     

MRI纹理分析对前列腺癌及Gleason分级的诊断价值

目的评估多参数MRI纹理分析法对前列腺癌的诊断价值及其鉴别低危与中高危前列腺癌的诊断效能。方法回顾性分析经穿刺活检或手术病理证实的61例前列腺癌病人,中位年龄66岁(42～89岁),前列腺特异性抗原(PSA)范围3.4～300 ng/mL,并进行Gleason(GS)评分。其中低危(GS≤6分)病人10例,中高危(GS≥7分)病人51例。所有病人均行前列腺常规MRI及扩散加权成像(DWI)检查,基于T2WI勾画三维兴趣区(ROI),使用纹理分析软件(Matlab)提取ROI的直方图纹理特征参数(熵、偏度、峰度和方差),并计算平均ADC值。采用单因素方差分析评估T2WI和ADC图上各直方图纹理参数及平均ADC值在低危前列腺癌、中高危前列腺癌及正常外周区之间的差异。采用受试者操作特征(ROC)曲线计算曲线下面积(AUC),评估各参数的诊断效能,并评价定量纹理参数对低危和中高危前列腺癌的鉴别诊断效能。结果 ADC图及T2WI上,3组之间各诊断参数差异均有统计学意义(P0.05)。中高危前列腺癌在ADC图上平均ADC值的AUC(0.88)最大,在T2WI图纹理分析中,方差值AUC(0.88)最大。低危和中高危前列腺癌鉴别诊断中,ADC图和T2WI的纹理参数中熵值AUC最大,分别为0.87和0.79。结论多参数MRI纹理分析可用于诊断前列腺癌,并能为鉴别诊断低危与中高危前列腺癌提供可靠的量化信息,其中熵值有助于前列腺癌病理分级。     

MR增强后液体衰减反转恢复序列对脑转移瘤的诊断价值

目的 分析MR增强后液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)序列对脑转移瘤的诊断价值. 资料与方法 确诊恶性肿瘤可疑有脑转移患者159例.MR检查除常规平扫和增强外,在增强后加扫FLAIR序列,图像由3名有经验的放射科医师评估. 结果 58例有脑内转移,6例增强后FLAIR脑实质病灶数目显示较增强T1WI多,11例病灶强化较T1WI明显;在11例柔脑膜转移者中,7例病灶强化程度优于增强后T1WI. 结论 增强后FLAIR是增强后T1WI的有效补充,对脑内小病灶和脑膜病灶更敏感.     

MR双反转恢复序列在脑内多灶性病变中的临床应用研究

目的探讨MR双反转恢复(DIR)序列在脑内多发缺血性病变、多发性硬化及脑转移瘤中的临床应用价值。方法回顾性分析经临床病理证实的肺癌脑转移20例、脑内多发缺血性病变20例、经随访证实的MS 20例的MR资料。所有患者均行了颅脑常规MRI及矢状位3D DIR扫描,肺癌脑转移患者平扫后继续行对比增强T_1WI(T_1WI+C)扫描。针对肺癌脑转移病人,以T_1WI+C上的病灶数目为参考,统计T_2FLAIR与DIR序列上的脑转移瘤数目;对于脑内多发缺血性病变及MS患者,计算病灶在DIR及FLAIR上的平均CNR、CR。所得数据应用SPSS 20.0软件进行统计学分析,判断两序列上病变数目、CNR及CR有无统计学差异。结果脑转移瘤在DIR图像上表现为低信号,周围常伴有片状长T_1长T_2信号,瘤体与周围水肿带分界清晰。T_1WI+C上的转移瘤数目为120个,T_2FLAIR序列上为61个,DIR上为94个,T_2FLAIR和DIR在病变数目上的差异有统计学意义(P0.001)。脑内多发缺血性病变在DIR图像上可表现为明显高信号,同时表现为高信号的病灶在DIR及T_2FLAIR图像上的平均CNR分别为33.98±12.31、24.88±9.54,两者间的差异有统计学意义(P0.05);平均CR分别为1.32±0.52、0.48±0.14,差异有统计学意义(P0.001)。MS病灶在DIR上常表现为白质内的斑点、片状或不规则形高信号。病变在DIR及T_2FLAIR上的平均CNR分别为36.17±11.89、29.16±8.59,两者间差异有统计学意义(P0.05);平均CR分别为2.37±0.86、0.66±0.19,差异有统计学意义(P0.001)。结论 3D DIR成像技术较常规T_2FLAIR序列可以清晰的显示病灶,病灶的CNR及CR较高,同时在不使用对比剂的情况下可以发现更多的肺癌脑转移病灶。     

Contrast-enhanced FLAIR imaging in combination with pre- and postcontrast magnetization transfer T1-weighted imaging: usefulness in the evaluation of brain metastases

PURPOSE: To assess whether the use of postcontrast fluid-attenuated inversion recovery (FLAIR) imaging in combination with pre- and postcontrast magnetization transfer (MT) T1-weighted imaging (T1WI) can increase diagnostic confidence in the evaluation of brain metastases. MATERIALS AND METHODS: Brain MR images from 41 patients with suspected brain metastases were reviewed. Two radiologists viewed pre- and postcontrast MT-T1W images for the presence of metastatic tumors and rated the possible enhanced lesions using a five-point confidence scale (session 1). The postcontrast FLAIR images were then viewed together with pre- and postcontrast MT-T1W images, and the presence of metastasis was rated again (session 2). RESULTS: A total of 240 possible enhanced lesions were detected in session 1. Judging by follow-up MR examinations, 196 were considered to be nonmetastatic findings and 44 were determined to be metastasis. In session 2 the confidence rating for nonmetastasis increased significantly in the subset of nonmetastatic findings (P < 0.001), and the confidence rating for metastasis increased significantly in the subset of metastases (P < 0.05). CONCLUSION: The addition of postcontrast FLAIR imaging to pre- and postcontrast MT-T1WI improves diagnostic confidence in evaluation of brain metastases.     

Evaluation of the tumor-brain interface of intracranial meningiomas on MR imaging including FLAIR images.

PURPOSE: The usefulness of fluid-attenuated inversion recovery (FLAIR) imaging for the evaluation of brain diseases has been reported. The purpose of this study was to evaluate the brain-meningioma interface with MRI including FLAIR imaging. MATERIALS AND METHODS: This study involved 48 patients with 50 intracranial meningiomas. We retrospectively evaluated the brain-meningioma interface by various imaging method including FLAIR. If a thin layer with a signal intensity different from that of the tumor and brain was observed in the areas of the tumor-brain interface in T(1)-weighted IR (T(1)WIR) and T(2)-weighted turbo SE (T(2)WTSE) images, we defined this structure as the rim. The presence or absence of the rim and the signal intensity were evaluated, and the length and the signal intensity of the rim observed with FLAIR and contrast-enhanced T(1)WIR (CE-T(1)WIR) images were evaluated. RESULTS: In 35 of the 50 lesions (70.0%), the rim was observed in the tumor-brain interface as a layer of low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images. In 13 lesions (26.0%), no rim was detected. Flow voids were observed at the tumor-brain interface in 20 of the 50 lesions (40.0%). No rim showed a low signal intensity of the tumor-brain interface in both T(1)WIR and T(2)WTSE images. The rim exhibited an iso-to-high signal intensity compared to the tumor parenchyma in FLAIR images and an enhanced signal intensity in CE-T(1)WIR images. In contrast to T(1)WIR images, the rim in FLAIR images tended to be identified across the entire circumference. CONCLUSION: The rim at the brain-meningioma interface revealed as low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images, which was conventionally considered to be the CSF cleft, was often revealed in FLAIR images as high signal intensity compared to the tumor parenchyma, and an enhanced signal intensity in CE-T(1)WIR images. Therefore, the presence of CSF in such rims is unlikely, and the rims might reflect the capsule structure of the tumor surface.     

Utility of Contrast-Enhanced T2 FLAIR for Imaging Brain Metastases Using a Half-dose High-Relaxivity Contrast Agent

BACKGROUND AND PURPOSE:Efficient detection of metastases is important for patient’ treatment. This prospective study was to explore the clinical value of contrast-enhanced T2 FLAIR in imaging brain metastases using half-dose gadobenate dimeglumine.MATERIALS AND METHODS:In vitro signal intensity of various gadolinium concentrations was explored by spin-echo T1-weighted imaging and T2 FLAIR. Then, 46 patients with lung cancer underwent nonenhanced T2 FLAIR before administration of half-dose gadobenate dimeglumine and 3 consecutive contrast-enhanced T2 FLAIR sequences followed by 1 spin-echo T1WI after administration of half-dose gadobenate dimeglumine. After an additional dose of 0.05 mmol/kg, 3D brain volume imaging was performed. All brain metastases were classified as follows: solid-enhancing, ≥ 5 mm (group A); ring-enhancing, ≥ 5 mm (group B); and lesion diameter of <5 mm (group C). The contrast ratio of the lesions on 3 consecutive phases of contrast-enhanced T2 FLAIR was measured, and the percentage increase of contrast-enhanced T2 FLAIR among the 3 groups was compared.RESULTS:In vitro, the maximal signal intensity was achieved in T2 FLAIR at one-eighth to one-half of the contrast concentration needed for maximal signal intensity in T1WI. In vivo, the mean contrast ratio values of metastases on contrast-enhanced T2 FLAIR for the 3 consecutive phases ranged from 63.64% to 83.05%. The percentage increase (PI) values of contrast-enhanced T2 FLAIR were as follows: PI_A < PI_B (P = .001) and PI_A < PI_C (P < .001). The degree of enhancement of brain metastases on contrast-enhanced T2 FLAIR was lower than on 3D brain volume imaging (P < .001) in group A, and higher than on 3D brain volume imaging (P < .001) in group C.CONCLUSIONS:Small or ring-enhancing metastases can be better visualized on delayed contrast-enhanced T2 FLAIR using a half-dose high-relaxivity contrast agent.

Brain metastases occur in approximately 25% of patients with cancer and account for 40% of adult brain tumors.¹ The incidence of brain metastases in patients with lung cancer is highest (19.9%),² resulting in high morbidity and mortality.³ Small metastases, not combined with vasogenic edema or mass effects, are often missed.¹ Improvement of the early detection of small brain metastases will contribute to developing treatment protocols and will affect the outcomes⁴ because small lesions effectively respond to therapies and can be controlled at a substantially higher rate compared with larger lesions.^5,6 For patients with metastases, contrast-enhanced T1WI (CE-T1WI) should be repeatedly performed to assess the progress of brain metastases^7,8 or the efficacy of treatment.^9,10 The conspicuity and detection rate of brain metastases can be improved with a higher dose of gadolinium-based contrast agents (GBCA).¹¹ However, multiple enhanced examinations or use of higher contrast doses may increase the potential adverse effects, such as nephrogenic systemic fibrosis,^12,13 and may lead to higher gadolinium deposition in the brain¹⁴ or other tissues.^15,16Therefore, reducing the gadolinium-based contrast agent dose may decrease the adverse effects produced by gadolinium accumulation, which is crucial to the patient’s health. T2 FLAIR is an inversion recovery pulse sequence that is sensitive to low concentrations of GBCA in the tissue.¹⁷ It is reported that only one-quarter of the routine dose of GBCA is needed for CE-T2 FLAIR to achieve a signal enhancement comparable with that of CE-T1WI; moreover, CE-T2 FLAIR may offer additional morphologic information compared with CE-T1WI alone.^17,18 Due to the suppression of intravascular and CSF signal,¹⁹ CE-T2 FLAIR imaging has been used in the detection of various intra- and extra-axial brain lesions, eg, the delineation of meningeal lesions including meningoencephalitis and leptomeningeal metastases.^20-22Previous studies mostly focused on the use of CE-T2 FLAIR after use of the normal GBCA dose; no studies were performed to assess the utility of low-dose CE-T2 FLAIR in the detection of brain metastases. Additionally, an increased delay of CE-T2 FLAIR scanning can improve the diagnosis of leptomeningeal infectious or tumoral diseases,²³ which means CE-T2 FLAIR has a relationship with scanning time. The purpose of the present study was to investigate the value of delayed low-dose CE-T2 FLAIR compared with routine-dose CE brain volume imaging (BRAVO; GE Healthcare) for contrast enhancement in brain metastases.     

Detectability of metastatic brain tumors using gadoteridol-enhanced MRI: usefulness of standard-dose T1-weighted spin-echo image with magnetization transfer and enhanced FLAIR

PURPOSE: The aim of this study was to compare the detectability and image contrast of metastatic brain tumors depicted by T1-weighted MR imaging (T1WI) with the magnetization transfer (MT) technique after the administration of a standard dose(MT-SD-T1WI) or T1WI without MT after the administration of a double dose of gadoteridol(DD-T1WI). We also assessed the usefulness of enhanced fluid attenuated inversion recovery (FLAIR) for depicting very small metastatic tumors. METHODS: Forty-six MRI procedures were performed in 31 patients with metastatic brain tumors that had been diagnosed clinically and radiologically. An incremental dose technique was used with intravenous injections of 0.1 and 0.1 mmol/kg of gadoteridol. In 28 MRI procedures, enhanced FLAIR was carried out after an MT-SD-T1WI study. RESULTS: Detectability was significantly greater with both MT-SD-T1WI and DD-T1WI than with SD-T1WI. However, there was no significant difference between MT-SD- and DD-T1WI. Although an MT pulse increased the contrast between the enhanced tumor and white matter, the contrast between edema and white matter was decreased. Both MT-SD- and DD-T1WI showed small but conspicuous enhanced foci, but we could not determine whether these were vessels or small metastases on the brain surface. However, enhanced FLAIR only demonstrated foci that were thought to be small metastases. CONCLUSIONS: MT-SD- and DD-T1WI had equal ability to detect metastatic brain tumors. Enhanced FLAIR was useful for assessing very small metastases on the brain surface.     

FLAIR序列在脑部疾病中的应用研究

目的　对比脑梗塞、脑出血、脑炎患者颅脑MR平扫时FLAIR序列与SE序列T2 WI的差异。方法　采用液体衰减翻转恢复序列 (FLAIR)和SE序列T1 WI、T2 WI序列MR技术 ,对 36例脑梗塞、1 8例脑出血、1 0例脑炎患者行颅脑MR平扫。观察、统计、测量这三类疾病FLAIR序列与常规T2 WI序列的MR信号强度、病灶面积、数目、分布。结果　早期脑梗塞患者FLAIR序列与常规T2 WI信号强度相同 ,病灶面积显示FLAIR序列小于T2 WI序列。晚期脑梗塞患者尤其在脑软化灶形成后FLAIR序列呈现明显低信号 ,而T2 WI为明显高信号。中期和晚期FLAIR序列发现脑梗塞病灶优于T2 WI序列 ,在近脑表面部FLAIR序列有其明显的优势。各期脑出血患者FLAIR序列的信号强度与T2 WI序列相似。FLAIR序列在脑炎患者的病灶面积显示上要小于T2 WI,显示的病灶边界比T2 WI序列清晰。结论　FLAIR序列在显示脑梗塞尤其是靠近脑表面的梗塞灶、鉴别脑软化灶和脱髓鞘改变以及脑炎病灶面积的显示上优于T2 WI。     

增强FLAIR T2WI诊断脑膜转移瘤的价值

目的:探讨脑膜转移瘤的MRI表现及增强后FLAIR序列T2WI的诊断价值。方法:回顾性分析20例脑膜转移瘤患者的病例资料,其中硬脑膜转移瘤5例,软脑膜转移瘤15例。所有病例行常规MRI平扫及SE T1WI和FLAIR序列T2WI增强扫描并进行对比分析。结果:MRI平扫检出6例,病灶边界均显示不清;MRI增强扫描检出所有病例,SE-T1WI上病变主要表现为脑膜的线状和/或结节状强化,FLAIR T2WI对软脑膜转移瘤病灶范围的显示更清楚,可鉴别强化的血管与病变。结论:MRI增强扫描是诊断脑膜转移瘤的重要检查方法,增强后FLAIR序列T2WI与SE T1WI同时使用,可提高对软脑膜转移瘤的检出率及诊断准确性。     

低场MR FLAIR序列在脑白质疏松症诊断中的应用价值

目的：探讨低场MRI液体衰减反转恢复（fluid liquid attenuated inversion recovery,简称FLAIR） 序列在脑白质疏松症（LA）影像诊断中的应用价值。方法：采用0．3T低场MRI扫描仪对70例LA进行自旋回波（SE）序列和FLAIR序列成像，分析LA在SE及FLAIR序列中的影像表现，比较两种成像序列对LA病变的显示效果。结果：LA MRI表现为侧脑室周围和／或深部脑白质形态不规则、边缘模糊的斑点及点片状异常信号影，SE序列呈等T1或长T1、长T2信号改变，FLAIR呈略高或高信号改变；FLAIR序列成像与SE序列T2WI对LA病灶显示的满意程度及对病变的分级诊断均无明显差异。结论：在低场条件下采用FLAIR序列诊断LA，其成像效果并不比常规SE序列优越。     

Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three types of magnetic resonance images: a multicenter observer performance study

INTRODUCTION: We attempted to determine the most appropriate combination of magnetic resonance (MR) images that can accurately detect and discriminate between asymptomatic infarction and deep white matter hyperintensity (DWMH); these lesions have different clinical implications and are occasionally confused. MATERIALS AND METHODS: We performed an observer performance analysis using cerebral MR images of 45 individuals with or without asymptomatic small white matter infarction and/or mild DWMH who participated in a physical checkup program at four institutions. Six observers interpreted whether infarction and/or DWMH existed in combinations of two or three image types of the T1-weighted images (T1WI), T2-weighted images (T2WI), and fluid-attenuated inversion recovery (FLAIR) images. The observers' performance was evaluated with a receiver operating characteristic (ROC) analysis. RESULTS: The averaged area under the ROC curve (Az) for detecting a infarction was significantly larger in the combination of all the three image types (0.95) than that in any combinations of the two image types (T1WI and FLAIR images, 0.87; T2WI and FLAIR images, 0.85; T1WI and T2WI, 0.86). The Az for detecting DWMH was significantly smaller in the combination of T1WI and T2WI (0.79) than that in other image combinations (T1WI and FLAIR, 0.89; T2WI and FLAIR, 0.91; T1WI, T2WI, and FLAIR, 0.90). CONCLUSION: The combination of T1WI, T2WI, and FLAIR images is required to accurately detect both small white matter infarction and mild DWMH.