Brain: gadolinium-enhanced fast fluid-attenuated inversion-recovery MR imaging

PURPOSE: To determine the clinical utility of gadolinium-enhanced fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging of the brain by comparing results with those at gadolinium-enhanced T1-weighted MR imaging with magnetization transfer (MT) saturation. MATERIALS AND METHODS: In 105 consecutive patients referred for gadolinium-enhanced brain imaging, FLAIR and T1-weighted MR imaging with MT saturation were performed before and after administration of gadopentetate dimeglumine (0.1 mmol per kilogram of body weight). Pre- and postcontrast images were evaluated to determine the presence of abnormal contrast enhancement and whether enhancement was more conspicuous with the FLAIR or T1-weighted sequences. RESULTS: Thirty-nine studies showed intracranial contrast enhancement. Postcontrast T1-weighted images with MT saturation showed superior enhancement in 14 studies, whereas postcontrast fast FLAIR images showed superior enhancement in 15 studies. Four cases demonstrated approximately equal contrast enhancement with both sequences. Six cases showed some areas of enhancement better with T1-weighted imaging with MT saturation and other areas better with postcontrast fast FLAIR imaging. Superficial enhancement was typically better seen with postcontrast fast FLAIR imaging. CONCLUSION: Fast FLAIR images have noticeable T1 contrast making gadolinium-induced enhancement visible. Gadolinium enhancement in lesions that are hyperintense on precontrast FLAIR images, such as intraparenchymal tumors, may be better seen on T1-weighted images than on postcontrast fast FLAIR images. However, postcontrast fast FLAIR images may be useful for detecting superficial abnormalities, such as meningeal disease, because they do not demonstrate contrast enhancement of vessels with slow flow as do T1-weighted images.     

Pulse sequence and timing of contrast‐enhanced MRI for assessing blood–brain barrier disruption after transcranial focused ultrasound in the presence of hemorrhage

Purpose:

To optimize the timing of contrast‐enhanced magnetic resonance imaging (MRI) that best indicates blood–brain barrier (BBB) disruption induced by focused ultrasound (FUS) along with an ultrasound contrast agent (UCA) and to verify that the contrast‐enhanced spin‐echo MRI sequence can indicate the degree and location of BBB disruption in the presence of hemorrhage better than a gradient‐echo sequence.

Materials and Methods:

Sonication was applied to 12 rat brains with four different doses of UCA to cause variable degrees of hemorrhage. Two imaging sequences were performed to acquire T1‐weighted (T1W) images at two time‐points after the administration of a T1‐shortening contrast agent. The contrast enhancement at the sonicated regions was quantified and correlated against Evans blue (EB) staining.

Results:

The spin‐echo T1W images at 10 minutes post–contrast enhancement showed the best correlation with EB staining in both quantity of EB extravasation (r = 0.812; P < 0.01) and spatial distribution (r = 0.528, P < 0.01). This capability was more robust than the gradient‐echo sequence.

Conclusion:

Our results suggest that contrast‐enhanced T1W spin‐echo sequence acquired in the early phase post–contrast enhancement should be considered to monitor the degree and location of BBB disruption under the possibility of hemorrhage induced by FUS. J. Magn. Reson. Imaging 2010;31:1323–1330. © 2010 Wiley‐Liss, Inc.     

实验性部分兔脑组织切除术后早期影像学与病理学对照研究

目的　探讨正常脑组织部分切除术后早期的MRI特点和病理学基础。方法　选取 36只健康新西兰大白兔 ,按术后 1～ 10d的不同时间将动物分成 10个组 ,3、5、7、10d组各 6只动物 ,其余各组为 2只动物。 3%戊巴比妥耳缘静脉注射麻醉 ,无菌状态下切除右顶枕部分脑组织分别在术后1～ 10d行平扫及增强MR检查 ,随后立即取材 ,电子显微镜及普通光学显微镜下观察组织病理改变。结果　 (1)术后 2 4h术区边缘出现正常脑组织的反应性增强 ;(2 )术后一直到第 5天反应性强化程度逐渐加重 ,5d之后变化不明显 ;(3)术后 3d之内反应性增强为血脑屏障的破坏所致 ,3d之后为新生小血管和破坏的血脑屏障共同起作用 ,主要机制是新生血管数量的增加。结论　正常脑组织在术后早期反应性强化特点表现出明显的时间过程 ,在不同时间 ,血脑屏障的破坏和新生血管的数量对反应性增强所起的作用是不同的。     

Contrast-enhanced MR imaging of diffuse and focal splenic disease with use of magnetic starch microspheres

The diagnostic value of magnetic starch microspheres (MSM), a new superparamagnetic contrast agent, was studied in experimental models of diffuse and focal splenic disease in rats by means of ex vivo relaxometry and in vivo magnetic resonance (MR) imaging. Owing to small differences in unenhanced T1 and T2 values between diffuse lymphoma and normal spleen, MR imaging failed to distinguish tumor-bearing animals from control animals by signal-to-noise ratios (SNRs) obtained with T1- and T2-weighted spin-echo sequences. One hour after injection of 20 μmol/kg MSM, lymphomatous spleen showed significantly (P <.001) reduced enhancement relative to normal splenic tissue. As a result, animals with diffuse lymphoma (SNR: 10.3 ± 1.7) could be easily differentiated from control animals (SNR: 5.5 ± 0.6) on T2-weighted (TR msec/TE msec = 2,000/45) images. In focal splenic disease, MSM produced normal enhancement of nontumorous splenic tissue, whereas relaxation times of tumors were not different before and after contrast agent injection. On T2-weighted images (2,000/45), the tumor-spleen contrast-to-noise ratio increased from (4.8 ± 1.6 to 21.8 ± 1.9 +354%), improving conspicuity of splenic tumors. The results show that MSM-enhanced MR imaging improves the detection of diffuse and focal splenic disease.     

Contrast behavior and relaxation effects of conventional and hyperecho-turbo spin echo sequences at 1.5 and 3 T.

To overcome specific absorption rate (SAR) limitations of spin-echo-based MR imaging techniques, especially at (ultra) high fields, rapid acquisition relaxation enhancement/TSE (turbo spin echo)/fast spin echo sequences in combination with constant or variable low flip angles such as hyperechoes and TRAPS (hyperTSE) have been introduced. Due to the multiple spin echo and stimulated echo pathways involved in the signal formation, the contrast behavior of such sequences depends on both T2 and T1 relaxation times. In this work, constant and various variable flip angle sequences were analyzed in a volunteer study. It is demonstrated that a single effective echo time parameter TE(eff) can be calculated that accurately describes the overall T2 weighted image contrast. TE(eff) can be determined by means of the extended phase graph concept and is practically independent of field strength. Using the described formalism, the contrast of any TSE sequence can be predicted. HyperTSE sequences are demonstrated to show a robust and well-defined T2 contrast allowing clinical routine MRI to be performed with SAR reductions of typically at least 70%.     

Techniques for high-resolution echo-planar MR imaging of the pancreas.

Recent technical advances in echo-planar magnetic resonance (MR) imaging prompted an investigation of these new techniques in pancreatic MR imaging and evaluation of bowel lumen enhancement with an aqueous bowel contrast agent. In 42 subjects (36 healthy, six with pancreatic disease), various T1-weighted inversion-recovery and T2-weighted spin-echo fat-suppressed pulse sequences were assessed with an echo-planar technique implemented with a modified clinical MR imager. Single-excitation imaging (echo time, 26 msec) provided a higher (P less than .05) signal-to-noise ratio than did conventional spin-echo and all other echo-planar techniques. In 13 (72%) of 18 healthy subjects who did not undergo administration of the contrast agent, the entire pancreas was distinguished from adjoining bowel. In all 18 subjects who underwent contrast-enhanced imaging, a significantly greater (P less than .05) intraluminal signal intensity was apparent with all echo-planar pulse sequences and the entire pancreas was identified. In six patients with pancreatic disease, lesions could be identified by their difference in signal intensity.     

Delineation of gliomas with magnetic resonance imaging using Gd-DTPA in comparison with computed tomography and positron emission tomography

Fourteen patients with cerebral gliomas were investigated by MR imaging using Gd-DTPA (Magnevist), CT with the contrast agent iohexol (Omnipaque) and, as a reference, positron emission tomography (PET) using 11C-L-methionine. Tumour areas with disruption of the blood-brain-barrier (BBB) as seen on MR and CT were compared with areas increased accumulation of methionine in PET. There were 6 patients with high-grade astrocytoma (grade III-IV), 5 with low-grade astrocytoma (grade I-II) and 3 with oligodendroglioma. In 4 high-grade tumours, PET showed a larger tumour or tumour tissue in additional areas, compared with enhancement on MR and CT, while in 2 cases the tumour extension was similar in the three modalities. In the low grade tumour group, the findings on PET differed from those on post-contrast MR or CT in 7 cases. In 3 of these cases, no disruption of the BBB was seen either on MR or on CT. In 2 of our 14 patients CT showed larger enhancement extension than MR and in 2 cases MR was superior to CT in this respect. The enhancement intensity was higher on MR in 4 patients and on CT in 2 patients. No definite difference in the delineation of tumour tissue between the T1 weighted SE sequences was found. The gradient echo sequences FLASH and FISP gave limited information that was less than that provided by the T1 weighted SE sequences. A greater increase in signal intensity in T1 weighted images was usually seen 5 min post-contrast in the high-grade tumours than in the low-grade ones.     

Stability of osteochondral fragments of the femoral condyle: magnetic resonance imaging with histopathologic correlation in an animal model

The stability of surgically induced osteochondral fragments of the femoral condyle was examined by magnetic resonance imaging (MRI) using T1- and T2-weighted spin echo sequences in 7 dogs; contrast-enhanced T1-weighted spin-echo sequences were also obtained. Animals were sacrificed between the 34th and 196th day after surgery. MR images were compared with the histopathologic findings. Two loose and five stable fragments were found after injection of contrast medium. With the loose fragments, a well-defined line of high signal intensity between the fragment and the epiphysis showed marked enhancement. Histological examination revealed vascularized granulation tissue at the interface. Stable fragments also showed a similar, but irregularly defined line on plain sequences, but no enhancement after injection of contrast medium; histological examination showed no granulation tissue at the interface but intact bone trabeculae within the completely repaired fracture. Fibrocartilaginous repair at the articular cartilage surface also showed enhancement. Contrast-enhanced MR imaging allowed an exact delineation of the line of separation of unstable osteochondral fragments in this animal model with differentiation from a similar line occurring in stable fragments. However, this interface line in relation to stable fragments could not be explained histologically and probably reflects differences of binding or distribution of protons in healing osteochondral fragments.     

Relationship between contrast enhancement on fluid-attenuated inversion recovery MR sequences and signal intensity on T2-weighted MR images: visual evaluation of brain tumors

PURPOSE: To investigate the relationship between the degree of contrast enhancement in fluid-attenuated inversion recovery (FLAIR) sequences and tumor signal intensity on T2-weighted images. MATERIALS AND METHODS: A total of 96 patients suspected of having brain tumors were examined by MR imaging, and whenever a brain tumor with an enhancing part larger than the slice thickness was demonstrated on postcontrast T1-weighted images, postcontrast FLAIR images were additionally acquired. The tumor signal intensity on the T2-weighted images was visually classified as follows: equal or lower compared with normal cerebral cortex (group 1), higher than normal cortex (group 2), and as high as cerebrospinal fluid (CSF) (group 3). When a lesion contained several parts with different signal intensities on T2-weighted images, we assessed each part separately. In each group, we visually compared pre- and postcontrast FLAIR images and assessed whether tumor contrast enhancement was present. When contrast enhancement was present on FLAIR sequence, the degree of contrast enhancement in T1-weighted and FLAIR sequences was visually compared. RESULTS: Postcontrast T1-weighted images showed 46 enhancing lesions, including 48 parts, in 31 MR examinations. FLAIR images of the lesion-parts in group 1 (N=18) did not show significant contrast enhancement. In group 2 (N=12), all the parts were enhanced in FLAIR sequences, and three parts were enhanced more clearly in the FLAIR sequences than in the T1-weighted sequences. In group 3 (N=18), all the parts were enhanced equally or more clearly in the FLAIR sequences than in the T1-weighted sequences. CONCLUSION: The signal intensity in FLAIR sequences is largely influenced by both T1 and T2 relaxation time; there is a close relationship between the signal intensity of brain tumors on T2-weighted images and the degree of contrast enhancement on FLAIR sequences. When tumors have higher signal intensity than normal cortex on T2-weighted images, additional postcontrast FLAIR imaging may improve their depiction.     

Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system

The purpose of this study was to evaluate MR imaging findings of the common extensor tendon in patients with lateral epicondylitis and asymptomatic volunteers studied on a 0.2-T dedicated system. In 23 patients (age range 29–58 years, mean age 47 years) with clinical symptoms of lateral epicondylitis MR imaging was performed using T1-, T2- and contrast-enhanced T1-weighted spin-echo sequences. In addition, the elbows of seven healthy volunteers (age range 22–29 years, mean age 25 years) and the symptom-free contralateral elbow of 11 of the 23 patients (age range 29–58 years, mean age 47 years) were studied as controls. Five patients were surgically treated after the MR examination and the results of histopathology were correlated with MR findings. Of the patients, 95.6 % showed intratendinous signal intensity changes on T1-weighted images on the symptomatic side. In 69.6 % signal alterations were observed on T2-weighted sequences and in 56.5 % an intratendinous contrast enhancement was present. Histopathology showed fibrovascular proliferation and fatty degeneration in patients with distinct signal intensity changes and contrast enhancement. Patients with only minor signal intensity changes on T1- and T2-weighted sequences and no contrast enhancement demonstrated fibrosclerotic degeneration and intratendinous cartilage formation in histopathology. The contralateral elbow showed signal intensity changes in 6 of 11 (54.5 %) cases on T1-weighted images and in 3 of 11 (27.3 %) on T2-weighted images. In the group of healthy volunteers minor signal intensity changes of the common extensor tendon could be seen in only 1 case. In patients with lateral epicondylitis of the elbow the type and extent of pathologic changes within the common extensor tendon can be evaluated using a dedicated low-field MR system. On the basis of MR imaging findings a more specified therapy planning among the variety of treatment modalities can be achieved. Received: 10 April 1998; Revision received: 13 October 1998; Accepted: 25 November 1998     

Dynamic gadolinium-enhanced echo-planar MR imaging of the liver: Effect of pulse sequence and dose on enhancement

To develop guidelines for clinical magnetic resonance imaging of the liver, the authors undertook an animal study to investigate the effect of dose and pulse sequence on liver signal intensity in gadopentetate dimeglumine—enhanced echo-planar imaging. Serial imaging of the liver was performed in anesthetized rats after intravenous administration of five different doses (0.01, 0.05, 0.1, 0.2, and 0.5 mmol/kg) of contrast agent, with six different pulse sequences. The results show that gadopentetate dimeglumine—enhanced echo-planar images obtained during the perfusion phase can yield either positive (due to increased T1 relaxation rates) or negative (due to susceptibility-induced increased T2 relaxation rates) liver enhancement depending on choice of pulse sequence and dose. At the current clinically recommended dose of 0.1 mmol/kg, maximal liver signal enhancement was seen with a T1-weighted inversion-recovery sequence, while maximal liver signal diminution was seen with a T2*-weighted gradient-echo sequence. The authors conclude that gadopentetate dimeglumine—enhanced echo-planar imaging can provide T1, T2, and T2* contrast that may be exploited for both lesion detection and lesion characterization.     

Diffusionsgewichtete Magnetresonanztomographie in der Diagnostik der Encephalitis disseminata

Magnetic resonance (MR) imaging is one of the best methods in diagnosis of multiple sclerosis, particularly in disclosure of active demyelinating lesions. Aim of this study was to compare diffusion weighted imaging and contrast enhancement in the detection of active lesions. A MR study with a contrast enhanced T1-weighted pulse sequence with magnetization transfer presaturation and a diffusion weighted echoplanar pulse sequence (b = 1000 s/mm2) was performed in 17 patients (11 women, 6 men) with multiple sclerosis. 29 of 239 lesions showed an increased signal intensity in diffusion weighted imaging, 24 lesions a contrast enhancement, but only 16 lesions were visible in both pulse sequences. In patients with short clinical symptomatology significant more lesions could be detected with diffusion-weighted pulse sequence in comparison to patients with long standing symptomatology showing more lesions with contrast enhancement. Hence it is likely, that both pulse sequences detect different histopathologic changes. The early detection of demyelinating lesions in diffusion weighted imaging is attributed to the extracellular edema, however the contrast enhancement is caused by a blood brain barrier abnormality. It can be expected that diffusion weighted imaging will have a high impact on imaging of multiple sclerosis not only in therapeutic trials, but also in clinical routine.     

In vitro investigation of poor cerebrospinal fluid suppression on fluid-attenuated inversion recovery images in the presence of a gadolinium-based contrast agent.

Cerebrospinal fluid (CSF) enhancement on fluid-attenuated inversion recovery (FLAIR) images obtained post-gadolinium (Gd)-based agent injection is described in stroke and multiple sclerosis. Blood brain barrier (BBB) disruption with contrast agent extravasation into CSF shortens T(1) relaxation times, reducing fluid suppression. Reduced fluid suppression on FLAIR images was investigated in vitro in the presence of escalating gadopentetate dimeglumine (Gd-DTPA) concentrations mixed with artificial CSF. Low Gd-DTPA concentrations impair fluid suppression of FLAIR imaging in association with progressively reduced T(1) values. At higher concentrations, the prevalent T(2) shortening effect can explain signal intensity (SI) reduction. Post-Gd FLAIR may be useful in detecting subtle BBB leakage.     

CT and MR imaging of mediastinal hemangiomas

We describe the CT findings in two cases of mediastinal hemangioma. In one, contrast enhanced CT demonstrated peripheral puddles of contrast medium within the mass, similar to the findings seen in cavernous hemangiomas of the liver. In the other case magnetic resonance (MR) was performed; the mass had an intraspinal component and was hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences; imaging features were similar to those of neurogenic tumors. Although they have a nonspecific appearance on MR, these tumors may demonstrate characteristic contrast enhancement features on CT. Hence, hemangiomas of the mediastinum, although rare, should be included in the differential diagnosis of enhancing mediastinal masses.     

The effects of mannitol and furosemide on brain water changes in normal and MCA-occluded rats: a magnetic resonance study

Mannitol and furosemide treatment of ischaemic brain oedema caused by middle cerebral artery occlusion (MCAO) was studied by MRI in 87 rats. MRI was performed in all rats before and 30–360 min after drug infusion. The examinations were performed in the presence of an intact blood-brain barrier (BBB) 6 h after MCAO, and 3 days after MCAO at the time of maximal disruption of the BBB. Spin echo (SE) sequences were used for imaging and for determination of the relaxation times T1 and T2. Subtraction images were constructed. Furosemide dehydrated healthy and ischaemic brain. Mannitol had no dehydrating effect on healthy brain tissue. However, when the BBB was disrupted in severe oedema mannitol produced a decrease in water content, a shortening of T1 and T2, and a decrease in intracranial pressure (ICP), while in less severe oedema mannitol could increase brain water content, thus aggravating ICP. The subtraction technique allowed visualisation of the transient change in bulk in water animals with disruption of the BBB after mannitol treatment. Correspondence to: K.-Å. Thuomas     

MRI findings of Wernicke encephalopathy revisited due to hunger strike

BACKGROUND AND PURPOSE: The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings among a group of patients who presented with Wernicke encephalopathy (WE) due to the neurological complications of a long-term hunger strike (HS). METHODS: MRI studies also including the fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI) of six male patients with WE aged from 25 to 38 years (mean age 31 years) were evaluated. RESULTS: In all subjects, T2-weighted sequences, FLAIR and DWI revealed a signal hyperintensity within the posteromedial thalami and surrounding the third ventricle. In particular, on coronal images, the hyperintense areas around the third ventricle showed a suggestive "double wing" configuration. We observed an increased signal on proton-density and T2-weighted images in the mamillary bodies of three patients. Four patients demonstrated additional hyperintensities within the periaqueductal region and/or the tectal plate. At least one lesion area in five of six patients demonstrated contrast enhancement. CONCLUSION: The consistent imaging findings of our study suggest that MRI is a reliable means of diagnosing WE. Acute WE is sometimes underdiagnosed, yet early diagnosis and treatment of WE is crucial in order to avoid persistent brain damage. MRI, including postcontrast T1-weighted imaging, DWI beneath standardized T2-weighted imaging, and FLAIR sequences may prove to be a valuable adjunct to clinical diagnosis and to provide additional information in acute and/or subacute WE.     

Contrast-enhanced three-dimensional fast spoiled gradient-echo renal MR imaging: evaluation of vascular and nonvascular disease.

Breath-hold contrast material enhanced three-dimensional (3D) fast spoiled gradient-echo (FSPGR) sequences are valuable techniques for evaluation of renal arteries and veins and diagnosis of significant renal arterial stenosis at magnetic resonance (MR) imaging. The excellent spatial and contrast resolution with these techniques, combined with the ability to perform studies in multiple vascular phases, also make them attractive for the diagnosis of a wide range of nonvascular processes that affect the kidneys, including renal infections, renal parenchymal diseases, and renal trauma. Particularly when combined with T1- and T2-weighted MR imaging, the contrast-enhanced techniques are highly effective for characterization of renal masses owing to the ability to portray dynamic contrast enhancement. The ability to display venous structures with contrast-enhanced 3D FSPGR techniques helps staging of renal cell carcinoma. This article presents examples of the wide range of vascular and nonvascular renal diseases that may be effectively imaged with contrast material enhanced 3D FSPGR techniques and illustrates the usefulness of the techniques for renal MR imaging.     

Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions

Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.     

Magnetic resonance imaging of acoustic neuromas: the role of gadolinium-DTPA

Magnetic resonance imaging (MRI) was performed in 20 patients with evidence on computed tomography (CT) of 21 acoustic neuromas before and after intravenous administration (0.1-0.2 mmol/kg body weight) of gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA). Multi-section spin-echo (SE) sequences of varying repetition (TR) and echo (TE) times were performed in the transverse and coronal planes with a section thickness of 10 mm. All acoustic neuromas displayed marked enhancement on the T1-weighted (short TR/TE) SE sequence post-Gd-DTPA. The intrameatal component was particularly well demonstrated compared with non-enhanced magnetic resonance (MR) images and contrast-enhanced CT. Identification of intrameatal tumour was difficult on T2-weighted SE images and one tumour was not identified on the T1-weighted SE sequence prior to Gd-DTPA. Four of five intrameatal tumours measuring less than 8 mm could only be demonstrated on CT by using CT air meatography. Extrameatal tumour extension was demonstrated on contrast-enhanced CT, although the assessment of brain-stem involvement and displacement was not as clearly seen as on coronal MR images. In two patients with large acoustic neuromas and a cyst, the true relationship of the cyst to the tumour could only be identified on the post-Gd-DTPA scan. Magnetic resonance imaging with gadolinium-DTPA is a relatively quick, safe, well tolerated and effective method for the diagnosis of acoustic neuroma.     

Tissue characterisation of intracranial tumours: the value of magnetisation transfer and conventional MRI

We performed MRI on 85 patients with intracranial tumours to evaluate quantitative analysis in tumour characterisation. Signal intensities were measured on standard T2-and T1-weighted images, Gd-enhanced T1-weighted images and magnetisation transfer (MT) images. Statistically significant differences between tumour types were observed, but overlapping reduces their value. T2-weighted imaging was superior to T1-weighted imaging for tumour characterisation. Quantification of Gd enhancement was useful in the diagnosis of pituitary adenomas and haemangioblastomas, but of minor importance in other tumours, because of large nonspecific variation. The contribution of MT contrast to tumour characterisation resembled that of T2 contrast. However, MT imaging was superior to other sequences in the classification of intra-axial tumours. Low-grade astrocytomas, haemangioblastomas and craniopharyngiomas could be differentiated from other tumours on the basis of MT contrast. Reliable discrimination between meningiomas, high-grade astrocytomas and metastases was not possible by any of the methods.