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Cerebrospinal Fluid Signal Intensity Increase on FLAIR MR Images in Patients under General Anesthesia: The Role of Supplemental O₂¹

¹ From the Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific St, Seattle, WA 98195-7115 (A.V.D., D.J.F., K.R.M.); and the Department of Anesthesiology, Harborview Medical Center, Seattle, Wash (A.M.L.). Received February 2, 2000; revision requested March 16; revision received May 16; accepted June 1. Address correspondence to K.R.M. (e-mail: kmarav@u.washington.edu).

PURPOSE: To determine whether increased cerebrospinal fluid (CSF) signal intensity is seen on fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images in patients under general anesthesia and to investigate the cause of these changes.

MATERIALS AND METHODS: MR images from nine examinations performed in eight patients under general anesthesia were reviewed retrospectively. In phantom experiments, T1 measurements obtained with several inhaled anesthetic agents and propofol dissolved in saline were compared with those obtained with either 100% O₂ or room air. To confirm phantom experiment results, a healthy volunteer underwent sequential FLAIR imaging while breathing high-flow 100% O₂.

RESULTS: Of the nine examinations performed with patients under general anesthesia, eight had resultant images that showed increased CSF signal intensity within the basal cisterns and sulci over the cerebral convexities. Anesthetic phantom measurements showed T1 shortening only when the agent was administered with high concentrations of oxygen. In the healthy volunteer, images obtained before and during administration of 100% O₂ demonstrated increased CSF signal intensity after O₂ administration; this was identical to the changes observed in patients under anesthesia.

CONCLUSION: The paramagnetic effects of supplemental O₂ administration result in shortened CSF T1. Radiologists should be aware of this phenomenon to avoid attributing increased CSF signal intensity on FLAIR images to abnormal CSF properties such as hemorrhage or elevated protein content.

Index terms: Anesthesia • Brain, MR, 10.121411, 10.121413, 10.121415 • Cerebrospinal fluid, MR, 167.121411, 167.121413, 167.121415 • Magnetic resonance (MR), contrast enhancement, 10.12143, 167.121413 • Oxygen • Phantoms

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