Signal Intensity within Cerebral Venous Sinuses on Synthetic MRI

PURPOSE: Flowing blood sometimes appears bright on synthetic T(1)-weighted images, which could be misdiagnosed as a thrombus. This study aimed to investigate the frequency of hyperintensity within cerebral venous sinuses on synthetic MR images and to evaluate the influence of increasing flow rates on signal intensity using a flow phantom. MATERIALS AND METHODS: Imaging data, including synthetic and conventional MRI scans, from 22 patients were retrospectively analyzed. Signal intensities at eight locations of cerebral venous sinuses on synthetic images were graded using the following three-point scale: 0, “dark vessel”; 1, “hyperintensity within the walls”; and 2, “hyperintensity within the lumen.” A phantom with gadolinium solution inside a U-shaped tube was acquired without flow and then with increasing flow rates (60, 100, 200, 300, 400 ml/min). RESULTS: Considering all sinus locations, the venous signal intensity on synthetic T(1)-weighted images was graded as 2 in 79.8% of the patients. On synthetic T(2)-weighted images, all sinuses were graded as 0. On fluid-attenuated inversion recovery (FLAIR) images, sinuses were almost always graded as 0 (99.4%). In the phantom study, the signal initially became brighter on synthetic T(1)-weighted images as the flow rate increased. Above a certain flow rate, the signal started to decrease. CONCLUSION: High signal intensity within the cerebral venous sinuses is a frequent finding on synthetic T(1)-weighted images. This corresponds to the hyperintensity noted at certain flow rates in the phantom experiment.