MRI Hyperintensity: Causes and Clinical Significance
Hyperintensity on MRI means an area appears brighter than surrounding tissue on T2-weighted or FLAIR sequences. It reflects increased water content, altered macromolecular structure, or magnetic susceptibility effects.
Common Causes
- Edema: Vasogenic (BBB breakdown) or cytotoxic (cellular swelling).
- Inflammation/Demyelination: MS plaques, encephalitis, ADEM.
- Ischemia/Infarction: Acute/subacute stroke (DWI bright, ADC dark).
- Hemorrhage: Subacute blood (methemoglobin) is T1/T2 bright.
- Neoplasm: Tumor infiltration, peritumoral edema.
- Infection: Abscess, cerebritis.
- Fat/Protein: Lipomas, dermoids, high-protein cysts.
- Artifacts: Metal susceptibility, motion, flow.
Interpretation
Hyperintensity is non-specific. Diagnosis requires correlation with clinical history, other sequences (T1, DWI, GRE, contrast), and sometimes follow-up or biopsy.
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