We wished to assess the merits and weaknesses of postcontrast fat-suppression (FS) brain MR imaging in children for the evaluation of various enhancing lesions as compared with postcontrast conventional T1-weighted or magnetization transfer (MT) imaging.

We reviewed the records of those patients with enhancing lesions on brain MR imaging who had undergone both FS imaging and one of the conventional T1-weighted or MT imaging as a postcontrast T1-weighted brain MR imaging. Thirty-one patients (21 male, 10 female; mean age, 8.7 years) with 38 enhancing lesions (18 intra-axial, 16 extra-axial and 4 orbital locations) were included in this study. There were 27 pairs of FS and conventional imagings, and 13 pairs of FS and MT imagings available for evaluation. Two radiologists visually assessed by consensus the lesions' conspicuity, and they also looked for the presence of flow or susceptibility artifacts in a total of 40 pairs of MR imagings. For 19 measurable lesions (14 pairs of FS and conventional T1-weighted imagings, 5 pairs of FS and MT imagings), the contrast ratios between the lesion and the normal brain ([SIlesion-SIwater]/[SInormal brain-SIwater]) were calculated and compared.

Compared with conventional imaging, the lesion conspicuity on FS imaging was better in 10 cases (7 extra-axial lesions, 2 orbital lesions and 1 fat-containing intra-axial lesion), equal in 16 cases, and worse in one case. Compared with MT imaging, the lesion conspicuity on FS imaging was better in 3 cases (2 extra-axial lesions and 1 intra-axial lesion), equal in 8 cases, and worse in 2 cases. Image quality of FS imaging was compromised by flow or susceptibility artifacts for 7 patients. The contrast ratios for FS imaging were not significantly different from those for conventional imaging (2.2±0.7 vs. 2.2±0.6, respectively, p=0.914) and they were significantly lower than those for MT imaging (2.4±0.8 vs. 4.5±1.5, respectively, p=0.018).

Postcontrast FS brain MR imaging appears to be better than the conventional T1-weighted imaging and comparable to MT imaging for the visual assessment of enhancing lesions. Especially, the FS imaging has the merit to delineate orbital and extra-axial enhancing lesions or fat-containing lesions, whereas it is disadvantageous when flow or susceptibility artifacts occur.