In the spine, the differential diagnosis for subarachnoid T1 hyperintense lesions on MRI includes fibrolipomas, lipomas, epidural lipomatosis, dermoid, hemorrhage, and melanoma. Without an appropriate clinical history, CT can help differentiate among some of these possibilities; fat is typically very hypoattenuating on CT, while subacute hemorrhage and melanoma have intermediate attenuation. The differential diagnosis for leptomeningeal dissemination of Pantopaque into the intracranial compartment with hyperattenuation on CT mainly includes meningoangiomatosis and subarachnoid hemorrhage. On MRI, ruptured dermoid, leptomeningeal melanoma and/or hemorrhagic metastases, and subacute subarachnoid hemorrhage are potential differential diagnostic considerations.