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Subdural and epidural empyemas: MR imaging
K Weingarten1, R D Zimmerman, R D Becker
1Department of Radiology, New York Hospital-Cornell Medical Center, NY 10021.
Abstract:
The MR images of six patients with extraaxial empyemas (five subdural and four epidural) were reviewed and compared with CT scans. MR demonstrated convexity and interhemispheric collections, which were mildly hyperintense relative to CSF and hypointense relative to white matter on short TR pulse sequences and hyperintense relative to CSF and white matter on long TR pulse sequences, allowing distinction from sterile effusions and most chronic hematomas. A hypointense rim, representing displaced dura, was depicted at the interface between the lesion and brain in epidural empyemas, a feature absent in subdural empyemas. Inflammation-induced parenchymal abnormalities, including edema, mass effect, and reversible cortical hyperintensity, were well depicted on MR imaging. MR was superior to CT in demonstrating the presence, nature, and extent of these lesions in all cases. Because early and accurate diagnosis will significantly improve the prognosis of these serious infections, MR is preferred to CT for patients in whom an acute intracranial infection is suspected.
Insights
Magnetic resonance imaging (MRI) is superior to CT scans for diagnosing extraaxial empyemas. MRI effectively visualizes these infections and associated brain abnormalities, improving patient prognosis.
Area of Science:
- Neuroradiology
- Medical Imaging
- Infectious Disease
Background:
- Extraaxial empyemas are serious intracranial infections requiring prompt diagnosis.
- Computed tomography (CT) has limitations in fully characterizing these lesions.
- Magnetic resonance imaging (MRI) offers advanced visualization capabilities.
Observation:
- Six patients with extraaxial empyemas underwent both MRI and CT imaging.
- MRI sequences revealed characteristic signal intensities for empyemas.
- A hypointense rim was noted in epidural empyemas, differentiating them from subdural types.
Findings:
- MRI demonstrated superior visualization of empyema collections compared to CT.
- Characteristic MRI signal changes helped distinguish empyemas from sterile effusions and hematomas.
- MRI effectively depicted inflammation-induced parenchymal changes like edema and mass effect.
Implications:
- Early and accurate diagnosis of intracranial infections is crucial for improved patient outcomes.
- MRI is the preferred imaging modality for suspected acute intracranial infections.
- Advanced MRI visualization aids in precise diagnosis and management of extraaxial empyemas.