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Published on: September 16, 2017
T2*-Weighted and Diffusion Magnetic Resonance Imaging Differentiation of Cerebral Fat Embolism From Diffuse Axonal
Aaron M Rutman1, Elliot J Rapp, Daniel S Hippe
1From the Departments of *Radiology, and †Engineering, University of Washington, Seattle, WA.
Insights
Magnetic resonance imaging can differentiate cerebral fat embolism (CFE) from diffuse axonal injury (DAI). CFE shows more hemorrhages, while DAI has larger, linear hemorrhages. DWI findings differ between CFE and DAI.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebral fat embolism (CFE) and diffuse axonal injury (DAI) are distinct neurological conditions.
- Differentiating CFE and DAI is crucial for appropriate patient management.
- Diffusion-weighted imaging (DWI) and T2*-weighted imaging are advanced MRI techniques.
Purpose of the Study:
- To differentiate cerebral fat embolism (CFE) from diffuse axonal injury (DAI) using MRI.
- To analyze hemorrhage characteristics and DWI lesion patterns in CFE and DAI.
Main Methods:
- Retrospective analysis of consecutive CFE and DAI cases.
- Characterization of hemorrhages (number, size, shape, distribution) and DWI lesions (pattern).
- Statistical comparison using Mann-Whitney and Fisher exact tests.
Main Results:
- CFE cases (n=7) showed significantly more hemorrhages than DAI cases (n=20).
- CFE microhemorrhages were punctate/round; DAI hemorrhages were small/medium and linear.
- DAI had few scattered DWI abnormalities; CFE showed confluent abnormalities.
Conclusions:
- MRI, specifically DWI and T2*-weighted imaging, can differentiate CFE from DAI.
- CFE is associated with a higher number of hemorrhages.
- Hemorrhage characteristics and DWI patterns are key differentiating features.
Objective:
This study differentiates cerebral fat embolism (CFE) and diffuse axonal injury (DAI) on diffusion-weighted magnetic resonance imaging (DWI) and T2*-weighted magnetic resonance imaging.
Methods:
Consecutive CFE and DAI cases were retrospectively selected. Hemorrhages were characterized by number, size/shape, and distribution, whereas DWI lesions by pattern. The number of hemorrhages was compared using the Mann-Whitney test with adjustment for multiple comparisons, whereas DWI abnormality was compared using Fisher exact test.
Results:
Seven CFE and 20 DAI patients were included. Cerebral fat embolism had significantly more hemorrhages than DAI (mean, 670 ± 407 vs 136 ± 87; P = 0.01), particularly in the frontal (P = 0.025), parietal (P = 0.002), and occipital lobes (P = 0.01), the corpus callosum (P = 0.01), and cerebellum (P = 0.01). Cerebral fat embolism microhemorrhages were punctate/round, whereas DAI hemorrhages were small/medium sized (P < 0.001) and linear (P = 0.001). On DWI, DAI typically had few scattered abnormalities, whereas CFE had confluent abnormalities (P < 0.05).
Conclusions:
Magnetic resonance imaging can differentiate CFE from DAI. Cerebral fat embolism demonstrates more hemorrhages. Larger or linear hemorrhages favor DAI. Diffuse confluent diffusion restriction favors CFE, whereas few scattered foci favor DAI.
