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[Magnetic resonance imaging of supratentorial and parafalcial empyema]
Y Takamura1, T Uede, K Igarashi
1Department of Neurosurgery, Kushiro City General Hospital.
Abstract:
The authors report the MR imaging of two patients with multiple subdural empyemas, including one in the interhemispheric fissure. MRI demonstrated convexity and interhemispheric collections which were mild hyperintense relative to CSF, hypointense relative to gray and white matter on T1W1, and marked hyperintense relative to CSF, and brain on T2W1. On the basis of signal intensity differences, MRI can distinguish subdural empyemas from most sterile effusions and chronic subdural hematomas with similar CT appearances. MRI was found to be clearly more sensitive to subdural empyemas than CT, though such lesions missed on CT were considered to be relevant. MR was superior to CT in demonstrating the nature, presence, and extent of these lesions. In both cases, the capsule of the lesions demonstrated enhancement, and connection between each lesion was obvious on contrast-enhanced MRI. It seems that contrast-enhanced MR image may detect encapsulation of an abscess which can not be detected from contrast-enhanced CT. We emphasized that the most significant factor in the successful surgical management of multiple subdural empyema, particularly including interhemispheric collections is the accurate location of pus. This can be reliably achieved with MR imaging.
Insights
Magnetic Resonance (MR) imaging accurately detects multiple subdural empyemas, including those in the interhemispheric fissure. MR imaging is more sensitive than CT scans for identifying these brain infections and guiding surgical treatment.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Subdural empyemas are collections of pus between the dura mater and the arachnoid mater.
- Accurate diagnosis and localization are crucial for effective surgical management.
Observation:
- MR imaging revealed subdural empyemas with characteristic signal intensities on T1-weighted and T2-weighted images.
- Contrast-enhanced MR imaging demonstrated lesion encapsulation and interconnections, which were not apparent on CT scans.
Findings:
- MR imaging exhibited superior sensitivity and accuracy compared to CT in detecting and characterizing multiple subdural empyemas, including interhemispheric collections.
- Signal intensity differences on MR imaging aid in differentiating subdural empyemas from sterile effusions and chronic subdural hematomas.
Implications:
- Enhanced visualization of subdural empyemas with MR imaging improves surgical planning and patient outcomes.
- Contrast-enhanced MR imaging is valuable for detecting abscess encapsulation, aiding in surgical intervention for complex cases.