Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations.
OBJECTIVE
Cerebral fat embolism (CFE) is a serious complication after fracture of long bones. The mortality rate of CFE may be high. However, recent progress in treatment may decrease the mortality. We studied the validity of magnetic resonance imaging (MRI) to detect and grade severity of CFE in 11 patients with CFE.


METHODS
Glasgow Coma Scale score, PaO2, PaCO2 at the onset, and minimal hemoglobin and platelet levels were monitored, and phagocytes in bronchoalveolar lavage fluid were counted. Brain computed tomographic and MRI scans were performed serially. MRI findings were graded into four categories according to the severity of T2-weighted images.


RESULTS
High-intensity T2 signals were identified in the various brain regions as early as 4 hours after onset of CFE. The maximum MRI grade significantly correlated with Glasgow Coma Scale score at the onset of CFE (p < 0.01). High-intensity T2 signal lesions fused and enlarged with time. In most cases, they diminished within 2 weeks. Three patients had persistent morbidity.


CONCLUSIONS
MRI-T2-weighted imaging seems to be the most sensitive imaging technique for diagnosing CFE, and correlates well with the clinical severity of brain Injury. With the aid of proper treatment for pulmonary fat embolism, CFE is a potentially reversible disease that can have a good outcome.
Department of Neurosurgery, Showa University, Fujigaoka Hospital, Yokohama, Japan.
M
M
Takahashi
R
R
Suzuki
Y
Y
Osakabe
J I
JI
Asai
T
T
Miyo
G
G
Nagashima
T
T
Fujimoto
Y
Y
Takahashi
D000328:Adult; D004620:Embolism, Fat / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications*; D015600:Glasgow Coma Scale; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome