Mahmud Mossa-Basha MD, Presenter: Nothing to Disclose

Brian Eichinger MD, Abstract Co-Author: Nothing to Disclose

Manal El Refaei MD, Abstract Co-Author: Nothing to Disclose

Nafi Aygun MD, Abstract Co-Author: Nothing to Disclose

Daniel S. Hippe MS, Abstract Co-Author: Research Grant, Koninklijke Philips NV Research Grant, General Electric Company

The aim of this study is to compare the MR imaging characteristics of CFE and hemorrhagic DAI, as well as compare findings on SWI and GRE in both disease processes.

Adult patients were selected based on clinical characteristics of CFE, GCS of 14-15 at initial presentation with a latent decline to <6T, no LOC at time of injury and normal initial head CT. Hemorrhagic DAI patients were selected who presented with GCS<6T, no latent decline in GCS and no long bone fractures, to exclude the possibility of superimposed CFE. A single double blinded rater evaluated the T2-FLAIR and DWI pattern and extent of disease, and evaluated SWI and GRE for size, configuration and number of hemorrhagic lesions at the following stations:frontal, parietal, occipital and temporal subcortical, periventricular and deep white matter, medulla, pons, midbrain, cerebellum and striatocapsular regions. Hemorrhages were counted and categorized accordingly:0, 1-5, 6-10, 11-20, >20 lesions at each station, and total lesions were also categorized:0, 1-10, 11-20, 21-100, 101-200, >200. Hemorrhage size was assessed on the following criteria: punctate<3, small 4-10, medium 10-20 and large>20 mm. Mann-Whitney statistical analysis test was performed at each station and whole brain for each sequence and for hemorrhagic lesion size and shape.

12 patients with CFE and 16 patients with DAI were selected. 6 CFE had SWI only, 3 GRE and 3 had both. 11 DAI had SWI, and 5 had GRE only. CFE usually presented with confluent, patchy or punctate white matter abnormalities on FLAIR, while DAI had better defined lesions intermediate in size. On DWI, CFE had significantly more lesions (p=.027), typically with confluent or punctate abnormality. There was no significant difference in the total number of hemorrhagic lesions (p=.72), but CFE had significantly more lesions in the pv (p=.0011) and deep (p=.0061) white matter, brainstem and cerebellum.  CFE hemorrhages were typically smaller (p=.0061) and punctate or small, while DAI showed small and linear hemorrhages. There was a difference in the number of hemorrhages seen on SWI and GRE for both diseases, but this was more pronounced for CFE.

CFE can be differentiated from DAI on MRI, and should be evaluated using SWI in place of GRE.

Differentiation of CFE from hemorrhagic DAI is important for prognostic purposes, and in CFE can prevent future events with prompt treatment of the cause.

Mossa-Basha, M, Eichinger, B, El Refaei, M, Aygun, N, Hippe, D, Blood on the Brain:  Differentiation of Traumatic Cerebral Fat Embolism from Hemorrhagic Shear Injury on MR Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008161.html