Magnetic resonance imaging findings in cerebral fat embolism: Correlation with clinical manifestations

Objectives: 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 II patients with CFE. Methods: Glasgow Coma Scale score, Pao(2), Paco(2) at the onset, and mininal 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 T-2-weighted images. Results: High-intensity T-2 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 T-2 signal lesions fused and enlarged with time. In most cases, they diminished within 2 weeks. Three patients had persistent morbidity, Conclusion: MRI-T-2-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.