Contrast-enhanced MR imaging of cerebral fat embolism: case report and review of the literature

Abstract

We report a case of cerebral fat embolism (CFE) that was imaged with T2- and T2*-weighted, fluid-attenuated inversion recovery, and contrast-enhanced T1-weighted images. Multiple white matter lesions demonstrated contrast enhancement, with little evidence of hemorrhage. The patient regained complete neurologic function. CFE can cause capillary inflammation and breakdown of the blood-brain barrier, without associated hemorrhage or permanent neurologic deficit. In this case, both contrast-enhanced T1-weighted and gradient-echo T2*-weighted images were important in diagnosing CFE and in determining the severity of the patient's condition.

Fig 1.

Fluid-attenuated inversion recovery MR images of the brain acquired 9 days after a repair of long-bone fractures show multiple focal lesions in the periventricular, deep, and subcortical white matter. These are characteristic of CFE.

Fig 2.

Contrast-enhanced MR images of the brain show focal enhancement in many of the white matter lesions.

Fig 3.

T2*-weighted gradient-echo MR images of the brain show a single focus of susceptibility (arrow in C) in the left frontal white matter. This finding suggests a preexisting focus of hemorrhage from axonal shear injury or CFE or both. However, hemorrhage was not a predominant feature of the multiple white-matter lesions arising from CFE in this case.