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Open Access 01-12-2021 | Cerebral Fat Embolism | Educational Review

Microbleeds show a characteristic distribution in cerebral fat embolism

Authors: Omar Giyab, Bendegúz Balogh, Péter Bogner, Orsi Gergely, Arnold Tóth

Published in: Insights into Imaging | Issue 1/2021

Abstract

This systematic review aims to test the hypothesis that microbleeds detected by MRI are common and show a characteristic pattern in cerebral fat embolism (CFE). Eighty-four papers involving 140 CFE patients were eligible for this review based on a systematic literature search up to 31 January 2020. An additional case was added from hospital records. Patient data were individually scrutinised to extract epidemiological, clinical and imaging variables. Characteristic CFE microbleed pattern resembling a “walnut kernel” was defined as punctuate hypointensities of monotonous size, diffusely located in the subcortical white matter, the internal capsule and the corpus callosum, with mostly spared corona radiata and non-subcortical centrum semiovale, detected by susceptibility- or T2* weighted imaging. The presence rate of this pattern and other, previously described MRI markers of CFE such as the starfield pattern and further diffusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the “walnut kernel microbleed pattern”, diffusion abnormality of any pattern, the starfield pattern, and cytotoxic edema in the corpus callosum was found to be 98.11%, 89.74%, 97.64%, 68.5%, and 77.27% respectively. The presence rate between the walnut kernel and the starfield pattern was significantly (p < 0.05) different. Microbleeds are common and mostly occur in a characteristic pattern resembling a “walnut kernel” in the CFE MRI literature. Microbleeds of this pattern in SWI or T2* MRI, along with the starfield pattern in diffusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.

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Title: Microbleeds show a characteristic distribution in cerebral fat embolism
Authors: Omar Giyab
Bendegúz Balogh
Péter Bogner
Orsi Gergely
Arnold Tóth
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Cerebral Fat Embolism
Edema
Published in: Insights into Imaging / Issue 1/2021
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-021-00988-6

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Microbleeds show a characteristic distribution in cerebral fat embolism

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