Microbleeds show a characteristic distribution in cerebral fat embolism

Giyab, Omar and Balogh, Bendegúz and Bogner, Péter and Gergely, Orsi and Tóth, Arnold (2021) Microbleeds show a characteristic distribution in cerebral fat embolism. INSIGHTS INTO IMAGING, 12 (1). ISSN 1869-4101

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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 defned as punctuate hypointensities of monotonous size, difusely 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 starfeld pattern and further difusion abnormalities were recorded and statistically compared. The presence rate of microbleeds of any pattern, the “walnut kernel microbleed pattern”, difusion abnormality of any pattern, the starfeld 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 starfeld pattern was signifcantly (p<0.05) diferent. 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 starfeld pattern in difusion imaging appear to be the most important imaging markers of CFE and may aid the diagnosis in clinically equivocal cases.

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