Prospective study examining the probability of cerebral fat embolism based on magnetic resonance imaging
Norihide Kanda,
Takahito Miyake,
Hideshi Okada,
Yosuke Mizuno,
Masahiro Ichihashi,
Yoshinori Kakino,
Tetsuya Fukuta,
Yuichiro Kitagawa,
Ryu Yasuda,
Kodai Suzuki,
Yukichi Tanahashi,
Tomohiro Ando,
Takahiko Asano,
Takahiro Yoshida,
Shozo Yoshida,
Masayuki Matsuo,
Shinji Ogura
Affiliations
Norihide Kanda
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Takahito Miyake
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Corresponding author.
Hideshi Okada
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Yosuke Mizuno
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Masahiro Ichihashi
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Yoshinori Kakino
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Tetsuya Fukuta
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Yuichiro Kitagawa
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Ryu Yasuda
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Kodai Suzuki
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Yukichi Tanahashi
Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
Tomohiro Ando
Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
Takahiko Asano
Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
Takahiro Yoshida
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Shozo Yoshida
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Abuse Prevention Centre, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Masayuki Matsuo
Department of Radiology, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
Shinji Ogura
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
Purpose: Cerebral fat embolism (CFE) is a rare syndrome caused by the embolization of fat particles into the brain circulation. This prospective single-center observational study investigated the incidence of CFE in long-bone or pelvic fractures based on magnetic resonance imaging (MRI) findings. The purpose of this study was to investigate the incidence of CFE by MRI findings with or without symptoms suggestive of CFE. Methods: Eligible patients were consecutive, aged 15 years or older, with high-energy traumas, including pelvic or femur fractures. Excluded patients were those who died, could not undergo MRI resulting from medical conditions, or had insufficient mental capacity and no consultee to provide consent. The MRI was scheduled within 4 weeks of the injury, and the images were reviewed by one of the three neuroradiologists who were unaware of the patient's clinical information. Patient data regarding demographics, preceding trauma, injury severity score (ISS), presentation and examination timing of MRI, management including surgery, and outcome were collected. Results: Sixty-two patients were recruited, and three patients were excluded. All patients were injured by blunt trauma. The median patient age was 44 years. The median ISS was 13, and 53 patients needed surgical fixation. There were 22 patients with long-bone fractures, all of whom received external fixation or intramedullary nailing on admission day. MRI was performed after a median hospital day of 18 days. Using MRI imaging, three (5.0%) patients were diagnosed with CFE, and three patients were suspected of CFE. Conclusions: This is the first study to prospectively examine the probability of CFE based on MRI. Since fat embolism syndrome (FES) is confirmed in patients without clinical symptoms, CFE may be more common in patients with trauma than currently believed. Therefore, studies to determine the diagnostic criteria combined with symptoms, MRI, or other objective findings are required in the future.
