Imaging

Cerebral Edema

Preliminary Diagnosis: Cerebral Edema

I. What imaging technique is first-line for this diagnosis?

  • Noncontrast CT of the brain

II. Describe the advantages and disadvantages of this technique for diagnosis of cerebral edema.

Advantages

  • Relatively inexpensive and efficient way of imaging the brain for parenchymal edema

  • Best for evaluating for any associated osseous abnormality, i.e., cerebral edema in the setting of trauma and associated calvarial fracture

Disadvantages

  • Exposes patients to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

Noncontrast MRI of the brain may additionally be performed to detect subtle edema and any associated complications or underlying causes.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of cerebral edema.

Noncontrast MRI of the brain

Advantages

  • Offers better visualization of underlying gray and white matter than CT

  • Able to better detect subtle brain parenchymal edema and any underyling intra- or extra-axial lesion recently in vasogenic edema than CT

  • Able to detect a focal infarct any associated cytotoxic edema with 100% certainty

Disadvantages

  • Subject to motion artifact due to length of exam, which may degrade image quality

  • Expensive

VI. What are the contraindications for the alternative imaging techniques?

Noncontrast MRI of the brain

Contraindicated in patients with non-MR-compatible hardware

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