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Diffusion-Weighted MR Imaging of Subdural Empyemas in Children

Alex M. Wonga,b, Robert A. Zimmermana, Erin M. Simona, Avrum N. Pollocka and Larissa T. Bilaniuka

a Department of Radiology, the Children Hospital of Philadelphia, PA
a Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Kwei Shan, Tao Yuan, Taiwan, ROC



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  		FIG 1. Patient 8. Bifrontal and right parafalcine SDE.

A. Axial T1WI (650/14) shows slight hypointensity in the SDE (arrows).

B, Axial T2WI (6000/99) shows intermediate signal intensity in the bifrontal collections (arrows) and hyperintensity in the right parafalcine collection (arrowheads).

C, Coronal contrast-enhanced T1WI (800/20) with MT shows irregular capsular enhancement of the collections (arrows).

D and E, Axial DWI (4000/110, b = 1000 s/mm2) and ADC map show reduced water diffusion in the SDE.



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  		FIG 2. Patient 1. Right SDE and left RSE.

A, Axial T1WI (650/14) shows intermediate signal intensity in the right SDE and hypointensity in the left RSE.

B, Axial T2WI (6000/99) shows high signal intensity in both subdural collections. Strands of intermediate signal intensity (arrows) are noted in the right SDE.

C, Axial contrast-enhanced T1WI (800/20) with MT shows peripheral enhancement of both subdural collections. The enhancement is thicker in the right SDE (arrows) than in the left RSE (arrowheads).

D, Axial DWI (4000/110, b = 1000 s/mm2) shows mixed high (arrows) and low signal intensities in the right SDE.

E, Corresponding ADC map shows mixed low (arrows) and high signal intensities in the right SDE, indicating heterogeneous water motion. Increased water motion is noted in the left RSE.



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  		FIG 3. Patient 7. Follow-up DWI show superimposed infection of a right RSE in this 10-year-old boy with right temporal and parafalcine SDEs.

A, Coronal contrast-enhanced T1WI (800/20) with MT shows capsular enhancement (arrows) of the right parietal subdural collection and the anterior aspect of the right temporal base SDE.

B, Axial DWI (4000/110, b = 1000 s/mm2) shows increased diffusion in the collections.

C, Follow-up coronal contrast-enhanced T1WI (800/20) with MT shows no substantial change in the capsular contrast enhancement of the collection.

D, Follow-up axial DWI (4000/110, b = 1000 s/mm2) shows increased signal intensity in the collection (arrows) and the interhemispheric fissure, suggesting superimposed infection.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X