Subdural empyema MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]


MRI in the optimal imaging study in the diagnosis of subdural empyema. Findings on MRI suggestive of subdural empyema are similar to those on CT scan, and include a crescent or bi-convex shaped collection. A surrounding membrane that enhances intensely and uniformly following gadolinium enhancement is typically identified and may also demonstrate restricted diffusion.[1]


MRI with gadolinium enhancement is considered the optimal imaging study for intracranial and spinal subdural empyema. MRI clearly reveals pus collections, and potentially meningitis. The characteristic image suggestive of a subdural empyema on an MRI is a fluid collection in a crescent shape surrounded by a contrast-enhancing rim. On MRI, subdural empyema appears with a low signal on T1 and a high signal on T2 weighted images.[2] MRI may be used in emergency situations, with high level of suspicion, for the potential diagnosis of subdural empyema at a time when symptoms include headache and fever, and there is absence of focal neurologic signs.[3] The diffusion-weighted imaging method increases the precision of diagnosis and offers the ability to monitor antibiotic therapy.[4] Additionally, the MRI should be evaluated for the presence of epidural abscess, meningitis, brain abscess, cerebral edema, sinusitis, otitis, and mastoiditis.[3]

MRI demonstrating extensive subdural collections with rim enhancement and diffusion restriction, consistent with subdural empyema


  1. Subdural empyema. (2015). Accessed on December 4, 2015.
  2. Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
  3. 3.0 3.1 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
  4. Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.

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