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Published on: November 30, 2021
Distinguishing necrotizing from non-necrotizing fasciitis: a new predictive scoring integrating MRI in the LRINEC
Min A Yoon1, Hye Won Chung2, Yujin Yeo1
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Objectives:
To develop and validate a scoring system integrating MRI and laboratory findings to differentiate necrotizing fasciitis (NF) from non-necrotizing fasciitis (non-NF).
Methods:
This retrospective study included 144 subjects who underwent surgery in one of three tertiary referral centers for NF or cellulitis with non-NF. The development cohort consisted of 96 subjects (NF = 47; non-NF = 49) from one center, and the validation cohort consisted of 48 subjects (NF = 23; cellulitis with non-NF = 25) from two different centers. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system and five MRI findings (thickening of the intermuscular deep fascia ≥ 3 mm, extensive involvement of the deep fascia, multi-compartmental involvement in one extremity, presence of gas, and contrast-enhancement pattern) were included in univariate and multivariate logistic regression analysis to identify independent predictors of NF. An additive scoring system was developed using the coefficients of the final regression model. Model performance was assessed for discrimination and calibration. The scoring system was externally validated.
Result:
The final scoring system consisted of three variables: thickening of the deep fascia ≥ 3 mm, multi-compartmental involvement, and LRINEC score. The new predictive model showed improved performance (area under the receiver operating characteristic curve [AUC], 0.862; positive and negative predictive values, 82% and 79%, respectively), compared with the LRINEC score alone (0.814, 77% and 67%, respectively). The model also showed good discrimination with the external validation dataset (AUC, 0.933).
Conclusions:
Differentiation of NF from severe cellulitis with non-NF can be achieved with the new predictive scoring system.
Key Points:
• The new predictive scoring system integrating two MRI findings with the LRINEC score can help in the differentiation of necrotizing fasciitis from severe cellulitis with non-necrotizing fasciitis. • Thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement were the most important MRI findings for the differentiation.
Insights
A new scoring system combining MRI findings and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score accurately differentiates necrotizing fasciitis (NF) from severe cellulitis. This tool improves diagnostic accuracy for NF.
Area of Science:
- Radiology and Imaging
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing fasciitis (NF) is a severe soft tissue infection requiring prompt diagnosis and treatment.
- Differentiating NF from severe cellulitis can be challenging, leading to delayed treatment or unnecessary surgery.
- Existing diagnostic tools, like the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, have limitations.
Purpose of the Study:
- To develop and validate a novel scoring system integrating Magnetic Resonance Imaging (MRI) findings with laboratory data.
- To enhance the diagnostic accuracy in distinguishing NF from non-necrotizing fasciitis (non-NF), including severe cellulitis.
- To provide clinicians with a more reliable tool for surgical decision-making in suspected NF cases.
Main Methods:
- A retrospective study involving 144 patients with suspected NF or cellulitis across three tertiary centers.
- Development and validation cohorts were used to identify independent predictors of NF through logistic regression analysis.
- Key MRI findings (fascial thickening, compartmental involvement, gas, enhancement patterns) and the LRINEC score were analyzed.
Main Results:
- A new scoring system was developed, incorporating deep fascial thickening (≥3 mm), multi-compartmental involvement, and the LRINEC score.
- The novel model demonstrated superior performance (AUC 0.862) compared to the LRINEC score alone (AUC 0.814).
- External validation confirmed the model's robust diagnostic capability (AUC 0.933).
Conclusions:
- The developed scoring system effectively differentiates NF from severe cellulitis with non-NF.
- Integrating specific MRI findings with the LRINEC score significantly improves diagnostic accuracy.
- This tool aids in timely and appropriate management of patients with suspected necrotizing fasciitis.
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