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MR imaging in acute infectious cellulitis
A Rahmouni1, O Chosidow, D Mathieu
1Department of Radiology, Hôpital Henri Mondor, Créteil, France.
Purpose:
To describe magnetic resonance (MR) imaging findings in acute infectious cellulitis and assess its value for the diagnosis of severe necrotizing forms.
Materials And Methods:
Spin-echo (SE) T1- and T2-weighted imaging was performed in 36 patients with acute infectious cellulitis. T1-weighted SE images obtained after injection of a paramagnetic contrast agent were also obtained when an abscess was suspected on precontrast images. Sixteen patients underwent surgical débridement, along with fascial and muscle biopsy.
Results:
Distinct MR imaging features were found in patients with necrotizing soft-tissue infections, that is, hyperintense signal on T2-weighted images at the deep fasciae, poorly defined areas of hyperintense signal on T2-weighted images within muscles, and peripheral enhancement on contrast material-enhanced T1-weighted images. In nonnecrotizing cellulitis, signal intensity abnormalities were seen only in the subcutaneous fat.
Conclusion:
The precise extent of acute cellulitis and the presence of necrotizing soft-tissue infections can be determined with MR imaging, particularly on T2-weighted images.
Insights
Magnetic resonance (MR) imaging can identify severe necrotizing infections in acute cellulitis. Specific MR imaging features, especially on T2-weighted images, help differentiate between necrotizing and non-necrotizing forms.
Area of Science:
- Radiology
- Infectious Diseases
- Medical Imaging
Background:
- Cellulitis is a common bacterial skin infection.
- Necrotizing soft-tissue infections are severe forms requiring prompt diagnosis.
- Accurate differentiation between necrotizing and non-necrotizing cellulitis is crucial for appropriate management.
Purpose of the Study:
- To detail magnetic resonance (MR) imaging findings in acute infectious cellulitis.
- To evaluate the diagnostic utility of MR imaging for identifying severe necrotizing forms of cellulitis.
Main Methods:
- Spin-echo (SE) T1- and T2-weighted MR imaging was performed on 36 patients with acute infectious cellulitis.
- Contrast-enhanced T1-weighted SE imaging was utilized when abscesses were suspected.
- Surgical débridement and tissue biopsies were conducted in 16 patients.
Main Results:
- Distinct MR imaging features were observed in necrotizing soft-tissue infections, including deep fascial hyperintensity on T2-weighted images, ill-defined muscular hyperintensity on T2-weighted images, and peripheral enhancement on contrast-enhanced T1-weighted images.
- Non-necrotizing cellulitis showed signal intensity abnormalities confined to the subcutaneous fat.
- MR imaging effectively delineated the extent of infection.
Conclusions:
- MR imaging is valuable for determining the precise extent of acute cellulitis.
- MR imaging, particularly T2-weighted sequences, aids in diagnosing necrotizing soft-tissue infections.