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Updated: Aug 25, 2026
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
Deep fascial hyperintensity in soft-tissue abnormalities as revealed by T2-weighted MR imaging
N N Loh1, I Y Ch'en, L P Cheung
1Department of Diagnostic Radiology, Stanford University Medical Center, CA 94305, USA.
Objective:
The purpose of this study was to determine whether recently described criteria, including hyperintense T2-weighted signal or other abnormalities revealed by MR imaging within deep fascial planes, are specific for necrotizing soft-tissue infections.
Materials And Methods:
We reviewed 22 MR imaging examinations that revealed abnormally high signal intensity within deep fascial planes on T2-weighted images. Twenty-one of the patients had clinical diagnoses other than necrotizing soft-tissue infection, including nonnecrotizing cellulitis (n = 4), abscess without evidence of necrotizing fasciitis (n = 5), and cellulitis with accompanying vascular thrombosis (n = 2). MR imaging was performed using T1-weighted spin-echo (range of TRs/range of TEs, 300-800/9-30) and fat-saturated T2-weighted fast spin-echo (3000-5000/76-108) sequences. Gadolinium-enhanced T1-weighted spin-echo MR images with fat saturation were obtained for 14 patients. Two reviewers, unaware of clinical diagnoses, evaluated each study for abnormalities in superficial and deep soft tissues and submitted a consensus diagnosis.
Results:
Using only the described MR imaging criteria, we interpreted all cases as necrotizing cellulitis, including the cases of 21 patients who had nonnecrotizing conditions.
Conclusion:
Hyperintense T2-weighted signal within deep fascial planes and muscle, with or without contrast enhancement, is not specific for necrotizing soft-tissue infection. A variety of conditions exhibited similar findings and were indistinguishable from necrotizing soft-tissue infection.
Insights
Magnetic resonance imaging (MRI) findings of hyperintense T2-weighted signals in deep fascial planes are not specific for necrotizing soft-tissue infections. Many non-necrotizing conditions mimic these imaging abnormalities.
Area of Science:
- Radiology
- Infectious Diseases
- Medical Imaging
Background:
- Necrotizing soft-tissue infections (NSTIs) are severe infections requiring prompt diagnosis.
- Magnetic resonance imaging (MRI) is increasingly used to evaluate soft-tissue abnormalities.
- Specific MRI criteria, including hyperintense T2-weighted signals in deep fascial planes, have been proposed for diagnosing NSTIs.
Purpose of the Study:
- To evaluate the specificity of hyperintense T2-weighted signals within deep fascial planes on MRI for diagnosing necrotizing soft-tissue infections (NSTIs).
Main Methods:
- Retrospective review of 22 MRI examinations showing high T2-weighted signal intensity in deep fascial planes.
- Analysis included T1-weighted and fat-saturated T2-weighted sequences, with contrast enhancement in 14 cases.
- Two blinded reviewers assessed soft tissue abnormalities and provided consensus diagnoses.
Main Results:
- All 22 cases were interpreted as necrotizing cellulitis based on the MRI criteria.
- However, 21 of the 22 patients had non-necrotizing conditions, such as cellulitis or abscess.
- MRI findings were indistinguishable between necrotizing and non-necrotizing soft-tissue infections.
Conclusions:
- Hyperintense T2-weighted signals in deep fascial planes and muscle on MRI are not specific for necrotizing soft-tissue infections.
- Various non-necrotizing conditions can present with similar MRI findings, complicating diagnosis.
- These MRI findings alone are insufficient to confirm necrotizing soft-tissue infections.
