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Differentiation of necrotizing fasciitis and cellulitis using MR imaging
M R Schmid1, T Kossmann, S Duewell
1Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.
AJR. American Journal of Roentgenology
|March 10, 1998
Summary
Magnetic resonance (MR) imaging can help differentiate necrotizing fasciitis from cellulitis by assessing deep fascial involvement. While MR imaging is valuable, clinical findings should guide treatment due to potential overestimation of disease extent.
Area of Science:
- Radiology
- Medical Imaging
- Infectious Diseases
Background:
- Necrotizing fasciitis is a severe soft tissue infection requiring prompt diagnosis.
- Differentiating necrotizing fasciitis from cellulitis can be challenging clinically.
- Magnetic resonance (MR) imaging offers detailed visualization of soft tissues.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MR imaging in distinguishing necrotizing fasciitis from cellulitis.
- To identify specific MR imaging features indicative of necrotizing fasciitis.
Main Methods:
- MR imaging (T1-weighted, T2-weighted, contrast-enhanced T1-weighted) was performed on patients with suspected necrotizing fasciitis.
- Imaging findings were correlated with surgical results, autopsy, and clinical outcomes.
- Specific criteria were developed based on fascial involvement and fluid collections.
Main Results:
- MR imaging identified deep fascial involvement, thickening, and enhancement in necrotizing fasciitis.
- The study correctly identified 11 cases of necrotizing fasciitis and six of cellulitis.
- Contrast-enhanced sequences better delineated necrosis and abscesses.
Conclusions:
- Absence of deep fascial involvement on MR imaging can exclude necrotizing fasciitis.
- MR imaging may overestimate the extent of deep fascial involvement, necessitating a combined approach.
- Treatment decisions should integrate both clinical assessment and MR imaging findings.