SpringerLink
Log in

Diagnostic performance of MRI and CT in diagnosing necrotizing soft tissue infection: a systematic review

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To systematically review the accuracy of MRI and CT in diagnosing necrotizing soft tissue infection (NSTI).

Methods

MEDLINE and Embase were searched for original studies which reported the diagnostic performance of MRI or CT in detecting NSTI. Individual study quality was assessed using the QUADAS-2 tool. Sensitivity and specificity of MRI and CT were calculated and, if supported by data from at least two studies, pooled using a bivariate random-effects model.

Results

Six MRI studies and 7 CT studies were included. There were no major concerns with regard to study quality and applicability. The included studies used multiple diagnostic criteria, with sensitivities and specificities of both MRI and CT ranging between 0 and 100%. T2 hyperintensity of deep fascia was the most commonly used diagnostic MRI criterion (5 studies), yielding a pooled sensitivity of 86.4% (95% confidence interval [CI] 76.1–92.7%) and a pooled specificity of 65.2% (95% CI 35.4–86.6%). Presence of gas was the most commonly used diagnostic CT criterion (3 studies), yielding a pooled sensitivity of 48.6% (95% CI 37.1–60.2%) and a pooled specificity of 93.2% (95% CI 73.3–98.5%).

Conclusion

T2 hyperintensity of deep fascia at MRI has high sensitivity and moderate specificity in diagnosing NSTI. Presence of gas at CT has low sensitivity but high specificity. A combination of diagnostic criteria may improve diagnostic performance, but this needs further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med. 2017;377(23):2253–65. https://doi.org/10.1056/NEJMra1600673.

    Article  PubMed  Google Scholar 

  2. Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–62. https://doi.org/10.1067/j.cpsurg.2014.06.001.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Henry SM, Davis KA, Morrison JJ, Scalea TM. Can necrotizing soft tissue infection be reliably diagnosed in the emergency department? Trauma Surg Acute Care Open. 2018;3(1): e000157. https://doi.org/10.1136/tsaco-2017-000157.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Howell EC, Keeley JA, Kaji AH, Deane MR, Kim DY, Putnam B, Lee SL, Woods AL, Neville AL. Chance to cut: defining a negative exploration rate in patients with suspected necrotizing soft tissue infection. Trauma Surg Acute Care Open. 2019;4(1): e000264. https://doi.org/10.1136/tsaco-2018-000264.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41. https://doi.org/10.1097/01.ccm.0000129486.35458.7d.

    Article  PubMed  Google Scholar 

  6. Abdullah M, McWilliams B, Khan SU. Reliability of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score. Surgeon. 2019;17(5):309–18. https://doi.org/10.1016/j.surge.2018.08.001.

    Article  PubMed  Google Scholar 

  7. Fayad LM, Carrino JA, Fishman EK. Musculoskeletal infection: role of CT in the emergency department. Radiographics. 2007;27(6):1723–36. https://doi.org/10.1148/rg.276075033.

    Article  PubMed  Google Scholar 

  8. PRISMA. Transparent reporting of systematic reviews and meta-analyses. http://www.prisma-statement.org

  9. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009.

    Article  PubMed  Google Scholar 

  10. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5. https://doi.org/10.1002/1097-0142(1950)3:1%3c32::aid-cncr2820030106%3e3.0.co;2-3.

    Article  CAS  PubMed  Google Scholar 

  11. Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58(10):982–90. https://doi.org/10.1016/j.jclinepi.2005.02.022.

    Article  PubMed  Google Scholar 

  12. Bruls RJM, Kwee RM. CT in necrotizing soft tissue infection: diagnostic criteria and comparison with LRINEC score. Eur Radiol. 2021. https://doi.org/10.1007/s00330-021-08005-6.

    Article  PubMed  Google Scholar 

  13. Kim MC, Kim S, Cho EB, Lee GY, Choi SH, Kim SO, Chung JW. Utility of magnetic resonance imaging for differentiating necrotizing fasciitis from severe cellulitis: a Magnetic Resonance Indicator for Necrotizing Fasciitis (MRINEC) Algorithm. J Clin Med. 2020;9(9):3040. https://doi.org/10.3390/jcm9093040.

    Article  CAS  PubMed Central  Google Scholar 

  14. Yoon MA, Chung HW, Yeo Y, Yoo HJ, Kang Y, Chee CG, Lee MH, Lee SH, Shin MJ. Distinguishing necrotizing from non-necrotizing fasciitis: a new predictive scoring integrating MRI in the LRINEC score. Eur Radiol. 2019;29(7):3414–23. https://doi.org/10.1007/s00330-019-06103-0.

    Article  PubMed  Google Scholar 

  15. Martinez M, Peponis T, Hage A, Yeh DD, Kaafarani HMA, Fagenholz PJ, King DR, de Moya MA, Velmahos GC. The role of computed tomography in the diagnosis of necrotizing soft tissue infections. World J Surg. 2018;42(1):82–7. https://doi.org/10.1007/s00268-017-4145-x.

    Article  PubMed  Google Scholar 

  16. Leichtle SW, Tung L, Khan M, Inaba K, Demetriades D. The role of radiologic evaluation in necrotizing soft tissue infections. J Trauma Acute Care Surg. 2016;81(5):921–4. https://doi.org/10.1097/TA.0000000000001244.

    Article  CAS  PubMed  Google Scholar 

  17. Carbonetti F, Cremona A, Carusi V, Guidi M, Iannicelli E, Di Girolamo M, Sergi D, Clarioni A, Baio G, Antonelli G, Fratini L, David V. The role of contrast enhanced computed tomography in the diagnosis of necrotizing fasciitis and comparison with the laboratory risk indicator for necrotizing fasciitis (LRINEC). Radiol Med. 2016;121(2):106–21. https://doi.org/10.1007/s11547-015-0575-4.

    Article  PubMed  Google Scholar 

  18. Kim KT, Kim YJ, Won Lee J, Kim YJ, Park SW, Lim MK, Suh CH. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology. 2011;259(3):816–24. https://doi.org/10.1148/radiol.11101164.

    Article  PubMed  Google Scholar 

  19. McGillicuddy EA, Lischuk AW, Schuster KM, Kaplan LJ, Maung A, Lui FY, Bokhari SA, Davis KA. Development of a computed tomography-based scoring system for necrotizing soft-tissue infections. J Trauma. 2011;70(4):894–9. https://doi.org/10.1097/TA.0b013e3182134a76.

    Article  PubMed  Google Scholar 

  20. Zacharias N, Velmahos GC, Salama A, Alam HB, de Moya M, King DR, Novelline RA. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg. 2010;145(5):452–5. https://doi.org/10.1001/archsurg.2010.50.

    Article  PubMed  Google Scholar 

  21. Seok JH, Jee WH, Chun KA, Kim JY, Jung CK, Kim YR, Eo WK, Kim YS, Chung YG. Necrotizing fasciitis versus pyomyositis: discrimination with using MR imaging. Korean J Radiol. 2009;10(2):121–8. https://doi.org/10.3348/kjr.2009.10.2.121.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol. 1998;170(3):615–20. https://doi.org/10.2214/ajr.170.3.9490940.

    Article  CAS  PubMed  Google Scholar 

  23. Rahmouni A, Chosidow O, Mathieu D, Gueorguieva E, Jazaerli N, Radier C, Faivre JM, Roujeau JC, Vasile N. MR imaging in acute infectious cellulitis. Radiology. 1994;192(2):493–6. https://doi.org/10.1148/radiology.192.2.8029421.

    Article  CAS  PubMed  Google Scholar 

  24. Thomas AJ, Meyer TK. Retrospective evaluation of laboratory-based diagnostic tools for cervical necrotizing fasciitis. Laryngoscope. 2012;122(12):2683–7. https://doi.org/10.1002/lary.23680.

    Article  PubMed  Google Scholar 

  25. Chaudhry AA, Baker KS, Gould ES, Gupta R. Necrotizing fasciitis and its mimics: what radiologists need to know. AJR Am J Roentgenol. 2015;204(1):128–39. https://doi.org/10.2214/AJR.14.12676.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

    Robert M. Kwee

  2. Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Thomas C. Kwee

Authors
  1. Robert M. Kwee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas C. Kwee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert M. Kwee.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwee, R.M., Kwee, T.C. Diagnostic performance of MRI and CT in diagnosing necrotizing soft tissue infection: a systematic review. Skeletal Radiol 51, 727–736 (2022). https://doi.org/10.1007/s00256-021-03875-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03875-9

Keywords

Search

Navigation