Necrotizing fasciitis versus pyomyositis: discrimination with using MR imaging.
OBJECTIVE
We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM).


METHODS
The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them.


RESULTS
The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2-weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2-weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively.


CONCLUSIONS
MR imaging is helpful for differentiating between NF and PM.
Seok
Jee Hyun
JH
Department of Radiology, The Catholic University of Korea, Seoul, Korea.
Jee
Won-Hee
WH
Chun
Kyung-Ah
KA
Kim
Ji-Young
JY
Jung
Chan-Kwon
CK
Kim
Yang Ree
YR
Eo
Wan-Kyu
WK
Kim
Yang-Soo
YS
Chung
Yang Guk
YG
D000038:Abscess / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005205:Fascia / Q000473:pathology; D019115:Fasciitis, Necrotizing / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D052880:Pyomyositis / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult