title: Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging?
abstract: OBJECTIVE
  To retrospectively evaluate whether magnetic resonance (MR) imaging findings can be used to differentiate necrotizing infectious fasciitis (NIF) from nonnecrotizing infectious fasciitis (non-NIF).
  
  
  METHODS
  Institutional review board approval was obtained, but patient consent was not required for this retrospective review of records and images because patient anonymity was preserved. Thirty patients (seven with NIF, 23 with non-NIF) were included in the study. The following imaging findings were analyzed on fat-suppressed T2-weighted MR images: (a) signal intensity in the deep fascia (low, high, or mixed high and low), (b) thickness of abnormal signal intensity in the deep fascia (≥3 mm or <3 mm), (c) pattern of abnormal signal intensity in muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity), (d) degree of deep fascia involvement (partial or extensive), and (e) degree of compartment involvement (fewer than three compartments or three or more compartments). On contrast material-enhanced fat-suppressed T1-weighted images, the contrast enhancement patterns of the abnormal deep fascia (no enhancement, enhancement, or enhancement with nonenhancing portion) and the muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity) were evaluated. The presence of abscesses in the subcutaneous fat layer was evaluated with all sequences.
  
  
  RESULTS
  The patients with NIF had a significantly greater frequency of (a) thick (≥3 mm) abnormal signal intensity on fat-suppressed T2-weighted images, (b) low signal intensity in the deep fascia on fat-suppressed T2-weighted images, (c) a focal or diffuse nonenhancing portion in the area of abnormal signal intensity in the deep fascia, (d) extensive involvement of the deep fascia, and (e) involvement of three or more compartments in one extremity (P < .05).
  
  
  CONCLUSIONS
  MR imaging is potentially helpful for differentiating NIF from non-NIF.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101164/-/DC1.
authors.affiliation: Department of Radiology, Inha University Hospital, 3-ga Shinheung-dong, Choong-gu, Incheon 400-700, South Korea.
authors.forename: Kyoung-Tae
authors.initials: KT
authors.lastname: Kim
authors.forename: Yeo Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ju
authors.initials: J
authors.lastname: Won Lee
authors.forename: Youn Jeong
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sun-Won
authors.initials: SW
authors.lastname: Park
authors.forename: Myung Kwan
authors.initials: MK
authors.lastname: Lim
authors.forename: Chang Hae
authors.initials: CH
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002481:Cellulitis / Q000175:diagnosis* / Q000382:microbiology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005208:Fasciitis / Q000175:diagnosis*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology*
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA