The role of contrast enhanced computed tomography in the diagnosis of necrotizing fasciitis and comparison with the laboratory risk indicator for necrotizing fasciitis (LRINEC).
OBJECTIVE
To evaluate the diagnostic efficacy of contrast enhanced computed tomography (CECT) in emergency departments for diagnosis of necrotizing fasciitis (NF) and for differential diagnosis of other musculoskeletal infections; to correlate radiological findings with the laboratory risk indicator for necrotizing fasciitis (LRINEC).


METHODS
7 radiological parameters to be analysed on CECT scans were established, exams of 36 patients with proven diagnosis of NF (n 12) and other musculoskeletal infections (n 24) were retrospectively reviewed; LRINEC score was calculated. Fisher's test and Spearman's and Kendall's coefficients of rank correlations were performed.


RESULTS
Two parameters were found to be strongly associated with the diagnosis of NF: involvement of the fascia (Spearman's ρ of 0.888, p < 0.001) and lack of fascial enhancement (Spearman's ρ of 0.672, p < 0.001). LRINEC score did not show strong association with the presence of fasciitis NF (Spearman's ρ of 0.490, p = 0.0024).


CONCLUSIONS
Computed tomography (CT) parameters, which are significantly associated with the diagnosis of NF, are the involvement of the fascia and its lack of enhancement; LRINEC score could be high (>5) also in other musculoskeletal infections. Final diagnosis of necrosis among the fascia is surgical. Presence of gas is not a specific sign of necrotizing fasciitis being present in other musculoskeletal infections. CT could easily discriminate NF from other musculoskeletal infections, adds an important value to clinical and laboratory tests in diagnosis of NF in an emergency context when magnetic resonance imaging, which is superior to CT in this discernment, could not be performed.
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. francescocarbonetti799@hotmail.com.
Francesco
F
Carbonetti
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. antonio.cremona@alice.it.
Antonio
A
Cremona
Department of Internal Medicine and Immunology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. valentina.carusi@libero.it.
Valentina
V
Carusi
Department of Orthopaedics, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. marcoguidi984@hotmail.com.
Marco
M
Guidi
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. elsa.iannicelli@uniroma1.it.
Elsa
E
Iannicelli
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. marcodigiro@hotmail.com.
Marco
M
Di Girolamo
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. danielasergi@ospedalesantandrea.it.
Daniela
D
Sergi
Department of Orthopaedics, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. alvise.clarioni@ospedalesantandrea.it.
Alvise
A
Clarioni
Department of Anaesthesiology and Intensive Care Unit, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. giulio.baio@gmail.com.
Giulio
G
Baio
Department of Internal Medicine, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. giulio.antonelli@gmail.com.
Giulio
G
Antonelli
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. fratini.luca@gmail.com.
Luca
L
Fratini
Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. enzo-david@libero.it.
Vincenzo
V
David
D000368:Aged; D003287:Contrast Media; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
D003287:Contrast Media
Computed tomography; LRINEC score; Musculoskeletal infections; Necrotizing fasciitis; Soft tissue infections