“…Yoon et al integrated MRI findings with LRINEC score for differentiating necrotizing fasciitis from non-necrotizing fasciitis. The area under the (receiver operating characteristic) curve (AUC) was 0.814 (95% CI, 0.727–0.900; p < 0.001) for the LRINEC score alone, and 0.862 (95% CI, 0.787–0.938; p < 0.001) for the integrated model using two important MRI features—thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement [ 59 ]. Fig.…”
Section: Soft Tissuementioning
confidence: 99%
“…The LRINEC score in isolation exhibits moderate accuracy for necrotizing soft tissue infection. Although an integrated predictive model appears to be the most accurate [ 59 ], no single criteria can unequivocally diagnose or exclude, as identification of necrosis in the mound of inflammation and edema might be beyond the resolution of current imaging [ 57 ]. Lack of deep fascial involvement is useful in excluding necrotizing soft tissue infection.…”
The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.
“…Yoon et al integrated MRI findings with LRINEC score for differentiating necrotizing fasciitis from non-necrotizing fasciitis. The area under the (receiver operating characteristic) curve (AUC) was 0.814 (95% CI, 0.727–0.900; p < 0.001) for the LRINEC score alone, and 0.862 (95% CI, 0.787–0.938; p < 0.001) for the integrated model using two important MRI features—thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement [ 59 ]. Fig.…”
Section: Soft Tissuementioning
confidence: 99%
“…The LRINEC score in isolation exhibits moderate accuracy for necrotizing soft tissue infection. Although an integrated predictive model appears to be the most accurate [ 59 ], no single criteria can unequivocally diagnose or exclude, as identification of necrosis in the mound of inflammation and edema might be beyond the resolution of current imaging [ 57 ]. Lack of deep fascial involvement is useful in excluding necrotizing soft tissue infection.…”
The Society of Skeletal Radiology (SSR) Practice Guidelines and Technical Standards Committee identified musculoskeletal infection as a White Paper topic, and selected a Committee, tasked with developing a consensus on nomenclature for MRI of musculoskeletal infection outside the spine. The objective of the White Paper was to critically assess the literature and propose standardized terminology for imaging findings of infection on MRI, in order to improve both communication with clinical colleagues and patient care.A definition was proposed for each term; debate followed, and the committee reached consensus. Potential controversies were raised, with formulated recommendations. The committee arrived at consensus definitions for cellulitis, soft tissue abscess, and necrotizing infection, while discouraging the nonspecific term phlegmon. For bone infection, the term osteitis is not useful; the panel recommends using terms that describe the likelihood of osteomyelitis in cases where definitive signal changes are lacking. The work was presented virtually to SSR members, who had the opportunity for review and modification prior to submission for publication.
“…Furthermore, previous studies have another important limitation, in that they have not evaluated the diagnostic utility of the MRI findings in the context of the clinical judgment based on the LRINEC score. Recently, Yoon et al, reported that a new scoring system including thickening of the deep fascia ≥3 mm, multi-compartmental involvement, and LRINEC score improved sensitivity and specificity for the diagnosis of NF compared with the LRINEC score alone [ 14 ]. However, their study did not provide insights as to when MRI might be advisable, although MRI might not be feasible in a considerable number of patients with NF due to the aggressiveness of the disease.…”
We developed a new magnetic resonance indicator for necrotizing fasciitis (MRINEC) algorithm for differentiating necrotizing fasciitis (NF) from severe cellulitis (SC). All adults with suspected NF between 2010 and 2018 in a tertiary hospital in South Korea were enrolled. Sixty-one patients were diagnosed with NF and 28 with SC. Among them, 34 with NF and 15 with SC underwent magnetic resonance imaging (MRI). The MRINEC algorithm, a two-step decision tree including T2 hyperintensity of intermuscular deep fascia and diffuse T2 hyperintensity of deep peripheral fascia, diagnosed NF with 94% sensitivity (95% confidence interval (CI), 80–99%) and 60% specificity (95% CI, 32–84%). The algorithm accurately diagnosed all 15 NF patients with a high (≥8) laboratory risk indicator for necrotizing fasciitis (LRINEC) score. Among the five patients with an intermediate (6–7) LRINEC score, sensitivity and specificity were 100% (95% CI, 78–100%) and 0% (95% CI, 0–84%), respectively. Finally, among the 29 patients with a low (≤5) LRINEC score, the algorithm had a sensitivity and specificity of 88% (95% CI, 62–98%) and 69% (95% CI, 39–91%), respectively. The MRINEC algorithm may be a useful adjuvant method for diagnosing NF, especially when NF is suspected in patients with a low LRINEC score.
“…Screening references of these studies resulted in one additional study, which was also included Screening references of these studies yielded one additional study that was also included. Finally, 13 studies remained, which were included in this systematic review [12][13][14][15][16][17][18][19][20][21][22][23][24]. Principal study characteristics are displayed in Table 2.…”
Section: Literature Searchmentioning
confidence: 99%
“…Only two of the included MRI studies reported data on interobserver agreement between two radiologists [14,18], which ranged from moderate to perfect (kappa coefficients of 0.464 to 1.00). None of the included CT studies reported data on either interobserver or intraobserver agreement.…”
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.
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