The role of radiologic evaluation in necrotizing soft tissue infections

Abstract

Diagnostic test, level IV.

Untitled

“…Current use of simple X-rays is limited to ruling out underlying bone injuries or presence of foreign bodies. 6 Previously, CT was questioned because of its low sensitivity and specificity in the diagnosis of necrotizing infections. 1 However, most studies were based solely on gas detection.…”

Impact of clinical interventions in the timely diagnosis and therapeutic approach of necrotizing soft tissue infections

“…In patients with physical findings that do not support urgent debridement, imaging techniques can clarify tissue involvement and define whether the clinical picture corresponds to NSTIs. 6 However, it should not be forgotten that in presence of clear signs and symptoms, surgical intervention without any delay of images is mandatory. NSTIs are characterized by massive tissue destruction; the initial presentation can be restricted to deep planes, preserving intact skin.…”

“…[2][3][4][5] It is important to consider the abscense of universally accepted imaging protocol to address patients with suspected NSTIs. 6 Techniques such as computed tomography (CT), flat X-rays and magnetic resonance imaging (MRI) have been used, but none of those is the gold standard. 6,7 The use of images seeks to demonstrate pathognomonic and complementary features to guide the diagnosis of NSTIs.…”

“…6 Techniques such as computed tomography (CT), flat X-rays and magnetic resonance imaging (MRI) have been used, but none of those is the gold standard. 6,7 The use of images seeks to demonstrate pathognomonic and complementary features to guide the diagnosis of NSTIs. In this sense, flat X-rays are excluded from the scenario, as they rarely show the presence of gas.…”

“…Therefore, previous reports restricted the use of CT only to address this particular NSTI. [1][2][3][4][5][6] Its capacity to guide diagnosis of the spectrum of necrotizing infections has increased significantly with updated technology, introduction of contrast media and updating criteria. 7 Inflammatory changes observation under fascias, presence of multiple fluid collections and unequal contrast medium distribution has been incorporated 7 With the inclusion of these variables, high sensitivity and Negative Predictive Value (NPV) are obtained, in one study 100% was reported for both parameters, suggesting its use to reliably rule out the need for surgical intervention in patients with high suspicion of NSTIs.…”