Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis
Identifieur interne : 000895 ( Istex/Corpus ); précédent : 000894; suivant : 000896Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis
Auteurs : Arzu Arslan ; Claude Pierre-Jerome ; Arne BorthneSource :
- European Journal of Radiology [ 0720-048X ] ; 2000.
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- KwdEn :
Abstract
The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.
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DOI: 10.1016/S0720-048X(00)00164-9
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<notesStmt><note type="content">Fig. 1: Necrotizing fasciitis. (a) Axial T2-weighted TSE image (TR/TE: 2000/100) of the left leg. The deep fascia between soleus and gastrocnemius is hyperintense and thick (white arrow). There is a more remarkably thicker hyperintense signal along a deep fascial plane continuous with the superficial fascia (open arrow). The deep fascial planes are more severely involved than the superficial fascia. Signal intensity is increased diffusely throughout the soleus muscle with a well-circumscribed heterogeneously high signal posterolaterally (black arrow). (b) Axial T2-weighted TSE image with fat suppression (SPIR). Thickening of the subcutaneous fat is better appreciated, as well as the more easily visible high signal intensity of the superficial fascia (arrow).</note>
<note type="content">Fig. 2: Necrotizing fasciitis. (a) Axial T2-weighted TSE image with SPIR (TR/TE: 6400/70). Hyperintense linear streaks in the subcutaneous fat. The skin and the superficial fascia are thick and hyperintense. There is a well-defined heterogeneously hyperintense area in the triceps muscle (black arrow). Two deeper fasciae are thickened and hyperintense (white arrows). There is an ill-defined involvement of the latissimus dorsi muscle (curved arrow) which is surrounded by hyperintense superficial and deep fasciae. (b) Postcontrast T1-weighted TSE image with SPIR (TR/TE: 600/20). There is enhancement of the skin, superficial fascia, subcutaneous fat and the involved area in the triceps muscle without a prominent enhancement of the deep fascial planes.</note>
<note type="content">Fig. 3: Dermatomyositis. (a) Proton density TSE, SPIR image (TR/TE: 4852/14) of both legs. In the left leg, subcutaneous fat is thickened. Both superficial (white arrow) and deep (black arrow) fascial planes are thick and hyperintense. A well-circumscribed hyperintense area involving the extensor digitorum longus and peroneum longus muscles is seen. On the right side, the superficial and deep fascial planes are involved to a lesser extent with an ill-defined hyperintense area in the neighbouring muscle. (b) Postcontrast T1-weighted SPIR image (TR/TE: 600/12). The deep fascial planes and the involved muscles are enhanced. Some parts of the superficial and deep fasciae which were hyperintense in T2-weighted images are not enhanced (thick arrows). Bilateral involvement of gastrocnemius muscles on the posteromedial aspect are more prominent compared to the T2-weighted image (thin arrows). (c) T2-weighted inversion recovery (TR/TE/TI: 3629/70/160) image 1 week after the first MRI examination. The signal intensity of the involved structures is more spread with the additional finding of local skin involvement (arrow).</note>
<note type="content">Fig. 4: Posttraumatic muscle injury. T2-weighted SPIR image (TR/TE: 3000/90). Linear hyperintense streaks are seen in the subcutaneous fat. Superficial fascia is thickened to some extent (arrows), without remarkable involvement of the deep fasciae. There are intramuscular hyperintense signal changes in biceps femoris.</note>
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<abstract lang="en">The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.</abstract>
<note type="content">Fig. 1: Necrotizing fasciitis. (a) Axial T2-weighted TSE image (TR/TE: 2000/100) of the left leg. The deep fascia between soleus and gastrocnemius is hyperintense and thick (white arrow). There is a more remarkably thicker hyperintense signal along a deep fascial plane continuous with the superficial fascia (open arrow). The deep fascial planes are more severely involved than the superficial fascia. Signal intensity is increased diffusely throughout the soleus muscle with a well-circumscribed heterogeneously high signal posterolaterally (black arrow). (b) Axial T2-weighted TSE image with fat suppression (SPIR). Thickening of the subcutaneous fat is better appreciated, as well as the more easily visible high signal intensity of the superficial fascia (arrow).</note>
<note type="content">Fig. 2: Necrotizing fasciitis. (a) Axial T2-weighted TSE image with SPIR (TR/TE: 6400/70). Hyperintense linear streaks in the subcutaneous fat. The skin and the superficial fascia are thick and hyperintense. There is a well-defined heterogeneously hyperintense area in the triceps muscle (black arrow). Two deeper fasciae are thickened and hyperintense (white arrows). There is an ill-defined involvement of the latissimus dorsi muscle (curved arrow) which is surrounded by hyperintense superficial and deep fasciae. (b) Postcontrast T1-weighted TSE image with SPIR (TR/TE: 600/20). There is enhancement of the skin, superficial fascia, subcutaneous fat and the involved area in the triceps muscle without a prominent enhancement of the deep fascial planes.</note>
<note type="content">Fig. 3: Dermatomyositis. (a) Proton density TSE, SPIR image (TR/TE: 4852/14) of both legs. In the left leg, subcutaneous fat is thickened. Both superficial (white arrow) and deep (black arrow) fascial planes are thick and hyperintense. A well-circumscribed hyperintense area involving the extensor digitorum longus and peroneum longus muscles is seen. On the right side, the superficial and deep fascial planes are involved to a lesser extent with an ill-defined hyperintense area in the neighbouring muscle. (b) Postcontrast T1-weighted SPIR image (TR/TE: 600/12). The deep fascial planes and the involved muscles are enhanced. Some parts of the superficial and deep fasciae which were hyperintense in T2-weighted images are not enhanced (thick arrows). Bilateral involvement of gastrocnemius muscles on the posteromedial aspect are more prominent compared to the T2-weighted image (thin arrows). (c) T2-weighted inversion recovery (TR/TE/TI: 3629/70/160) image 1 week after the first MRI examination. The signal intensity of the involved structures is more spread with the additional finding of local skin involvement (arrow).</note>
<note type="content">Fig. 4: Posttraumatic muscle injury. T2-weighted SPIR image (TR/TE: 3000/90). Linear hyperintense streaks are seen in the subcutaneous fat. Superficial fascia is thickened to some extent (arrows), without remarkable involvement of the deep fasciae. There are intramuscular hyperintense signal changes in biceps femoris.</note>
<subject lang="en"><genre>Keywords</genre>
<topic>Magnetic resonance</topic>
<topic>Myositis</topic>
<topic>Fasciitis</topic>
</subject>
<relatedItem type="host"><titleInfo><title>European Journal of Radiology</title>
</titleInfo>
<titleInfo type="abbreviated"><title>EURR</title>
</titleInfo>
<genre type="journal">journal</genre>
<originInfo><dateIssued encoding="w3cdtf">20001201</dateIssued>
</originInfo>
<identifier type="ISSN">0720-048X</identifier>
<identifier type="PII">S0720-048X(00)X0053-8</identifier>
<part><date>20001201</date>
<detail type="volume"><number>36</number>
<caption>vol.</caption>
</detail>
<detail type="issue"><number>3</number>
<caption>no.</caption>
</detail>
<extent unit="issue pages"><start>123</start>
<end>182</end>
</extent>
<extent unit="pages"><start>139</start>
<end>143</end>
</extent>
</part>
</relatedItem>
<identifier type="istex">134377C186C5F56E3E73C06DC8A9F3899D194517</identifier>
<identifier type="DOI">10.1016/S0720-048X(00)00164-9</identifier>
<identifier type="PII">S0720-048X(00)00164-9</identifier>
<accessCondition type="use and reproduction" contentType="copyright">©2000 Elsevier Science Ireland Ltd</accessCondition>
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<recordOrigin>Elsevier Science Ireland Ltd, ©2000</recordOrigin>
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<serie></serie>
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