MRI in necrotizing fasciitis of the extremities
Identifieur interne : 004775 ( Pmc/Corpus ); précédent : 004774; suivant : 004776MRI in necrotizing fasciitis of the extremities
Auteurs : S Z Ali ; S. Srinivasan ; W C G. PehSource :
- The British Journal of Radiology [ 0007-1285 ] ; 2013.
Abstract
Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed
Url:
DOI: 10.1259/bjr.20130560
PubMed: 24288403
PubMed Central: 3898976
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PMC:3898976Le document en format XML
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<author><name sortKey="Ali, S Z" sort="Ali, S Z" uniqKey="Ali S" first="S Z" last="Ali">S Z Ali</name>
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<author><name sortKey="Srinivasan, S" sort="Srinivasan, S" uniqKey="Srinivasan S" first="S" last="Srinivasan">S. Srinivasan</name>
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<author><name sortKey="Peh, W C G" sort="Peh, W C G" uniqKey="Peh W" first="W C G" last="Peh">W C G. Peh</name>
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<series><title level="j">The British Journal of Radiology</title>
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<front><div type="abstract" xml:lang="en"><p>Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed <italic>T</italic>
<sub>2</sub>
weighted or short tau inversion–recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that <italic>T</italic>
<sub>2</sub>
-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.</p>
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<pmc article-type="review-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Br J Radiol</journal-id>
<journal-id journal-id-type="iso-abbrev">Br J Radiol</journal-id>
<journal-id journal-id-type="publisher-id">bjr</journal-id>
<journal-title-group><journal-title>The British Journal of Radiology</journal-title>
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<issn pub-type="ppub">0007-1285</issn>
<issn pub-type="epub">1748-880X</issn>
<publisher><publisher-name>The British Institute of Radiology.</publisher-name>
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<article-id pub-id-type="pmc">3898976</article-id>
<article-id pub-id-type="publisher-manuscript">13560</article-id>
<article-id pub-id-type="doi">10.1259/bjr.20130560</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Pictorial Review</subject>
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<title-group><article-title>MRI in necrotizing fasciitis of the extremities</article-title>
<alt-title alt-title-type="left-running-head">S Z Ali <italic>et al</italic>
</alt-title>
<alt-title alt-title-type="right-running-head">MRI in necrotizing fasciitis</alt-title>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Ali</surname>
<given-names>S Z</given-names>
</name>
<pmc-comment>S Z Ali </pmc-comment>
<degrees>MD, FRCR</degrees>
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<contrib contrib-type="author"><name><surname>Srinivasan</surname>
<given-names>S</given-names>
</name>
<pmc-comment>S Srinivasan </pmc-comment>
<degrees>MD, FRCR</degrees>
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<contrib contrib-type="author"><name><surname>Peh</surname>
<given-names>W C G</given-names>
</name>
<pmc-comment>W C G Peh </pmc-comment>
<degrees>FRCP, FRCR</degrees>
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<aff><addr-line>Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore</addr-line>
</aff>
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<author-notes><corresp id="cor1">Address correspondence to: Dr Syed Zama Ali Email: <email xlink:href="syed.zama@gmail.com">syed.zama@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>1</month>
<year>2014</year>
<pmc-comment>January 1, 2014 </pmc-comment>
</pub-date>
<pub-date pub-type="epub"><day>18</day>
<month>12</month>
<year>2013</year>
</pub-date>
<volume>87</volume>
<issue>1033</issue>
<elocation-id>20130560</elocation-id>
<history><date date-type="received"><day>4</day>
<month>9</month>
<year>2013</year>
<pmc-comment>Received on September 4, 2013 </pmc-comment>
</date>
<date date-type="rev-recd"><day>10</day>
<month>11</month>
<year>2013</year>
<pmc-comment>Revised on November 10, 2013 </pmc-comment>
</date>
<date date-type="accepted"><day>26</day>
<month>11</month>
<year>2013</year>
<pmc-comment>Accepted on November 26, 2013 </pmc-comment>
</date>
</history>
<permissions><copyright-statement>© 2014 The Authors. Published by the British Institute of Radiology</copyright-statement>
<copyright-year>2014</copyright-year>
<copyright-holder>The British Institute of Radiology</copyright-holder>
</permissions>
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<abstract><p>Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed <italic>T</italic>
<sub>2</sub>
weighted or short tau inversion–recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that <italic>T</italic>
<sub>2</sub>
-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.</p>
</abstract>
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