Francesco Carbonetti1, Antonio Cremona2, Valentina Carusi3, Marco Guidi4, Elsa Iannicelli5, Marco Di Girolamo6, Daniela Sergi7, Alvise Clarioni8, Giulio Baio9, Giulio Antonelli10, Luca Fratini11, Vincenzo David12. 1. 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. 2. 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. 3. 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. 4. 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. 5. 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. 6. 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. 7. 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. 8. 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. 9. 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. 10. 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. 11. 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. 12. 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.
Abstract
PURPOSE: 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). MATERIALS AND 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). CONCLUSION: 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.
PURPOSE: 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). MATERIALS AND 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). CONCLUSION: 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.
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