Robert M Kwee1, Thomas C Kwee2. 1. Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands. rmkwee@gmail.com. 2. Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Abstract
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.
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.
Authors: Penny F Whiting; Anne W S Rutjes; Marie E Westwood; Susan Mallett; Jonathan J Deeks; Johannes B Reitsma; Mariska M G Leeflang; Jonathan A C Sterne; Patrick M M Bossuyt Journal: Ann Intern Med Date: 2011-10-18 Impact factor: 25.391
Authors: Erin C Howell; Jessica A Keeley; Amy H Kaji; Molly R Deane; Dennis Y Kim; Brant Putnam; Steven L Lee; Alexis L Woods; Angela L Neville Journal: Trauma Surg Acute Care Open Date: 2019-02-27