MR 成像能否区分坏死性感染性筋膜炎和非坏死性感染性筋膜炎？
Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging?
机构信息
Department of Radiology, Inha University Hospital, 3-ga Shinheung-dong, Choong-gu, Incheon 400-700, South Korea.
出版信息
Radiology. 2011 Jun;259(3):816-24. doi: 10.1148/radiol.11101164. Epub 2011 Mar 15.
PURPOSE
To retrospectively evaluate whether magnetic resonance (MR) imaging findings can be used to differentiate necrotizing infectious fasciitis (NIF) from nonnecrotizing infectious fasciitis (non-NIF).
MATERIALS AND METHODS
Institutional review board approval was obtained, but patient consent was not required for this retrospective review of records and images because patient anonymity was preserved. Thirty patients (seven with NIF, 23 with non-NIF) were included in the study. The following imaging findings were analyzed on fat-suppressed T2-weighted MR images: (a) signal intensity in the deep fascia (low, high, or mixed high and low), (b) thickness of abnormal signal intensity in the deep fascia (≥3 mm or <3 mm), (c) pattern of abnormal signal intensity in muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity), (d) degree of deep fascia involvement (partial or extensive), and (e) degree of compartment involvement (fewer than three compartments or three or more compartments). On contrast material-enhanced fat-suppressed T1-weighted images, the contrast enhancement patterns of the abnormal deep fascia (no enhancement, enhancement, or enhancement with nonenhancing portion) and the muscle (no abnormality, peripheral bandlike signal intensity, or patchy high signal intensity) were evaluated. The presence of abscesses in the subcutaneous fat layer was evaluated with all sequences.
RESULTS
The patients with NIF had a significantly greater frequency of (a) thick (≥3 mm) abnormal signal intensity on fat-suppressed T2-weighted images, (b) low signal intensity in the deep fascia on fat-suppressed T2-weighted images, (c) a focal or diffuse nonenhancing portion in the area of abnormal signal intensity in the deep fascia, (d) extensive involvement of the deep fascia, and (e) involvement of three or more compartments in one extremity (P < .05).
CONCLUSION
MR imaging is potentially helpful for differentiating NIF from non-NIF.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101164/-/DC1.
目的
回顾性评价磁共振成像（MR）表现能否用于鉴别坏死性感染性筋膜炎（NIF）与非坏死性感染性筋膜炎（非-NIF）。
材料与方法
本研究经机构审查委员会批准，由于患者匿名得以保留，因此回顾性分析病历和图像无需患者同意。研究纳入 30 例患者（7 例 NIF，23 例非-NIF）。对脂肪抑制 T2 加权 MR 图像进行如下影像学分析：（a）深筋膜信号强度（低、高或混合高和低），（b）深筋膜异常信号强度的厚度（≥3 mm 或<3 mm），（c）肌肉异常信号强度模式（无异常、外周条带状信号强度或斑片状高信号强度），（d）深筋膜受累程度（部分或广泛），以及（e）间隔受累程度（少于三个间隔或三个或更多间隔）。在对比增强脂肪抑制 T1 加权图像上，评估异常深筋膜（无强化、强化或强化伴无强化部分）和肌肉（无异常、外周条带状信号强度或斑片状高信号强度）的对比增强模式。用所有序列评估皮下脂肪层内脓肿的存在。
结果
NIF 患者深筋膜脂肪抑制 T2 加权图像上异常信号强度较厚（≥3 mm）、（b）深筋膜脂肪抑制 T2 加权图像上信号强度低、（c）深筋膜异常信号强度区域内局灶性或弥漫性无强化部分、（d）深筋膜广泛受累和（e）同一肢体 3 个或更多间隔受累的频率显著更高（P<.05）。
结论
MR 成像有助于鉴别 NIF 与非-NIF。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101164/-/DC1.
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