Leichtle Stefan Walter, Tung Lily, Khan Moazzam, Inaba Kenji, Demetriades Demetrios
From the University of Southern California, LAC+USC Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2016 Nov;81(5):921-924. doi: 10.1097/TA.0000000000001244.
The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTIs) is not clear owing to concerns about its value and possible delays in definitive surgical care.
Plain radiograph (XR) and computed tomography (CT) results of all patients who underwent operative debridement for a presumed NSTI from 2007 through 2014 at LAC + USC Medical Center were reviewed. Preoperative imaging was classified as being negative, suspicious (inflammatory changes), or diagnostic (soft tissue gas) for NSTI.
Of 226 patients undergoing operative exploration for a suspected NSTI, 172 (76.1%) were found to have a true NSTI based on intraoperative or pathology findings. In patients with true NSTI, preoperative XR and CT demonstrated soft tissue gas in 47.9% and 70.3% of cases, respectively. CT diagnosed or highly suspected NSTI in 97.3% of cases with true NSTI compared to 83.6% with XR; p < 0.001).
CT was superior to XR in the radiologic evaluation of patients with suspected NSTIs.
Diagnostic test, level IV.
由于对诊断性成像在疑似坏死性软组织感染（NSTIs）中的价值以及可能导致确定性手术治疗延迟的担忧，其作用尚不清楚。
回顾了2007年至2014年在洛杉矶县+南加州大学医学中心因疑似NSTI接受手术清创的所有患者的X线平片（XR）和计算机断层扫描（CT）结果。术前成像被分类为对NSTI呈阴性、可疑（炎症改变）或诊断性（软组织气体）。
在226例因疑似NSTI接受手术探查的患者中，根据术中或病理结果，172例（76.1%）被发现患有真正的NSTI。在患有真正NSTI的患者中，术前XR和CT分别在47.9%和70.3%的病例中显示软组织气体。与XR的83.6%相比，CT在97.3%的真正NSTI病例中诊断或高度怀疑NSTI；p<0.001）。
在疑似NSTIs患者的放射学评估中，CT优于XR。
诊断试验，IV级。
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