Loh N N, Ch'en I Y, Cheung L P, Li K C
Department of Diagnostic Radiology, Stanford University Medical Center, CA 94305, USA.
AJR Am J Roentgenol. 1997 May;168(5):1301-4. doi: 10.2214/ajr.168.5.9129430.
The purpose of this study was to determine whether recently described criteria, including hyperintense T2-weighted signal or other abnormalities revealed by MR imaging within deep fascial planes, are specific for necrotizing soft-tissue infections.
We reviewed 22 MR imaging examinations that revealed abnormally high signal intensity within deep fascial planes on T2-weighted images. Twenty-one of the patients had clinical diagnoses other than necrotizing soft-tissue infection, including nonnecrotizing cellulitis (n = 4), abscess without evidence of necrotizing fasciitis (n = 5), and cellulitis with accompanying vascular thrombosis (n = 2). MR imaging was performed using T1-weighted spin-echo (range of TRs/range of TEs, 300-800/9-30) and fat-saturated T2-weighted fast spin-echo (3000-5000/76-108) sequences. Gadolinium-enhanced T1-weighted spin-echo MR images with fat saturation were obtained for 14 patients. Two reviewers, unaware of clinical diagnoses, evaluated each study for abnormalities in superficial and deep soft tissues and submitted a consensus diagnosis.
Using only the described MR imaging criteria, we interpreted all cases as necrotizing cellulitis, including the cases of 21 patients who had nonnecrotizing conditions.
Hyperintense T2-weighted signal within deep fascial planes and muscle, with or without contrast enhancement, is not specific for necrotizing soft-tissue infection. A variety of conditions exhibited similar findings and were indistinguishable from necrotizing soft-tissue infection.
本研究的目的是确定最近描述的标准,包括T2加权像上的高信号或磁共振成像(MR)显示的深筋膜平面内的其他异常,是否对坏死性软组织感染具有特异性。
我们回顾了22例在T2加权像上显示深筋膜平面内信号强度异常增高的MR检查。其中21例患者的临床诊断并非坏死性软组织感染,包括非坏死性蜂窝织炎(n = 4)、无坏死性筋膜炎证据的脓肿(n = 5)以及伴有血管血栓形成的蜂窝织炎(n = 2)。MR成像采用T1加权自旋回波序列(重复时间范围/回波时间范围,300 - 800/9 - 30)和脂肪饱和T2加权快速自旋回波序列(3000 - 5000/76 - 108)。14例患者进行了钆增强T1加权脂肪饱和自旋回波MR成像。两名不知临床诊断结果的阅片者对每项研究的浅表和深部软组织异常进行评估,并给出一致诊断。
仅采用所述的MR成像标准,我们将所有病例均解释为坏死性蜂窝织炎,包括21例患有非坏死性疾病的患者。
深筋膜平面和肌肉内T2加权像高信号,无论有无强化,对坏死性软组织感染均无特异性。多种情况表现出类似的表现,与坏死性软组织感染难以区分。