Brothers T E, Tagge D U, Stutley J E, Conway W F, Del Schutte H, Byrne T K
Department of Surgery, Medical University of South Carolina, Charleston, USA.
J Am Coll Surg. 1998 Oct;187(4):416-21. doi: 10.1016/s1072-7515(98)00192-6.
Distinction between uncomplicated infective fasciitis and early necrotizing fasciitis can be extremely difficult without operation, yet the management and prognosis of both conditions depend greatly on early recognition and assessment of the extent of involvement.
This was a prospective review of the utility of magnetic resonance imaging (MRI) in nine patients with suspected infective or necrotizing fasciitis treated at an academic medical center or a Veterans Administration hospital.
Magnetic resonance imaging documented fascial inflammation, characterized by low intensity on T1-weighted images and high intensity on T2-weighted images, in all nine patients. Absence of gadolinium contrast enhancement on T1-weighted images reliably detected fascial necrosis in all six patients who required operative debridement. Magnetic resonance imaging was extremely useful in defining the extent of fasciitis and was more accurate in predicting necrosis or pyomyositis than was myoglobinuria or elevation of serum creatine kinase or lactate dehydrogenase. Operation was avoided in two patients without evidence of necrosis on MRI. One patient without evidence of necrosis, explored because of contradictory clinical findings, was confirmed at operation to have cellulitis without necrosis.
Magnetic resonance imaging with gadolinium contrast accurately determines the presence of necrosis and the need for operation in patients with fasciitis of the lower extremity. Preoperative determination of the extent of involvement facilitates operative planning.
在未进行手术的情况下，区分单纯性感染性筋膜炎和早期坏死性筋膜炎极为困难，然而这两种情况的治疗和预后在很大程度上取决于早期识别以及对受累范围的评估。
这是一项对在一所学术医疗中心或一家退伍军人管理局医院接受治疗的9例疑似感染性或坏死性筋膜炎患者进行的磁共振成像（MRI）效用的前瞻性研究。
磁共振成像显示所有9例患者均存在筋膜炎症，其特征为T1加权像上呈低信号，T2加权像上呈高信号。在所有6例需要手术清创的患者中，T1加权像上钆对比剂无强化可可靠地检测到筋膜坏死。磁共振成像在确定筋膜炎范围方面极其有用，并且在预测坏死或脓性肌炎方面比肌红蛋白尿、血清肌酸激酶或乳酸脱氢酶升高更准确。2例MRI未显示坏死证据的患者避免了手术。1例因临床发现相互矛盾而接受探查但无坏死证据的患者，术中证实为无坏死的蜂窝织炎。
钆对比增强磁共振成像可准确确定下肢筋膜炎患者坏死的存在及手术需求。术前确定受累范围有助于手术规划。
