Q: Which radiographic imaging is preferred in necrotizing soft tissue infection (NSTI)? (select one)
A) CT scan
B) MRI
Answer: A
It should be emphasized first that NSTI is a clinical diagnosis and surgical evaluation/intervention should not be halted due to delay in radiographic imaging.
If radiographic imaging is readily available CT scan is preferred over MRI for a couple of reasons.
First, MRI is not as useful as CT for detection of gas in soft tissues.
Second, MRI is usually oversensitive, may overestimate deep tissue involvement, and may not reliably distinguish between necrotizing cellulitis and deeper infection.
CT scan can well define gas in soft tissues, fluid collections, absence or heterogeneity of tissue enhancement with intravenous contrast, and inflammatory changes beneath the fascia.
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References:
1. Zacharias N, Velmahos GC, Salama A, et al. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg 2010; 145:452.
2. Bruls RJM, Kwee RM. CT in necrotizing soft tissue infection: diagnostic criteria and comparison with LRINEC score. Eur Radiol 2021; 31:8536.
3. Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol 1998; 170:615.
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