What is the role of MRI for the diagnosis of necrotizing fasciitis?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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While no published, well-controlled, clinical trial has compared the efficacy of various diagnostic imaging modalities in the diagnosis of necrotizing infections, MRI is the preferred technique to detect soft tissue infection because of its unsurpassed soft tissue contrast and sensitivity in detecting soft tissue fluid, its spatial resolution, and its multiplanar capabilities. [29, 30]

The usefulness of MRI in the diagnosis of necrotizing fasciitis has been supported in a study by Rahmouni et al, who were able to differentiate nonnecrotizing cellulitis that would respond to medical treatment from severe necrotizing infections that required rapid life-saving surgery. [73] In necrotizing fasciitis, MRI can provide dramatic evidence of an inflammatory process infiltrating the fascial planes. [60]

Craig notes that the combined use of MRI and aspiration under ultrasonographic guidance is very useful in complicated infections (eg, septic arthritis and osteomyelitis) and that its role in the diagnosis of necrotizing fasciitis should be considered. [74] Early muscle necrosis may be apparent.

Absence of gadolinium contrast enhancement in T1 images reliably detects fascial necrosis in those requiring operative debridement. Combined with clinical assessment, MRI can determine the presence of necrosis and the need for surgical debridement. T2-weighted MRI may show well-defined regions of high signal intensity in the deep tissues. However, the sensitivity of MRI exceeds its specificity. [75]

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