The role of radiologic evaluation in necrotizing soft tissue infections

Abstract

BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION CT was superior to XR in the radiologic evaluation of patients with suspected NSTIs. LEVEL OF EVIDENCE Diagnostic test, level IV.