Korean J Radiol.  2009 Apr;10(2):121-128. 10.3348/kjr.2009.10.2.121.

Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

• Seok JH
• Jee WH
• Chun KA
• Kim JY
• Jung CK
• Kim YR
• Eo WK
• Kim YS
• Chung YG

• KMID: 1088722
• DOI: http://doi.org/10.3348/kjr.2009.10.2.121

Abstract

OBJECTIVE
We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM).
MATERIALS AND METHODS
The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them.
RESULTS
The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2-weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2-weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively.
CONCLUSION
MR imaging is helpful for differentiating between NF and PM.

Keyword

Soft tissue; Infection; Necrotizing fasciitis; Pyomyositis, MR

MeSH Terms

Abscess/pathology
Adolescent
Adult
Aged
Aged, 80 and over
Diagnosis, Differential
Fascia/pathology
Fasciitis, Necrotizing/*pathology
Female
Humans
Image Processing, Computer-Assisted
*Magnetic Resonance Imaging
Male
Middle Aged
Muscle, Skeletal/pathology
Pyomyositis/*pathology
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 51-year-old man with surgically confirmed necrotizing fasciitis.

• 

  Fig. 2 37-year-old man with surgically confirmed necrotizing fasciitis.

• 

  Fig. 3 29-year-old woman with pathologically confirmed pyomyositis.

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