If clinical suspicion for potentially life-threatening necrotizing fasciitis is high, detection of hyperintense signal within chest wall deep fascial compartments on fluid-sensitive MRI sequences is highly suggestive of the disease, and the absence of these findings essentially exclude the disease [48,58]. MRI also serves a role in surgical planning prior to debridement procedures, distinguishing viable from nonviable tissue based on tissue signal and enhancement characteristics [48]. MRI may be helpful in the differentiation of chest wall infection from tumor. Anterior chest wall pain is a common complaint among patients who have underlying spondyloarthritis, but the diagnosis may be delayed for many years [53]. MRI was 62.5% sensitive in determining sternoclavicular and sternocostal involvement by inflammatory spondyloarthritis in patients who presented with anterior chest wall pain as an early manifestation of their disease and was able to provide specific information regarding disease activity and severity beyond that provided by bone scintigraphy [49]. Another study showed higher sensitivity of MRI for detection of disease activity (bone marrow edema, erosions, and fat infiltration) than other serologic and clinical Nontraumatic Chest Wall Pain parameters, and especially involvement of the manubriosternal joint [59]. Other systemic inflammatory conditions can also be suggested by MRI with abnormal signal intensity of skeletal muscle (whether from edema or fatty atrophy), such as immune-mediated myositis and other neurodegenerative diseases [48]. Radiography Rib Views There is no relevant literature to support the use of radiography rib views beyond chest radiography in the primary evaluation of chest wall pain in patients with suspected chest wall infectious or inflammatory conditions.
Nontraumatic Chest Wall Pain. If clinical suspicion for potentially life-threatening necrotizing fasciitis is high, detection of hyperintense signal within chest wall deep fascial compartments on fluid-sensitive MRI sequences is highly suggestive of the disease, and the absence of these findings essentially exclude the disease [48,58]. MRI also serves a role in surgical planning prior to debridement procedures, distinguishing viable from nonviable tissue based on tissue signal and enhancement characteristics [48]. MRI may be helpful in the differentiation of chest wall infection from tumor. Anterior chest wall pain is a common complaint among patients who have underlying spondyloarthritis, but the diagnosis may be delayed for many years [53]. MRI was 62.5% sensitive in determining sternoclavicular and sternocostal involvement by inflammatory spondyloarthritis in patients who presented with anterior chest wall pain as an early manifestation of their disease and was able to provide specific information regarding disease activity and severity beyond that provided by bone scintigraphy [49]. Another study showed higher sensitivity of MRI for detection of disease activity (bone marrow edema, erosions, and fat infiltration) than other serologic and clinical Nontraumatic Chest Wall Pain parameters, and especially involvement of the manubriosternal joint [59]. Other systemic inflammatory conditions can also be suggested by MRI with abnormal signal intensity of skeletal muscle (whether from edema or fatty atrophy), such as immune-mediated myositis and other neurodegenerative diseases [48]. Radiography Rib Views There is no relevant literature to support the use of radiography rib views beyond chest radiography in the primary evaluation of chest wall pain in patients with suspected chest wall infectious or inflammatory conditions.