Early in the disease process, especially NF infections with more aerobic organisms, and in diabetic patients, soft tissue gas may not be present or detectable by CT [52]. In the Fernando et al meta-analysis of NF studies, most CT examinations were performed without IV contrast or the type of CT examination was not specified [52,54]. The evaluation of the use of contrast-enhanced imaging in the medical literature is limited [2]. Carbonetti et al [51] performed a retrospective study investigating 36 selected patients who had contrast-enhanced CT imaging performed and concern for NF or other severe soft tissue infection, which included confirmed patients with NF (10 surgically proven patients), non-NF (2 patients), cellulitis (10 patients), soft tissue abscess (7 patients), myositis (5 patients), and gas gangrene (2 patients). This study concluded that CT findings of fascial fluid and thickening and lack of enhancement of the fascia after CT with IV contrast administration were both highly associated with NF. The Carbonetti et al study reported that more patients with surgically proven NF had absence of fascial enhancement compared with those with other musculoskeletal infections, suggesting that the absence of fascial enhancement was specific for NF [55]. Contrast-enhanced CT imaging also improves the assessment for abscess, tissue necrosis, and vascular complications [6,52]. However, noncontrast CT is highly accurate for detection of NF [2,49,52,54]. Suspected Osteomyelitis, Septic Arthritis MRI Area of Interest MRI is the modality of choice for detecting superficial or deep fascial fluid or edema [2,49,50,52,56,57]. MRI can recognize small amounts of fluid or edema in the fascia, potentially allowing for earlier diagnosis [54,56].
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. Early in the disease process, especially NF infections with more aerobic organisms, and in diabetic patients, soft tissue gas may not be present or detectable by CT [52]. In the Fernando et al meta-analysis of NF studies, most CT examinations were performed without IV contrast or the type of CT examination was not specified [52,54]. The evaluation of the use of contrast-enhanced imaging in the medical literature is limited [2]. Carbonetti et al [51] performed a retrospective study investigating 36 selected patients who had contrast-enhanced CT imaging performed and concern for NF or other severe soft tissue infection, which included confirmed patients with NF (10 surgically proven patients), non-NF (2 patients), cellulitis (10 patients), soft tissue abscess (7 patients), myositis (5 patients), and gas gangrene (2 patients). This study concluded that CT findings of fascial fluid and thickening and lack of enhancement of the fascia after CT with IV contrast administration were both highly associated with NF. The Carbonetti et al study reported that more patients with surgically proven NF had absence of fascial enhancement compared with those with other musculoskeletal infections, suggesting that the absence of fascial enhancement was specific for NF [55]. Contrast-enhanced CT imaging also improves the assessment for abscess, tissue necrosis, and vascular complications [6,52]. However, noncontrast CT is highly accurate for detection of NF [2,49,52,54]. Suspected Osteomyelitis, Septic Arthritis MRI Area of Interest MRI is the modality of choice for detecting superficial or deep fascial fluid or edema [2,49,50,52,56,57]. MRI can recognize small amounts of fluid or edema in the fascia, potentially allowing for earlier diagnosis [54,56].