• Francesco Carbonetti, Antonio Cremona, Valentina Carusi, Marco Guidi, Elsa Iannicelli, Marco Di Girolamo, Daniela Sergi, Alvise Clarioni, Giulio Baio, Giulio Antonelli, Luca Fratini, and Vincenzo David.
• Department of Radiology, Faculty of Medicine and Psychology, Sant' Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa 1035, cap 00189, Rome, Italy. francescocarbonetti799@hotmail.com.
• Radiol Med. 2016 Feb 1; 121 (2): 106-21.

PurposeTo evaluate the diagnostic efficacy of contrast enhanced computed tomography (CECT) in emergency departments for diagnosis of necrotizing fasciitis (NF) and for differential diagnosis of other musculoskeletal infections; to correlate radiological findings with the laboratory risk indicator for necrotizing fasciitis (LRINEC).Materials And Methods7 radiological parameters to be analysed on CECT scans were established, exams of 36 patients with proven diagnosis of NF (n 12) and other musculoskeletal infections (n 24) were retrospectively reviewed; LRINEC score was calculated. Fisher's test and Spearman's and Kendall's coefficients of rank correlations were performed.ResultsTwo parameters were found to be strongly associated with the diagnosis of NF: involvement of the fascia (Spearman's ρ of 0.888, p < 0.001) and lack of fascial enhancement (Spearman's ρ of 0.672, p < 0.001). LRINEC score did not show strong association with the presence of fasciitis NF (Spearman's ρ of 0.490, p = 0.0024).ConclusionComputed tomography (CT) parameters, which are significantly associated with the diagnosis of NF, are the involvement of the fascia and its lack of enhancement; LRINEC score could be high (>5) also in other musculoskeletal infections. Final diagnosis of necrosis among the fascia is surgical. Presence of gas is not a specific sign of necrotizing fasciitis being present in other musculoskeletal infections. CT could easily discriminate NF from other musculoskeletal infections, adds an important value to clinical and laboratory tests in diagnosis of NF in an emergency context when magnetic resonance imaging, which is superior to CT in this discernment, could not be performed.

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