The role of radiologic evaluation in necrotizing soft tissue infections.

Background: The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTI) is not clear due 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 highly diagnosed or highly suspected NSTI in 97.3% of cases with true NSTI as compared to, 83.6% with XR, P

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