By Fatin Chowdhury ‘19

Imaging technology has become more useful for preventing surgery and aiding in its success. Technologies such as CT (computed tomography) scans have expanded the breadth of diagnostic methodologies available to physicians. Dr. Myriam Martinez in Boston, Massachusetts, sought to pinpoint the usefulness of CT technology in allowing for necrotizing soft infections (NSTI) diagnoses. The researchers found that NSTIs could be examined effectively with computed tomography (CT) scans of the contrast-enhanced category.

The researchers analyzed medical record data relating to 184 patients admitted for a suspected NSTI. The patients underwent a CT scan with intravenous contrast, along with gas in soft tissue, multiple fluid collections, tissue enhancement, and connective tissue inflammation as NSTI markers sought out from the scan results. STATA software was used to perform t-test analyses.

Positive CT scans occurred in 9% of the selected patients, and following surgery, 76% were found to have a NSTI.  In patients with negative CT scans, 23% underwent surgery because it was thought that they had NSTIs, but these patients had non-necrotizing infections. 77% of patients were treated without any operations. Two variables that were significantly different between NSTI diagnosed and non-NSTI diagnosed patients were white blood cell counts and hemoglobin levels.

Although the sample size was small, the researchers suggested that CT imaging technology was an effective supplement to surgery-related decisions concerning suspected NSTIs. They suggested that NSTI symptoms were often missed or indistinguishable from other diseases, leading to high mortality rates that could be reduced through CT technology. In the future, computed tomography could be refined into a non-invasive way of detecting NSTIs, with surgeons being trained to identify them.

References:

1. M. Martinez, et al., The role of computed tomography in the diagnosis of necrotizing soft tissue infections. World Journal of Surgery 42, 82-87 (2018). doi: 10.1007/s00268-017-4145-x.
2. Image retrieved from: https://www.twenty20.com/photos/bab509ff-475c-4602-8dde-eedc4b866bc7