{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:13:42Z","timestamp":1793092422117,"version":"4.5.0"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T00:00:00Z","timestamp":1600646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We developed a new magnetic resonance indicator for necrotizing fasciitis (MRINEC) algorithm for differentiating necrotizing fasciitis (NF) from severe cellulitis (SC). All adults with suspected NF between 2010 and 2018 in a tertiary hospital in South Korea were enrolled. Sixty-one patients were diagnosed with NF and 28 with SC. Among them, 34 with NF and 15 with SC underwent magnetic resonance imaging (MRI). The MRINEC algorithm, a two-step decision tree including T2 hyperintensity of intermuscular deep fascia and diffuse T2 hyperintensity of deep peripheral fascia, diagnosed NF with 94% sensitivity (95% confidence interval (CI), 80\u201399%) and 60% specificity (95% CI, 32\u201384%). The algorithm accurately diagnosed all 15 NF patients with a high (\u22658) laboratory risk indicator for necrotizing fasciitis (LRINEC) score. Among the five patients with an intermediate (6\u20137) LRINEC score, sensitivity and specificity were 100% (95% CI, 78\u2013100%) and 0% (95% CI, 0\u201384%), respectively. Finally, among the 29 patients with a low (\u22645) LRINEC score, the algorithm had a sensitivity and specificity of 88% (95% CI, 62\u201398%) and 69% (95% CI, 39\u201391%), respectively. The MRINEC algorithm may be a useful adjuvant method for diagnosing NF, especially when NF is suspected in patients with a low LRINEC score.<\/jats:p>","DOI":"10.3390\/jcm9093040","type":"journal-article","created":{"date-parts":[[2020,9,21]],"date-time":"2020-09-21T21:01:21Z","timestamp":1600722081000},"page":"3040","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Utility of Magnetic Resonance Imaging for Differentiating Necrotizing Fasciitis from Severe Cellulitis: A Magnetic Resonance Indicator for Necrotizing Fasciitis (MRINEC) Algorithm"],"prefix":"10.3390","volume":"9","author":[{"given":"Min-Chul","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Been","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guen Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-2412","authenticated-orcid":false,"given":"Seong-Ho","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9010-5460","authenticated-orcid":false,"given":"Seon Ok","family":"Kim","sequence":"additional","affiliation":[{"name":"Departments of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4811-6056","authenticated-orcid":false,"given":"Jin-Won","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul 06973, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"ref_1","first-page":"971","article-title":"Necrotizing Soft-Tissue Infections","volume":"378","author":"Stevens","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/00000658-199505000-00013","article-title":"Determinants of mortality for necrotizing soft-tissue infections","volume":"221","author":"McHenry","year":"1995","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/SLA.0000000000002774","article-title":"Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis","volume":"269","author":"Fernando","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1086\/511638","article-title":"Necrotizing soft-tissue infection: Diagnosis and management","volume":"44","author":"Anaya","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.5811\/westjem.2016.2.29069","article-title":"Inadequate Sensitivity of Laboratory Risk Indicator to Rule Out Necrotizing Fasciitis in the Emergency Department","volume":"17","author":"Burner","year":"2016","journal-title":"West. J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1148\/radiol.11101164","article-title":"Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging?","volume":"259","author":"Kim","year":"2011","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S1072-7515(98)00192-6","article-title":"Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity","volume":"187","author":"Brothers","year":"1998","journal-title":"J. Am. Coll. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"20130560","DOI":"10.1259\/bjr.20130560","article-title":"MRI in necrotizing fasciitis of the extremities","volume":"87","author":"Ali","year":"2014","journal-title":"Br. J. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"615","DOI":"10.2214\/ajr.170.3.9490940","article-title":"Differentiation of necrotizing fasciitis and cellulitis using MR imaging","volume":"170","author":"Schmid","year":"1998","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.jbspin.2012.08.009","article-title":"Necrotizing fasciitis: Contribution and limitations of diagnostic imaging","volume":"80","author":"Malghem","year":"2013","journal-title":"Jt. Bone Spine"},{"key":"ref_13","unstructured":"Breiman, L., Friedman, J.H., Olshen, R.A., and Stone, C.J. (1984). Classification and Regression Trees, Chapman and Hall\/CRC."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3414","DOI":"10.1007\/s00330-019-06103-0","article-title":"Distinguishing necrotizing from non-necrotizing fasciitis: A new predictive scoring integrating MRI in the LRINEC score","volume":"29","author":"Yoon","year":"2019","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.bjps.2014.11.003","article-title":"Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: A retrospective case series","volume":"68","author":"Hodgins","year":"2015","journal-title":"J. Plast. Reconstr. Aesthet Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jemermed.2012.09.039","article-title":"A case of necrotizing fasciitis with a LRINEC score of zero: Clinical suspicion should trump scoring systems","volume":"44","author":"Wilson","year":"2013","journal-title":"J. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1308\/003588413X13511609956093","article-title":"A five-year review of necrotising fasciitis in a tertiary referral unit","volume":"95","author":"Swain","year":"2013","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1177\/0310057X0903700416","article-title":"Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score to patients in a tropical tertiary referral centre","volume":"37","author":"Holland","year":"2009","journal-title":"Anaesth. Intensive Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s13017-016-0080-7","article-title":"Review of 58 patients with necrotizing fasciitis in the Netherlands","volume":"11","author":"Bijker","year":"2016","journal-title":"World J. Emerg. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Borschitz, T., Schlicht, S., Siegel, E., Hanke, E., and von Stebut, E. (2015). Improvement of a Clinical Score for Necrotizing Fasciitis: \u2018Pain Out of Proportion\u2019 and High CRP Levels Aid the Diagnosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132775"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jpedsurg.2016.02.076","article-title":"Laboratory evaluation for pediatric patients with suspected necrotizing soft tissue infections: A case-control study","volume":"51","author":"Putnam","year":"2016","journal-title":"J. Pediatric Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/TA.0000000000001857","article-title":"Optimal timing of initial debridement for necrotizing soft tissue infection: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma","volume":"85","author":"Gelbard","year":"2018","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/3040\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:12:07Z","timestamp":1760177527000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/3040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,21]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9093040"],"URL":"https:\/\/doi.org\/10.3390\/jcm9093040","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,21]]}}}