Abstract
ObjectivesDue to its superior soft-tissue contrast and ability to delineate abscesses, MRI has high diagnostic accuracy in neck infections. Whether MRI findings can predict the clinical course in these patients is unknown. The purpose of this study was to determine the clinical and prognostic significance of various MRI findings in emergency patients with acute neck infections.Materials and methodsWe retrospectively reviewed the 3-T MRI findings of 371 patients with acute neck infections from a 5-year period in a single tertiary emergency radiology department. We correlated various MRI findings, including retropharyngeal (RPE) and mediastinal edema (ME) and abscess diameter, to clinical findings and outcomes, such as the need for intensive care unit (ICU) treatment and length of hospital stay (LOS).ResultsA total of 201 out of 371 patients (54%) with neck infections showed evidence of RPE, and 81 out of 314 patients (26%) had ME. Both RPE (OR = 9.5, p < 0.001) and ME (OR = 5.3, p < 0.001) were more prevalent among the patients who required ICU treatment than among those who did not. In a multivariate analysis, C-reactive protein (CRP) levels, RPE, and maximal abscess diameter were independent predictors of the need for ICU treatment, and CRP, ME, and maximal abscess diameter were independent predictors of LOS.ConclusionIn patients with an acute neck infection that requires emergency imaging, RPE, ME, and abscess diameter, as shown by MRI, are significant predictors of a more severe illness.Key Points• Two hundred one out of 371 patients (54%) with neck infection showed evidence of retropharyngeal edema (RPE), and 81 out of 314 patients (26%) had mediastinal edema (ME).• Maximal abscess diameter, RPE, and C-reactive protein (CRP) were independent predictors of the need for intensive care unit (ICU) treatment, and maximal abscess diameter, ME, and CRP were independent predictors of length of hospital stay.• Prognostic significance of MRI findings was evident also while controlling for CRP values.
Highlights
Deep neck infections present challenges, even in modern medicine, due to their complex anatomy and potentially lethalEur Radiol complications [1]
Distinguishing between reactive non-suppurative edema and true abscesses in deep neck spaces using CT may be challenging [4,5,6]. This distinction is critical for choosing the appropriate treatment: abscesses usually require surgical drainage, whereas infections without abscesses usually resolve after conservative treatment
We focused on maximal abscess diameter and two specific edema patterns: retropharyngeal edema (RPE) and mediastinal edema (ME)
Summary
Deep neck infections present challenges, even in modern medicine, due to their complex anatomy and potentially lethalEur Radiol complications [1]. Deep neck infections present challenges, even in modern medicine, due to their complex anatomy and potentially lethal. Emergency imaging is often required to determine the exact location and extent of the disease. In suspected neck infection cases, CT has traditionally been the first-line imaging method [2, 3]. Distinguishing between reactive non-suppurative edema and true abscesses in deep neck spaces using CT may be challenging [4,5,6]. This distinction is critical for choosing the appropriate treatment: abscesses usually require surgical drainage, whereas infections without abscesses usually resolve after conservative treatment. MRI is often considered time consuming and challenging for acutely ill patients, emergency neck MRI has recently shown to be feasible and to have superior diagnostic accuracy to that previously reported for CT [8]
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