Background and Purpose:The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal sinusitis (AIFS) and associated comorbidities. Methods:A retrospective study was conducted on 25 patients (12 males and 13 females, mean age of 53.9±9.1 years). All patients had positive polymerase chain reaction test for COVID-19 and histopathological proof of AIFS. Patients underwent computed tomography (CT) and magnetic resonance examinations to assess sinonasal, orbital, and cranial spread. Results:The most prevalent comorbidity among the study cohort was diabetes mellitus (DM). Twenty-one patients (84%) were diagnosed in the post-COVID-19 period after hospital discharge, with a mean interval of 19.1±9.2 days. Steroid treatment was given to 19 patients (76%). Orbital manifestations were the presenting symptoms in all patients, followed by facial edema, nasal discharge, and neurological symptoms. Sinonasal involvement ranged from mucosal thickening to complete sinus opacification by a predominant isodensity on CT, low T1, and high T2 signal intensity with variable enhancement patterns.Twenty-four patients had a unilateral orbital extension, and 12 patients showed signs of intracranial extension. Bone involvement was detected in 16 patients (64%). Follow-up scans in 18 patients (72%) showed rapid progression of the disease. Eight patients (32%) died, six from neurological complications and two from severe respiratory failure. Conclusion: Steroids, DM, and severe COVID-19 are the major risk factors of AIFS in the post-COVID-19 era. Imaging scans in all patients revealed different sinonasal, facial, orbital features, and intracranial involvement with rapid progression of the findings on follow-up scans.

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Purpose: to demonstrate role of diffusion tensor imaging (DTI) in diagnosis of pediatric chronic kidney disease (CKD) using fraction anisotropy (FA) and apparent diffusion coefficient (ADC). Material and methods: Prospective study done on 35 CKD patients (19 boys, 16 girls; mean age 12.2±2.7 years) and 19 age and sex-matched volunteers. Patients with sclerotic (n = 25) and non-sclerotic (n= 10) CKD that underwent DTI of kidney. Results: Mean FA of renal cortex/ medulla in CKD (0.20±0.07, and 0.18±0.08) was significantly lower (p = 0.001) from volunteers (0.27±0.08, 0.31±0.09). Cutoff renal FA of cortex/ medulla used for diagnosis of CKD was 0.23, and 0.22 with AUC of 0.828, 0.828 and accuracy of 82.9%, 80.7%. Mean ADC of renal cortex/ medulla in CKD (1.98±0.23 and 2.03±0.23 X10-3mm2/s) was significantly higher (p = 0.001) that of volunteers (1.65±0.134 and 1.68±0.16 X10-3mm2/s. Cutoff renal ADC of cortex/medulla used to diagnosis of CKD were 1.75 and 1.85X10-3mm2/s with AUC of 0.828, 0.910, 0.828 and 0.81 and accuracy of 82.9%, 84.1%, 80.7% and 79.5%. FA of renal cortex/medulla in sclerotic CKD was significantly different (p = 0.001) than non-sclerotic CKD (0.26±0.07 and 0.25±0.08). The FA of renal cortex/medulla in CKD patients correlated with serum creatinine (r = -0.468; p = 0.000, r =-0.381; p = 0.001), e GFR (r = 0.364; p = 0.002, r = 0.318; p = 0.007). Conclusion: FA and ADC of renal cortex/ medulla can help in diagnosis of CKD, FA cortex/ medulla predicts sclerotic CKD and correlated with some of serum biomarkers.

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