Objective
:
To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis.
Method
:
The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability.
Results
:
The overall interreader agreement of the MR staging system was very good (k-score= 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n=7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n=28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n=7 patients, 11.1%), sino-naso-orbital mucormycosis (n=13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n= 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (
P
>0.05). MRI-based staging involved four stages: stage 1 (n=7, 11.1%); stage 2 (n=35, 55.6%), and stage 3 (n=13, 20.6%), and stage 4 (n=8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients’ mortality
P=0.012
and
0.033
, respectively.
Conclusions
:
This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.
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