Objective: To determine if there was an increase in the rate of cases presenting with rhino-orbital-cerebral mucormycosis (ROCM) to a tertiary care center during the first wave of the coronavirus disease 2019 (COVID-19) pandemic and the characteristics of the presenting cases.Methods: Retrospective observational study reviewing ROCM cases presenting from March 25 until September 25, 2020. Cases fulfilling the clinical, radiological, and pathological/microbiological criteria for diagnosis with ROCM were included. The number of cases presenting during the designated interval, their COVID-19 status, comorbidities, and clinical presentation were analyzed. The number of cases during the corresponding interval in the previous 3 years was used as reference to detect if there was a recent spike.Results: Of the 12 ROCM cases identified, 5 had a concurrent positive reverse transcription PCR (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 had a prior positive result, and 6 did not have concurrent nor prior positive test results. Nine of the 12 cases had poorly controlled diabetes mellitus, and 2 cases had a hematological malignancy. All cases had orbital invasion, and eight cases had cerebral invasion. The number of cases identified during the interval is much higher than the numbers presenting in the prior 3 years during equivalent intervals (range, one to two cases) than those reported in the literature in different settings in the pre-pandemic era.Conclusions: There is an increased rate of ROCM cases presenting to our center during the first wave of the COVID-19 pandemic. This is a preliminary report, and further studies are needed to corroborate the findings and explain possible underlying links.

Background: The incidence of devastating opportunistic coinfections in patients with COVID-19 infection, their imaging features and their morbidity and mortality consequences need to be unraveled. Methods: This is a case series presenting the radiologic features and clinical presentation of acute invasive fungal rhino-orbital-cerebral sinusitis (AIFS) in eight hospitalized patients with confirmed COVID-19 infection. Results: Our patient cohort presented with symptoms of the invasive fungal disease within 12-35 days from their initial presentation with COVID-19 infection. The cross-sectional imaging features of AIFS associated with COVID-19 infection do not differ from those reported in the literature for AIFS associated with other risk factors, yet our patients had features of aggressive late-stage forms with high morbidity and mortality rate. Conclusion: AIFS is a possible encounter in patients with COVID-19 patients and radiologists should be familiar with its imaging features.

The diagnosis of thyroid cartilage invasion in patients presenting with laryngeal carcinoma is essential for pre-therapeutic staging. Compared to CT, diffusion-weighted magnetic resonance imaging (MRI) has a similar ability to define the interface between fat and tumor, but is superior for assessing muscle and cartilage invasion. Diffusion-weighted MRI may be indicated if there are equivocal findings in the CT, including possible cartilage invasion. The aim of this study is to assess the validity of diffusion-weighted MRI in predicting inner and outer thyroid cartilage laminae invasion in patients with laryngeal carcinoma. A prospective study was carried out between August 2011 and May 2013. The study included 26 patients. Twenty-three patients underwent total laryngectomy and three patients underwent partial laryngectomy. Histopathology reports of resected specimens and pre-operative staging were blind to the consultant radiologist who reviewed the scans to comment on thyroid cartilage invasion with special emphasis on inner and outer lamina invasion by conventional MRI criteria, contrast enhancement and DWI. The sensitivity, specificity, efficiency (correct classification rate), and positive and negative predictive values of MRI for identification of inner thyroid lamina invasion were: 93, 82, 88, 88 and 90 % respectively, while those of outer thyroid lamina invasion were: 85, 85, 85, 85 and 85 %, respectively. Diffusion-weighted MRI showed high validity and precision in detecting inner and outer thyroid lamina invasion. This can have an important impact on the decision making for management of laryngeal carcinoma.

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Background: To evaluate the inter-and intrareader agreement and reproducibility of the NI-RADS scoring system and lexicon with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). Methods: This retrospective study included 97 CECT and CEMRI scans from 58 treated cases of head and neck squamous cell carcinoma (HNSCC) after the exclusion of head and neck cancers (HNCs) other than SCC and noncontrast and poor quality CT and MRI scans, with a total of 111 primary targets and 124 lymph node (LN) targets. Two experienced readers independently scored the likelihood of residual/recurrence for these targets based on the NI-RADS criteria and filled in report templates for NI-RADS lexicon diagnostic features. Inter-and intraobserver reproducibility was assessed with Cohen's kappa, and the percent agreement was calculated. Results: Almost perfect interreader agreement was found for the final NI-RADS category of the primary lesions and LNs, with K = 0.808 and 0.806, respectively. Better agreement was found for CT than for MRI (K = 0.843 and 0.77, respectively, P value 0.001). There was almost perfect agreement for excluding tissue enhancement (K = 0.826, 95% CI = 0.658-0.993, P value 0.001), with a percent agreement of 96.4%, and substantial agreement for discrete nodular and diffuse mucosal enhancement (K = 0.826, 95% CI = 0.658-0.993, P value 0.001), with a percent agreement of 96.4%. There was fair agreement for focal mucosal nonmass and deep ill-defined enhancement. The intrareader agreement was almost perfect for most of the rated features (K ranging from 0.802 to 1), with the exception of enlarging discrete nodule/mass and focal mucosal nonmass-like enhancement, which had substantial intraobserver agreement (K ranging from 0.768 to 0.786). Conclusion: The individual features of NI-RADS show variable degrees of confidence; however, the overall NI-RADS category was not significantly affected.