COVID-Associated Sinonasal Mucormycosis: Radiological Pathological Correlation and Prognostic Value of MR Imaging

Agarwal, Saurabh; Gautam, Richa; Kumar, Jyoti; Garg, Anju; Khurana, Nita; Meher, Ravi; Wadhwa, Vibhor; Goel, Ruchi; Arora, Ritu

doi:10.1055/s-0042-1759639

Cited by 4 publications

(8 citation statements)

References 20 publications

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“…In sinuses, Agarwal et al observed variable signal intensity on T2WI and predominantly (90%) hypointensity on T1WI (14). In our study, we also found variable signal intensity on T2WI (60% hyperintense, 25% isointense and 4% hypointense) and all showed hypointensity on T1WI.…”

Section: Tablesupporting

confidence: 80%

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Radiological spectrum of rhino-occulo-cerebral mucormycosis

Dinesh

Prasad

Suman

et al. 2023

Preprint

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Aim and objectives Aim To study the spectrum of imaging findings in patients Rhino-occulo-cerebral mucormycosis (ROCM). Objectives l To study the demographic profile of patients with ROCM l To detect the associated extrasinus complications of ROCM l To aid in clinical diagnosis of ROCM Materials & methods This retrospective descriptive study was performed in histopathologically confirmed cases of ROCM. The case records of patients with radiological, culture and histological evidence of acute invasive rhinocerebral mucormycosis were retrospectively evaluated for relevant radiological and clinical data between May 2021 to June 2022. Results The radiological evaluation included CT and MRI scans were done in 52 patients. The patient's average age was 48 years. The ethmoid sinus was involved in 46 cases (88%) and the maxillary sinus in 27 cases (52%). Biltaral (45, 86%) and pansinus (27, 52%) involvement were the most common. The orbit was involved in 39 cases (75%), the face in 25 cases (47%), and retroantral fat stranding in 24 cases (46%). Mucosal thickening (91%) was the most common pattern of involvement, followed by complete opacification (37%). Osseous involvement was seen in 17 of 44 patients who had CT scans, and the majority of patients had extrasinus extension with intact bone. MRI revealed variable T2SI, with T2 hyperintensity being the most common pattern. Heterogeneous enhancement in post contrast imaging was the most common. Conclusion Rhinocerebral mucormycosis is characterised by a variety of imaging abnormalities on CT and MRI. In determining the degree of involvement and consequences, imaging is crucial.

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Section: Tablesupporting

confidence: 80%

“…In our study, we also found variable signal intensity on T2WI (60% hyperintense, 25% isointense and 4% hypointense) and all showed hypointensity on T1WI. The accumulation of hemosiderin and paramagnetic materials such as calcium, iron, magnesium, and manganese has been linked to hypointensity on T1WI and T2WI in fungal disease (3,14,15).…”

Section: Tablementioning

confidence: 99%

Radiological spectrum of rhino-occulo-cerebral mucormycosis

Dinesh

Prasad

Suman

et al. 2023

Preprint

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“…Regarding sinuses, Agarwal et al [ 14 ] observed variable signal intensity on T2WI and predominantly (90%) hypointensity on T1WI. In our study, we also found variable signal intensity on T2WI (60% hyperintense, 25% isointense, and 4% hypointense), and all showed hypointensity on T1WI.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we also found variable signal intensity on T2WI (60% hyperintense, 25% isointense, and 4% hypointense), and all showed hypointensity on T1WI. The accumulation of hemosiderin and paramagnetic materials such as calcium, iron, magnesium, and manganese has been linked to hypointensity on T1WI and T2WI in fungal disease [ 2 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Radiological Spectrum of Rhino-Oculo-Cerebral Mucormycosis

Dinesh¹,

Prasad²,

Suman³

et al. 2023

Cureus

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Aim We aim to study the spectrum of imaging findings in patients with rhino-oculo-cerebral mucormycosis (ROCM). Materials and methods This retrospective descriptive study was performed in histopathologically confirmed cases of rhino-oculo-cerebral mucormycosis in a tertiary care center in Bihar, India. The case records of patients with radiological, cultural, and histological evidence of acute invasive ROCM were retrospectively evaluated for relevant radiological and clinical data between May 2021 and June 2022. Results The radiological evaluation included computed tomography (CT) and magnetic resonance imaging (MRI) scans done on 52 patients. The patient's average age was 48 years. The ethmoid sinus was involved in 51 (98%) cases and the maxillary sinus in 50 (96%) cases. Bilateral sinus involvement (45, 86%) was the most common, followed by pansinus involvement (27, 52%). The orbit was involved in 39 (75%) cases, the face in 25 (47%) cases, and retroantral fat stranding in 24 (46%) cases. Mucosal thickening (91%) was the most common pattern of involvement, followed by complete opacification (77%). Osseous involvement was seen in 17 of 44 patients who had CT scans, and the majority of patients had extrasinus extension with intact bone. MRI revealed variable T2SI, with T2 hyperintensity being the most common pattern. Heterogeneous enhancement in post-contrast imaging was the most common. Conclusion ROCM is a life-threatening invasive fungal infection, especially in an immunocompromised state. ROCM is characterized by a variety of imaging abnormalities on CT and MRI, although nonspecific. Imaging aids in suspicion or early diagnosis in appropriate clinical contexts, particularly in an immunocompromised state, and in determining the degree of involvement and complications. Early detection of ROCM and its complications enables proper treatment, which can lower the cost of care, morbidity, and mortality.

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“…Few studies have described imaging features of COVID-19associated AIFR. 10,[13][14][15][16][17][18][19] We have described imaging findings in 90 studies including computed tomography (CT) and magnetic resonance imaging (MRI) of 60 patients of post-COVID-19 AIFR admitted and managed at our institute.…”

Section: Introductionmentioning

confidence: 99%

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

Yadav

Kumar

Sachdeva

et al. 2023

Indian Journal of Neurosurgery

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Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion (n = 3), vascular narrowing (n = 3), and pseudoaneurysm (n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.

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COVID-Associated Sinonasal Mucormycosis: Radiological Pathological Correlation and Prognostic Value of MR Imaging

Cited by 4 publications

References 20 publications

Radiological spectrum of rhino-occulo-cerebral mucormycosis

Radiological spectrum of rhino-occulo-cerebral mucormycosis

The Radiological Spectrum of Rhino-Oculo-Cerebral Mucormycosis

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

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