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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(01): 046-052
DOI: 10.1055/s-0042-1759639
Original Article

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

Sheetal Agarwal
1   Department of Radiodiagnosis, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Richa Gautam
1   Department of Radiodiagnosis, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Jyoti Kumar 
1   Department of Radiodiagnosis, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Anju Garg
1   Department of Radiodiagnosis, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Nita Khurana
2   Department of Pathology, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Ravi Meher
3   Department of Otorhinolaryngology, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Vikram Wadhwa
3   Department of Otorhinolaryngology, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
,
Ruchi Goel
4   Department of Ophthalmology, Guru Nanak Eye Center and Maulana Azad Medical College, New Delhi, India
,
Ritu Arora
4   Department of Ophthalmology, Guru Nanak Eye Center and Maulana Azad Medical College, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Purpose Our aim was to assess the sinonasal magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) in coronavirus disease (COVID)-associated mucormycosis (CAM) and to correlate these with histopathology and patient outcome in terms of duration of hospital stay and survival at 10 weeks.

Methods Twenty patients with histopathologically confirmed sinonasal CAM underwent MRI (including postcontrast T1-weighted and diffusion-weighted imaging). Histopathological findings (presence of coagulative necrosis, granulomatous reaction, and fungal burden) were recorded and all patients were followed up at 6 and 10 weeks. Statistical analysis was done using chi-square test and Fischer's exact test.

Results Enhancement patterns seen in our subjects included homogeneous, heterogeneous, and lack of contrast enhancement (LOC), with LOC being the most common (65%). Diffusion restriction was found in 90% patients. Statistically significant correlation was found between LOC pattern and presence of coagulative necrosis (p-value = 0.007), extent of fungal hyphae (p-value = 0.047), and duration of hospital stay (p-value = 0.004). Restricted diffusion was also seen to correlate with a high fungal load (p-value = 0.007).

Conclusion Our study describes the MRI findings of AIFRS in CAM and highlights the imaging features which may be surrogate markers for coagulative necrosis and fungal burden.

Keywords

lack of contrast enhancement - MRI - diffusion restriction - fungal load - coagulative necrosis


Publication History

Article published online:
16 December 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis 2014; 20 (03) 349-355
    CrossrefPubMedSearch in Google Scholar
  • 2 Arora R, Goel R, Khanam S. et al. Rhino-orbito-cerebral-mucormycosis during the COVID-19 second wave in 2021 - a preliminary report from a single hospital. Clin Ophthalmol 2021; 15: 3505-3514
    CrossrefPubMedSearch in Google Scholar
  • 3 Aribandi M, McCoy VA, Bazan III C. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 2007; 27 (05) 1283-1296
    CrossrefPubMedSearch in Google Scholar
  • 4 Therakathu J, Prabhu S, Irodi A, Sudhakar SV, Yadav VK, Rupa V. Imaging features of rhinocerebral mucormycosis: a study of 43 patients. Egypt J Radiol Nucl Med 2018; 49: 447-452
    CrossrefSearch in Google Scholar
  • 5 deShazo RD, Chapin K, Swain RE. Fungal sinusitis. N Engl J Med 1997; 337 (04) 254-259
    CrossrefPubMedSearch in Google Scholar
  • 6 Fatterpekar G, Mukherji S, Arbealez A, Maheshwari S, Castillo M. Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR 1999; 20 (06) 391-401
    CrossrefPubMedSearch in Google Scholar
  • 7 Ilica AT, Mossa-Basha M, Maluf F, Izbudak I, Aygun N. Clinical and radiologic features of fungal diseases of the paranasal sinuses. J Comput Assist Tomogr 2012; 36 (05) 570-576
    CrossrefPubMedSearch in Google Scholar
  • 8 Mossa-Basha M, Ilica AT, Maluf F, Karakoç Ö, Izbudak I, Aygün N. The many faces of fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol 2013; 19 (03) 195-200
    PubMedSearch in Google Scholar
  • 9 Howells RC, Ramadan HH. Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis. Am J Rhinol 2001; 15 (04) 255-261
    CrossrefPubMedSearch in Google Scholar
  • 10 Choi YR, Kim JH, Min HS. et al. Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis. Neuroradiology 2018; 60 (07) 715-723
    CrossrefPubMedSearch in Google Scholar
  • 11 Safder S, Carpenter JS, Roberts TD, Bailey N. The “Black Turbinate” sign: an early MR imaging finding of nasal mucormycosis. AJNR Am J Neuroradiol 2010; 31 (04) 771-774
    CrossrefPubMedSearch in Google Scholar
  • 12 Taylor AM, Vasan K, Wong EH. et al. Black Turbinate sign: MRI finding in acute invasive fungal sinusitis. Otolaryngol Case Rep 2020; 17: 100222
    CrossrefSearch in Google Scholar
  • 13 Seo J, Kim HJ, Chung SK. et al. Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology 2013; 55 (04) 467-473
    CrossrefPubMedSearch in Google Scholar
  • 14 Zinreich SJ, Kennedy DW, Malat J. et al. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 1988; 169 (02) 439-444
    CrossrefPubMedSearch in Google Scholar
  • 15 Deshazo RD. Syndromes of invasive fungal sinusitis. Med Mycol 2009; 47 (Suppl. 01) S309-S314
    CrossrefPubMedSearch in Google Scholar
  • 16 Koc Z, Koc F, Yerdelen D, Ozdogu H. Rhino-orbital-cerebral mucormycosis with different cerebral involvements: infarct, hemorrhage, and ophthalmoplegia. Int J Neurosci 2007; 117 (12) 1677-1690
    CrossrefPubMedSearch in Google Scholar
  • 17 Sreshta K, Dave TV, Varma DR. et al. Magnetic resonance imaging in rhino-orbital-cerebral mucormycosis. Indian J Ophthalmol 2021; 69 (07) 1915-1927
    CrossrefPubMedSearch in Google Scholar
  • 18 Cho HJ, Jang MS, Hong SD, Chung SK, Kim HY, Dhong HJ. Prognostic factors for survival in patients with acute invasive fungal rhinosinusitis. Am J Rhinol Allergy 2015; 29 (01) 48-53
    CrossrefPubMedSearch in Google Scholar
  • 19 Kim JH, Kang BC, Lee JH, Jang YJ, Lee BJ, Chung YS. The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis. J Infect 2015; 70 (01) 88-95
    CrossrefPubMedSearch in Google Scholar
  • 20 Meher R, Wadhwa V, Kumar V. et al. COVID associated mucormycosis: a preliminary study from a dedicated COVID Hospital in Delhi. Am J Otolaryngol 2022; 43 (01) 103220
    CrossrefPubMedSearch in Google Scholar