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Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis

Ye Ra Choi1,2, Ji-Hoon Kim3, Hye Sook Min4

  • 1Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.

Neuroradiology
|May 19, 2018
PubMed
Abstract

Insights

Acute invasive fungal rhinosinusitis (AIFRS) often spreads beyond the sinuses, with lack of contrast enhancement (LoCE) on MRI being a key indicator. This imaging feature independently predicts a worse prognosis and higher mortality in AIFRS patients.

Area of Science:

  • Radiology
  • Infectious Diseases
  • Oncology

Background:

  • Acute invasive fungal rhinosinusitis (AIFRS) is a severe, challenging-to-diagnose condition.
  • Limited understanding exists regarding its comprehensive imaging features and prognostic implications.

Purpose of the Study:

  • To delineate the characteristic Magnetic Resonance (MR) imaging features of AIFRS.
  • To assess the prognostic impact of these MR imaging features on patient survival.

Main Methods:

  • Retrospective analysis of MR images and clinical data from 23 AIFRS patients.
  • Identification of imaging features and prognostic factors using multivariable Cox proportional hazard models and Kaplan-Meier survival analysis.

Main Results:

  • Extra-sinonasal involvement was universal, with the orbit being the most frequent site (65.2%).
  • Lesion enhancement patterns included lack of contrast enhancement (LoCE) (47.8%), homogeneous (34.8%), and heterogeneous (17.4%).
  • LoCE was identified as the sole independent prognostic factor for disease-specific mortality (HR=16.819, p=0.017), correlating with coagulation necrosis and associated with significantly worse survival (p=0.008).

Conclusions:

  • AIFRS frequently presents with extra-sinonasal spread and diverse MR enhancement patterns.
  • LoCE on MR imaging is a critical, unique prognostic factor in AIFRS, indicating a poorer patient outcome.
Keywords:
Acute invasive fungal rhinosinusitisCoagulative necrosisLack of contrast enhancementMagnetic resonance imagingPrognosis

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