Fungal sinusitis: diagnosis with CT and MR imaging

Area of Science:

• Radiology
• Medical Imaging
• Pathology

Background:

• Chronic sinusitis affects a significant number of patients.
• Accurate diagnosis of fungal sinusitis is crucial for effective treatment.
• Computed tomography (CT) and magnetic resonance (MR) imaging are key diagnostic tools.

Purpose of the Study:

• To compare the diagnostic efficacy of CT and MR imaging in identifying fungal sinusitis.
• To investigate the imaging characteristics of fungal sinusitis.
• To explore the elemental composition of fungal mycetoma.

Main Methods:

• Retrospective analysis of 293 patients with chronic sinusitis undergoing CT, surgery, and pathology.
• Evaluation of CT findings, including foci of increased attenuation and CT numbers.
• MR imaging of selected patients, focusing on T2-weighted signal characteristics.
• Furnace atomic absorption spectrometry to analyze elemental concentrations in mycetoma and mucus.

Main Results:

• Twenty-five patients were diagnosed with fungal sinusitis pathologically.
• CT identified increased attenuation foci in 22 of 25 patients, with a 76% diagnostic rate based on study criteria.
• MR imaging revealed hypointense signal characteristics on T2-weighted images in all evaluated cases.
• Elevated iron and manganese concentrations were found in mycetoma compared to bacterially infected mucus.

Conclusions:

• MR imaging, particularly T2-weighted sequences, demonstrates more characteristic findings for fungal sinusitis than CT.
• The hypointense signal on MR images may be attributed to increased concentrations of iron, manganese, and calcium within fungal concretions.
• Advanced imaging techniques and elemental analysis enhance the understanding and diagnosis of fungal sinusitis.