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Imaging findings using a combined MRI/CT protocol to identify the "entire iceberg" in post-COVID-19 mucormycosis
S M Desai1, A Gujarathi-Saraf1, E A Agarwal1
1Department of Radiology, Deenanath Mangeshkar Hospital, Pune, Maharshtra, India.
Aim:
To analyse combined computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of invasive rhino-orbital mucormycosis (IROM) in post-COVID-19 infection patients for accurate diagnosis and delineation of the extent of involvement.
Materials And Methods:
A retrospective analysis was undertaken of 50 patients who developed IROM post-COVID-19 infection who underwent combined CT/MRI evaluation.
Results:
The age range of the 50 affected patients was 23-73 years. Out of these, 41 were diabetic. CT/MRI showed predominant involvement of the maxillary (n=26) and ethmoid (n=19) sinuses. Extension of disease to the orbit (n=35), cavernous sinus (n=18), hard palate (n=15), skull base (n=8), and intracranial involvement (n=3) was seen. Perineural spread of the disease was analysed along all divisions of the trigeminal nerve and its branches. MRI showed T2-hypointense soft-tissue thickening with heterogeneous contrast enhancement with corresponding hyperdensities on CT diagnosing the presence of fungal elements.
Conclusion:
Clinicians should be aware of the possibility of IROM post-COVID-19 infection. Conjunctive use of CT, which depicts bone destruction and other reactive bony changes along with MRI, which reveals characteristic findings of soft-tissue thickening of the involved sinuses with extension of disease to the orbits, cavernous sinus, dura, hard palate, skull base, and intracranial structures. Accurate diagnosis and early recognition of the disease and its extension with appropriate use of these techniques helps to initiate appropriate and timely treatment, which is vital to prevent a fatal outcome.
Insights
This study analyzed combined CT and MRI scans in 50 patients with invasive rhino-orbital mucormycosis (IROM) after COVID-19. Findings highlight imaging features crucial for diagnosing IROM and its spread, aiding timely treatment.
Area of Science:
- Radiology
- Infectious Diseases
- Ophthalmology
Background:
- Invasive rhino-orbital mucormycosis (IROM) is a serious fungal infection.
- Post-COVID-19 infection is an emerging risk factor for IROM.
- Accurate diagnosis and staging are critical for patient outcomes.
Purpose of the Study:
- To analyze combined computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of IROM in post-COVID-19 patients.
- To accurately diagnose IROM and delineate the extent of disease involvement.
- To correlate imaging findings with clinical presentation.
Main Methods:
- Retrospective analysis of 50 patients with IROM post-COVID-19.
- Combined CT and MRI evaluation.
- Analysis of disease extension to orbits, sinuses, skull base, and intracranial structures.
Main Results:
- Predominant sinus involvement: maxillary (n=26) and ethmoid (n=19).
- Orbital (n=35), cavernous sinus (n=18), and intracranial (n=3) extension observed.
- MRI showed T2-hypointense soft-tissue thickening with heterogeneous enhancement; CT showed hyperdensities.
Conclusions:
- Clinicians must consider IROM in post-COVID-19 patients.
- Combined CT and MRI are vital for diagnosing IROM and assessing its extent.
- Timely diagnosis and treatment initiation are crucial to prevent fatal outcomes.
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