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Utilizing CT soft-tissue markers as a screening tool for acute invasive fungal sinusitis
Deepa Susan John1, Karthik Shyam1, Dhilip Andrew1
1Department of Radiology, St. John's Medical College Hospital, Bangalore, Karnataka, India.
Objectives:
Acute invasive fungal sinusitis (AIFS) is a rapidly progressive disease, whose delayed identification results in poor outcomes, especially in immunocompromised individuals. A surge in of AIFS in the wake of the COVID-19 pandemic has lent additional morbidity and mortality to an already precarious clinical scenario. Early detection of AIFS in individuals who are symptomatic/ at risk can allow early therapy, enabling better patient outcomes. Our study aims to determine optimal soft-tissue markers on CT for the early detection of AIFS.
Methods:
In this case-control study, 142 patients with equal distribution of subjects were chosen based on histopathological diagnosis of AIFS; and their non-contrast CT scans were retrospectively assessed to determine the diagnostic utility of specific soft-tissue markers that would enable diagnosis of AIFS.
Results:
A total of nine markers with adequate sensitivity and specificity were identified, including pterygopalatine and sphenopalatine fossae, inferior orbital fissure and nasolacrimal duct involvement, premaxillary thickening, retro-antral and orbital stranding, and infratemporal muscle oedema. It was determined that the combined occurrence of any three out of nine markers was 91.5% sensitive and 95.9% specific for diagnosis of AIFS (p < 0.005).
Conclusion:
Early, accurate detection of AIFS in predisposed individuals is possible with identification of soft-tissue markers on NECT, enabling early intervention.
Advances In Knowledge:
Being the aggressive disease that it is, AIFS may be managed early if the index of suspicion is held high via CT imaging; which our diagnostic checklist aims at enabling.
Insights
Early detection of acute invasive fungal sinusitis (AIFS) is crucial for better outcomes. Identifying specific soft-tissue markers on CT scans can aid in the early diagnosis of AIFS.
Area of Science:
- Radiology and Imaging
- Infectious Diseases
- Otolaryngology
Background:
- Acute invasive fungal sinusitis (AIFS) is a severe, rapidly progressing infection.
- Delayed diagnosis of AIFS leads to poor patient outcomes, particularly in immunocompromised individuals.
- The COVID-19 pandemic has seen a rise in AIFS cases, increasing morbidity and mortality.
Purpose of the Study:
- To identify optimal soft-tissue markers on CT scans for the early detection of AIFS.
- To improve diagnostic accuracy and enable timely therapeutic intervention for AIFS.
- To establish a diagnostic checklist for AIFS based on CT findings.
Main Methods:
- A retrospective case-control study involving 142 patients with histopathologically confirmed AIFS.
- Assessment of non-contrast CT scans to evaluate the diagnostic utility of specific soft-tissue markers.
- Analysis of nine identified markers for sensitivity and specificity in diagnosing AIFS.
Main Results:
- Nine soft-tissue markers demonstrated adequate sensitivity and specificity for AIFS detection.
- These markers include involvement of pterygopalatine/sphenopalatine fossae, inferior orbital fissure, nasolacrimal duct, premaxillary thickening, retro-antral/orbital stranding, and infratemporal muscle edema.
- The combined presence of any three markers showed 91.5% sensitivity and 95.9% specificity for AIFS diagnosis (p < 0.005).
Conclusions:
- Early and accurate diagnosis of AIFS is achievable through the identification of specific soft-tissue markers on non-contrast CT (NECT).
- Utilizing a diagnostic checklist based on these CT markers can facilitate early intervention and improve management of AIFS.
- Maintaining a high index of suspicion for AIFS, supported by CT imaging, is essential for prompt treatment of this aggressive disease.
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