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Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study
Sharma Paudel1, Pradeep R Regmi1, Prakash Kayastha1
1Department of Radiology.
Background:
Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease.
Materials And Methods:
This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel's cave, and the brain parenchyma.
Results:
The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients.
Conclusion:
The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.
Insights
Rhino-orbital-cerebral mucormycosis (ROCM) is a serious fungal infection. MRI imaging is crucial for assessing ROCM extent and complications, aiding early diagnosis and treatment in immunocompromised patients.
Area of Science:
- Radiology
- Infectious Diseases
- Medical Imaging
Background:
- Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening fungal infection.
- It predominantly affects immunocompromised individuals, necessitating early diagnosis and treatment to prevent severe complications.
Purpose of the Study:
- To evaluate the imaging findings of invasive ROCM.
- To assess the spectrum of MRI findings in ROCM patients.
Main Methods:
- Retrospective study of 21 patients with biopsy-proven ROCM.
- Analysis of imaging findings including site of involvement, signal intensity, contrast characteristics, and extensions using MRI (Siemens Magnetom Amira 1.5T).
Main Results:
- The study included 21 patients (71% male, mean age 55.8 years), all COVID-19 positive and mostly diabetic.
- MRI revealed predominant involvement of maxillary (81%) and ethmoidal sinuses (71.4%), with orbital extension in 86%.
- Characteristic MRI findings included heterogeneous high signal intensity on T2/STIR and heterogenous postcontrast enhancement (95.2%).
Conclusions:
- The imaging spectrum of ROCM is variable.
- Multiplanar MRI with postcontrast imaging is a valuable tool for assessing ROCM extent and complications.
- Awareness of ROCM imaging features is essential for clinicians and radiologists.
