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MR Imaging in Covid-19-Associated Invasive Fungal Sinusitis
Divya Pabbisetti1, Anantaram Gudipati, Subhash Kaul
1Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Background And Aim:
We witnessed a sharp peak in the incidence of invasive fungal sinusitis, particularly mucormycosis, in patients with history of coronavirus disease 2019 (COVID-19) infection in India. Rhino-orbito-cerebral mucormycosis (ROCM) is a fulminant rapidly progressive disease. Early diagnosis significantly improves patient survival and outcomes. Hence, neuroimaging plays a very important role. We studied the magnetic resonance (MR) imaging manifestations of invasive fungal sinusitis and established an imaging protocol, which helps in early diagnosis of the disease per se as well as its complications. We evaluated the differences between COVID-19-associated and non-COVID-19-associated ROCM.
Materials And Methods:
We retrospectively analyzed the MR imaging manifestations of 91 histopathologically proven cases of post-COVID-19-invasive fungal sinusitis.
Results:
We observed stage I disease limited to sinuses in 25.2%, stage II disease with intraorbital spread in 23%, and stage III disease with intracranial spread in 51.6% of our patients. Dural involvement was the commonest and earliest sign of stage III disease. Direct parenchymal invasion from the adjacent paranasal sinuses was the commonest pattern of cerebral involvement, involving basifrontal lobe (14.2%) followed by anteromedial temporal lobe (5.4%). We observed orbital and intracranial complications including subperiosteal orbital abscess (1%), cavernous sinus involvement (29.6%), angioinvasion (15.3%), perineural spread (9.8%), and osteomyelitis of skull base and craniofacial bones (45%). Contrary to non-COVID-19-associated ROCM, we did not observe any case with superior ophthalmic vein/dural venous sinus thrombosis or basilar artery angioinvasion in our study.
Conclusions:
In our study, stage III disease was most commonly due to direct parenchymal invasion into frontal and temporal lobes from the adjacent frontal and sphenoid sinuses, respectively. The commonest vascular complications in our study were cavernous sinus involvement followed by angioinvasion into the cavernous ICA leading to watershed infarcts.
Insights
A sharp increase in invasive fungal sinusitis, especially mucormycosis, was seen in COVID-19 survivors in India. Magnetic resonance imaging (MRI) is crucial for early diagnosis of rhino-orbito-cerebral mucormycosis (ROCM) and its complications.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- A significant rise in invasive fungal sinusitis, particularly mucormycosis, observed in India post-coronavirus disease 2019 (COVID-19).
- Rhino-orbito-cerebral mucormycosis (ROCM) is a severe, rapidly progressing infection.
- Early diagnosis is critical for improving patient survival and outcomes.
Purpose of the Study:
- To analyze magnetic resonance (MR) imaging findings of invasive fungal sinusitis in post-COVID-19 patients.
- To establish an MR imaging protocol for early diagnosis of ROCM and its complications.
- To compare imaging features between COVID-19-associated and non-COVID-19-associated ROCM.
Main Methods:
- Retrospective analysis of MR imaging manifestations.
- Inclusion of 91 histopathologically confirmed cases of post-COVID-19 invasive fungal sinusitis.
Main Results:
- Stage III disease with intracranial spread occurred in 51.6% of patients.
- Dural involvement was the earliest sign of intracranial spread.
- Direct parenchymal invasion into the frontal and temporal lobes was the most common pattern of cerebral involvement.
- Common complications included cavernous sinus involvement (29.6%) and osteomyelitis (45%).
Conclusions:
- Stage III ROCM in COVID-19 survivors is often due to direct spread from sinuses to brain lobes.
- Cavernous sinus involvement and internal carotid artery angioinvasion were the most frequent vascular complications.
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