DOI: 10.65396/ejra.1923785 ISSN: 2636-8072

CT and MRI Findings in Histopathologically Proven Invasive Fungal Rhinosinusitis: Imaging Features of Angioinvasion and Extrasinus Spread

Gülten Taşkin, M Elmali, Özgür Kemal, İrem Ceren Koç, Mehmet Çelebi
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Objective:Invasive fungal rhinosinusitis (IFRS) is a rapidly progressive infection associated with high mortality, particularly in immunocompromised patients. Early recognition of imaging findings related to angioinvasion and extrasinus spread is essential for timely diagnosis and management. This study aimed to evaluate CT and MRI findings in histopathologically confirmed IFRS and to assess their association with histopathological angioinvasion.Methods:Fifteen patients with histopathologically confirmed IFRS between January 2016 and January 2026 were retrospectively analyzed. All patients underwent paranasal sinus CT, and eight had contrast-enhanced MRI. Imaging findings were reassessed using a standardized checklist including extrasinus extension, osseous changes, perineural spread, and features suggestive of angioinvasion. Findings were compared with histopathological results.Results:The most common findings were retroantral fat infiltration (66.7%) and bone defects (66.7%), followed by preantral fat infiltration (60%). Orbital involvement was present in 46.7% and pterygopalatine fossa involvement in 33.3%. Devitalized non-enhancing tissue was observed in all patients who underwent MRI, representing a consistent finding within this subgroup. Histopathological angioinvasion was present in 40% of cases. Imaging findings suggestive of angioinvasion or perineural spread were associated with histopathological angioinvasion (p = 0.028). In some cases, imaging findings suggestive of angioinvasion were present despite the absence of histopathological confirmation.Conclusion:Extrasinus extension, particularly retroantral fat infiltration, may indicate invasive disease before overt bone destruction. MRI is important for detecting devitalized tissue and evaluating disease extent. Imaging may demonstrate angioinvasive features even when histopathology is negative and may contribute to clinical decision-making.

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