Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study
Sharma Paudel, Pradeep Raj Regmi, Prakash Kayastha, Shailendra Katuwal, Prasoon Ghimire, Suraj Shrestha, Urmila Gurung- General Medicine
- Surgery
Background:
Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by saprophytic fungus 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 rhino-orbital-cerebral mucormycosis. The imaging was obtained from 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, infra-temporal, 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 maxillary sinus (17, 81%) and 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 STIR 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 post-contrast 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.