Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis
ABSTRACT To determine radiographic findings on computed tomography (CT) and magnetic resonance imaging (MRI) predictive of acute fulminant invasive fungal sinusitis (AFIFS) in an immunocompromised patient population.
Retrospective case-control study.
Tertiary referral hospital.
Cases were 17 immunocompromised patients with confirmed AFIFS after surgical debridement or biopsy. Controls were 6 immunocompromised patients histopathologically negative for AFIFS after surgical debridement or biopsy.
Computed tomographic and MRI scans were independently reviewed by 2 neuroradiologists to identify imaging characteristics predictive of AFIFS. Operative reports and histopathologic, microbiologic, and survival data were reviewed.
No significant differences with regard to baseline characteristics between the 2 groups were identified. There was moderate or substantial agreement (κ = 0.40-0.77) between the 2 radiologists for all imaging parameters except MRI loss of contrast enhancement (κ = 0.16). Magnetic resonance imaging was more sensitive than CT for the diagnosis of AFIFS (sensitivity 85% and 86% for both reviewers compared with 57% and 69%). Extrasinus invasion with MRI was the most sensitive individual parameter (87% and 100%). Magnetic resonance imaging and CT had similar specificities, and perisinus invasion was the most specific individual parameter (83% and 83% for MRI compared with 81% and 83% for CT). The positive predictive values were high for both imaging modalities (93% and 94% for MRI compared with 89% and 93% for CT). The negative predictive values were lower for both modalities and varied more between reviewers (71% and 100% for MRI compared with 45% and 67% for CT).
Magnetic resonance imaging is more sensitive for detecting early changes of AFIFS than CT. Both imaging modalities have similar specificities. Perisinus invasion with MRI was the most sensitive and specific single parameter evaluated.
- SourceAvailable from: Farhad Ardeshirpour[Show abstract] [Hide abstract]
ABSTRACT: Objective: To evaluate the management and outcomes of children with invasive fungal sinonasal disease treated with radical surgery. Study Design: Retrospective case series. Methods: From 1994 to 2007, eleven pediatric patients were identified with invasive fungal sinonasal disease treated surgically by the same pediatric otolaryngologist. Collected data included demographics, oncologic diagnoses, absolute neutrophil counts, symptoms, computed tomography scan findings, biopsy and culture results, surgical procedures, concurrent medical therapies, complications, and survival. Results: The studied patient population consisted of four males and seven females with an average age of ten years (range 2-14). Six patients were diagnosed with Acute Lymphoblastic Leukemia and five with Acute Myeloid Leukemia, which included ten cases of relapsed disease. The average number of severely neutropenic days prior to diagnosis of an invasive fungal infection was eighteen (range 8 - 41). Culture results demonstrated Alternaria in seven patients and Aspergillus in four. Nine patients underwent an external medial maxillectomy, five of which were bilateral, and six underwent septectomy. All eleven patients (100%) were cured of their invasive fungal sinonasal disease without relapse. Three patients eventually died from unrelated causes. Conclusion: Invasive fungal sinonasal disease is a life-threatening problem in immunocompromised children, especially with relapsed leukemia. Successful treatment depends on timely and aggressive surgical, antifungal, and supportive therapies. To our knowledge, this study represents the largest series of pediatric patients with invasive fungal sinonasal disease managed via an aggressive surgical approach with the best outcomes to date.The Laryngoscope 09/2011; 145(2 Suppl). DOI:10.1002/lary.24369 · 2.03 Impact Factor
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ABSTRACT: Fungal infections of the nose and paranasal sinuses represent a spectrum of diseases ranging from colonization to invasive rhinosinusitis. Clinical manifestations are largely dependent on the immune status of the host, and given the ubiquitous nature of these organisms, exposure is unavoidable. Noninvasive disease includes asymptomatic fungal colonization, fungus balls, and allergic fungal rhinosinusitis. Invasive disease includes indolent chronic rhinosinusitis, granulomatous fungal sinusitis, and acute fulminant fungal rhinosinusitis. A differentiation of these somewhat overlapping syndromes and the disparate treatment regimens required for effective management are the focus of this review.The Journal of allergy and clinical immunology 12/2011; 129(2):321-6. DOI:10.1016/j.jaci.2011.11.039 · 11.25 Impact Factor
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ABSTRACT: This report provides an overview of fungal rhinosinusitis with a particular focus on acute fulminant invasive fungal sinusitis (AFIFS). Imaging modalities and findings that aid in diagnosis and surgical planning are reviewed with a pathophysiologic focus. In addition, the differential diagnosis based on imaging suggestive of AFIFS is considered.Saudi Journal of Ophthalmology 10/2012; 26(4):419-26. DOI:10.1016/j.sjopt.2012.08.009