Computed Tomography and Magnetic Resonance Imaging Characteristics of Acute Invasive Fungal Sinusitis

Radiology and Biomedical Imaging, Otolaryngology-Head & Neck Surgery, and Radiation Oncology, University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA.
Archives of otolaryngology--head & neck surgery (Impact Factor: 2.33). 10/2011; 137(10):1005-10. DOI: 10.1001/archoto.2011.170
Source: PubMed


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.

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    • "Enhanced ill-defined lesions in the orbit, cavernous sinus, and/or brain were seen in all cases. Groppo et al. [17] reported that MRI was more sensitive in detecting early changes of acute fulminant IFS than CT, and perisinus invasion on MRI was the most sensitive and specific parameter. "
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    ABSTRACT: Objective This study was conducted to present the clinical outcome of invasive fungal sinusitis of the sphenoid sinus and to analyze clinical factors influencing patient survival. Methods A retrospective review of 12 cases of invasive fungal sphenoiditis was conducted. Results Cases were divided into acute fulminant invasive fungal spheonoidits (n=4) and chronic invasive fungal sphenoiditis (n=8). The most common underlying disease was diabetes mellitus (n=9). The most common presenting symptoms and signs included visual disturbance (100%). Intracranial extension was observed in 8 patients. Endoscopic debridement and intravenous antifungals were given to all patients. Fatal aneurysmal rupture of the internal carotid artery occurred suddenly in two patients. The mortality rate was 100% for patients with acute fulminant invasive fungal sphenoiditis and 25% for patients with chronic invasive fungal sphenoiditis. In survival analysis, intracranial extension was evaluated as a statistically significant factor (P=0.027). Conclusion The survival rate of chronic invasive fungal sphenoiditis was 75%. However, the prognosis of acute fulminant invasive fungal sphenoiditis was extremely poor despite the application of aggressive treatment, thus, a high index of suspicion should be required and new diagnostic markers need to be developed for early diagnosis of invasive fungal sinusitis of the sphenoid sinus.
    Full-text · Article · Sep 2014 · Clinical and Experimental Otorhinolaryngology
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    • "Acute invasive fungal rhinosinusitis (AIFRS) is a serious condition characterized by high morbidity and a high mortality rate of 50%–80% in immunocompromised patients [1]. Due to the need for expeditious imaging in suspected cases to assist in diagnosis and management, CT is often used as the initial diagnostic modality, though magnetic resonance imaging (MRI) plays a critical role in the diagnosis of AIFRS [2]. "
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    ABSTRACT: Gorlin Syndrome (GS), also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant condition characterized by developmental abnormalities and predisposition to certain neoplasms. Acute invasive fungal rhinosinusitis (AIFRS) is an uncommon clinical entity characterized by high morbidity and mortality. In immunocompromised patients, computed tomography plays a critical role in screening for suspected AIFRS. However, due to the association between exposure to ionizing radiation and subsequent development of malignancies in patients with GS, patients with GS and suspected AIFRS present a unique and challenging clinical scenario. We present a case of a pediatric patient with GS and acute lymphocytic leukemia (ALL) diagnosed with AIFRS; to the best of our knowledge, it is the only case described in the literature.
    Full-text · Article · Jun 2013
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    • "Because there are cyclical changes in the nasal cavity, turbinate and sphenoid sinus, the middle ear and paranasal sinus abnormalities on MRI have some discrepancies. In MRI, the nasal mucosal thickening and signal intensities alternate from one side to the other several times every 24 h [24]. During nasal cyclical changes, mucosal thickening up to 2 mm can be normal, but mucosal thickening exceeding 3 mm is considered abnormal [24]. "
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    ABSTRACT: To study the MRI findings of otic and sinus barotrauma in patients with carbon monoxide(CO) poisoning during hyperbaric oxygen (HBO) therapy and examine the discrepancies of otic and sinus abnormalities on MRI between barotrauma and acute otitis media with effusion. Eighty patients with CO-poisoning diagnosed with otic and sinus barotrauma after HBO therapy were recruited. Brain MRI was performed to predict delayed encephalopathy. Over the same period, 88 patients with acute otitis media with effusion on MRI served as control. The abnormalities of the middle ear and paranasal sinuses on MRI were noted and were compared between groups. Nine patients with barotrauma were followed up by MRI. In the barotrauma group, 92.5% of patients had bilateral middle ear abnormalities on MRI, and 60% of patients had both middle ear cavity and mastoid cavity abnormalities on MRI in both ears. Both rates were higher than those in the control group (p = 0.000). In the two groups, most abnormalities on MRI were observed in the mastoid cavity. The rate of sinus abnormalities of barotrauma was 66.3%, which was higher than the 50% in the control group (p = 0.033). In the nine patients with barotrauma followed up by MRI, the otic barotrauma and sinus abnormalities had worsened in 2 patients and 5 patients, respectively. MRI is able to depict the abnormalities of otic and sinus barotrauma in patients with CO-poisoning during HBO therapy and to differentiate these from acute otitis media with effusion.
    Full-text · Article · Jun 2013 · PLoS ONE
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