Radiological Manifestations of Rhino-Orbito-Cranial Mucormycosis in COVID-19 Patients Correlated With Pathological and Clinical Outcomes and Emphasis on Magnetic Resonance Imaging-Based Scoring System.
| Autor: | Patil C; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Kumar A; Radiodiagnosis, MaAx Super Speciality Hospital, Shimoga, IND., Battula V; Pediatric Intensive Care Unit, Ankura Hospital, Hyderabad, IND., Kumar P; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Kollu R; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Kotamraju S; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Nethi Balingari BL; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Reddy S; Radiodiagnosis, Malla Reddy Medical College for Women, Hyderabad, IND., Ravula S; Radiology, Malla Reddy Medical College for Women, Hyderabad, IND., Reddy AR; Internal Medicine, Bhaskara Medical College, Hyderabad, IND. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2023 Mar 03; Vol. 15 (3), pp. e35745. Date of Electronic Publication: 2023 Mar 03 (Print Publication: 2023). |
| DOI: | 10.7759/cureus.35745 |
| Abstrakt: | There was tremendous increase in the number of cases of mucormycosis among patients affected by coronavirus disease 2019 (COVID-19) during the second wave of pandemic in South Asian countries. This invasive fungal infection primarily affects paranasal sinuses and can have orbito-facial and intracranial extension. We are presenting the radiological findings of invasive mucormycosis with pathological and clinical outcome correlation. It is important for radiologists to have the knowledge of various presentations of this opportunistic infection for early diagnosis and helping clinicians in planning the appropriate line of management. The study also emphasizes on the correlation between the extent of involvement with clinical outcome and we proposed a magnetic resonance imaging (MRI) based scoring system to standardize and prognosticate the patients affected with mucormycosis. Materials and Methods: We utilized GE 1.5 tesla, 16-channeled MRI machine for scanning the clinically suspected mucormycosis patients and did plain and contrast study of the paranasal sinuses, orbito-facial study and included brain as and when required. Images were acquired in axial, coronal, and sagittal planes using T1, T2, and fat-saturated short tau inversion recovery sequences (STIR), fat-saturated contrast sequences for better evaluation of the extent of the disease. Diffusion-weighted sequence was also acquired to detect ischemic changes in optic nerve or brain parenchyma. Contrast study was used to detect any major vessel occlusion or cavernous sinus thrombosis in the study population. Results: Total number of cases (n) included in the study were 32. The mean age group was 41-50 years with the median age was 47 years. Out of 32 cases (n=32), in 16 cases (50%) the disease was limited only to the paranasal sinuses and in remaining 16 (50%) cases, disease has spread to other regions such as orbits, facial soft tissues, optic nerve, and brain parenchyma. All the 18 cases with Mild score (MRI ROCM score 1-3) survived and all those with severe score (2 cases) (MRI ROCM score 7-10) did not survive. Conclusion: During the second wave of COVID-19 pandemic, we observed a significant rise in acute invasive mucormycosis infection primarily involving the paranasal sinuses and spread to orbito-facial, cerebral parenchyma causing related complications and hence increased morbidity and death. Radiologically, using MRI, it was effectively possible to detect early extrasinonasal spread and other fatal complications thereby guiding the physicians and surgeons in the proper early aggressive management of the disease. Here, we have described the radiological characteristics of paranasal sinus mucormycosis and its spread to other regions. We also proposed an MRI-based Scoring System for standardized assessment of the disease severity. We observed in our study that the extent of disease on MRI is directly correlating with mortality. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Patil et al.) |
| Databáze: | MEDLINE |
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