To Determine The Role Of Imaging Findings On Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Predictive Of Acute Invasive Rhino-Orbito-Cerebral Mucormycosis (ROCM) In COVID 19 Patients

Role Of Imaging Findings On CT And MRI OF ROCM In Covid-19 Patients

Abstract

Background: There is a sudden rise of fungal infection with coronavirus disease. This is attributed to the immunomodulation by the disease and the drugs used, diabetes mellitus, steroid use, oxygen inhalation using dirty water, use of zinc and iron supplements, etc. Early diagnosis and prompt medical and surgical intervention is the mainstay of treatment. This can greatly reduce the high morbidity and mortality associated with this disease. The objective of the retrospective study is to describe the imaging findings of acute invasive rhino-orbito-cerebral mucormycosis (ROCM) in 58 patients with severe acute respiratory syndrome coronavirus 2, from SVP hospital with proven mucormycosis. Special emphasis is placed on the signal patterns of sinonasal mucosa, the earliest and most common findings. Material And Methods: We report the sinonasal, orbital and neuroimaging findings in patients of suspected acute invasive ROCM. A total of 58 patient’s scans were analyzed. The study comprises cases performed at two different imaging modalities and a tertiary care hospital from March 23, 2021 to September 1, 2021. All the patients had positive reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 and were hospitalized with clinically severe disease as per the guidelines laid down during the second wave in India. They were on intravenous steroids and oxygen. Thirty patients (52%) had diabetes mellitus. All of them presented with headache, facial and/or orbital pain, periorbital puffiness with decreased vision, during the course of treatment. CT or MRI examination of the paranasal sinuses, orbits and brain was done, with intravenous contrast wherever possible. The presence of mucormycosis was confirmed by histological diagnosis in all of them following clinico-radiological diagnosis of acute invasive ROCM. Result: Computed tomography (CT) and magnetic resonance imaging (MRI) of 58 patients showed most commonly involved sinuses as maxillary and ethmoid sinuses together. Sino-nasal mucosal thickening was the most common finding. Periantral infiltration preceded orbital, cerebral complications, with grossly intact bones. Sinus wall erosions were seen in only patients and maxillary alveolar arch erosion were frequent findings. CT showed hypodense soft tissue thickening or fat stranding as the predominant finding in involved areas, while MRI showed T2 iso- to hyperintense mucosal thickening with T2 hypointense component as the main finding. Conclusion: MRI is better at demonstrating early mucosal abnormalities, turbinate necrosis, devitalized tissues, orbital apex involvement and intra-cerebral extension. Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses in premaxillary, retroantral fat, facial muscles, pterygopalatine fossa, temporal, infratemporal fossa and extraconal orbital- fat along with typical patterns of sinonasal mucosal thickening should raise the suspicion of acute invasive fungal etiology given the short duration of history and immunocompromised status. High incidence of periantral and orbital extension of the disease is suggestive of acute invasive form of fungal infection. Also the rapidly progressive inflammatory changes without much bone involvement should suggest the suspicion of ROCM. Bony, cerebral and vascular involvements are relatively late complications. [Solanki T Natl J Integr Res Med, 2022; 13(4): 01-06, Published on Dated:10/07/2022]