Retrospective evaluation of radiological imaging findings in acute invasive fungal sinusitis

Acute invasive fungal sinusitis (AIFS) primarily affects immunosuppressed patients; however, it may also affect immunocompetent individuals. AIFS generally infiltrates orbita, cavernous sinuses, and skull base since these structures are adjacent to the sinonasal cavity. Unfortunately, AIFS is an aggressive pathology with high morbidity and mortality rates. In this thesis study, we investigated the factors associated with extra-sinusoidal extension (ESE) of the AIFS, and we also examined the radiological findings of AIFS. All AIFS diagnoses at Bursa Uludag University Hospital between 2012 and 2020 retrospectively screened. Patients who did not undergo computed tomography (CT) or magnetic resonance imaging (MRI) scans and patients with no follow-ups were excluded from the study. Consequently, sixty-two AIFS cases with pathological and microbiological confirmation were included in this study. Clinical and radiological findings of the cases were evaluated. Then, statistical analyses were performed to determine the association between ESE and potential predictor variables. In these analyses, MR was accepted as the gold standard in the evaluation of ESE and periantral infiltration (PI). ESE involvement was associated with several factors such as PI (OR:10.71, p=0.005, 95% confidence interval [CI]: 2.02-56.74), maxillary sinus infiltration (MSI) (OR:5.42, p=0.012, %95 CI: 1.45-20.24), mucorales pathogens (OR: 21.99, p=0.025, %95 CI: 1.48-325.71) and neutrophilia (14.05, p=0.014, %95 CI: 1.71-115.4). Moreover, there were significant associations between bone destruction and PI (p=0.005), between comorbidity and pathogen (p=0.002). The PI detection sensitivity of BT was 76.9% and a low level of compatibility between CT and MR in EST detection (%51.5, K=0.264, p=0.010). Another important finding was that mortality rates of non-diabetic patients were significantly higher compared to diabetic cases (HR:4.34, p=0.044, %95 CI: 1.04-18.08). A number of clinical characteristics and imaging factors can play a key role in predicting EST of AIFS. Our results suggest that a physician should be particularly alert in the case of PI, MSI, Mucorales pathogens, and neutrophilia. Therefore, in such cases, an MRI scan can significantly improve the prognosis by allowing early diagnosis. Keywords: Acute invasive fungal sinusitis, Mucor, Mucormycosis.