Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis

  • Ye Ra Choi
  • Ji-hoon Kim
  • Hye Sook Min
  • Jae-Kyung Won
  • Hyun Jik Kim
  • Roh-Eul Yoo
  • Koung Mi Kang
  • Sun-Won Park
  • Tae Jin Yun
  • Seung Hong Choi
  • Chul-Ho Sohn
  • Jung Hyo Rhim
  • Soo Chin Kim
  • Jae Wook Ryu
  • Dong Gyu Na
Head-Neck-ENT Radiology
  • 25 Downloads

Abstract

Purpose

Acute invasive fungal rhinosinusitis (AIFRS) is a life-threatening disease that is difficult to diagnose. Its overall imaging features have not been evaluated and the prognostic impact is unclear. The purpose of our study was to present MR imaging features and their impact on prognosis of AIFRS.

Methods

MR images and clinical records of 23 patients with AIFRS were retrospectively evaluated to identify the imaging features and to determine the factors affecting patients’ survival. A multivariable Cox proportional hazard model was used to estimate the hazard ratio of the prognostic factors, and Kaplan-Meier survival curves were compared by using a log-rank test.

Results

All cases showed extra-sinonasal involvement and the orbit was the most common (65.2%, 15/23) location. The lesion enhancement pattern was classified into lack of contrast enhancement (LoCE) (47.8%, 11/23) and homogeneous (34.8%, 8/23) and heterogeneous (17.4%, 4/23) enhancement. Although LoCE showed variable signal intensity (SI), homogeneously or heterogeneously enhancing lesions showed exclusively low SI (100%, 12/12) on T2WI. Among various clinical and imaging factors, LoCE was correlated with coagulation necrosis, probably provoked by numerous fungal hyphae, and was found to be a sole independent prognostic factor for disease-specific mortality (hazard ratio = 16.819; 95% CI, 1.646–171.841, p = 0.017). In addition, patients with LoCE showed worse survival than patients without LoCE (p = 0.008).

Conclusion

AIFRS showed frequent extra-sinonasal involvement and variable MR enhancement patterns. An enhancement pattern of LoCE was seen in about half of the cases and was a unique prognostic factor among the various clinico-radiologic factors.

Keywords

Acute invasive fungal rhinosinusitis Lack of contrast enhancement Magnetic resonance imaging Coagulative necrosis Prognosis 

Abbreviations

AIFRS

Acute invasive fungal rhinosinusitis

LoCE

Lack of contrast enhancement

SI

Signal intensity

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

Supplementary material

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234_2018_2034_MOESM2_ESM.doc (78 kb)
ESM 2 (DOC 78 kb)

References

  1. 1.
    Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, Pastore D, Picardi M, Bonini A, Chierichini A, Fanci R, Caramatti C, Invernizzi R, Mattei D, Mitra ME, Melillo L, Aversa F, van Lint M, Falcucci P, Valentini CG, Girmenia C, Nosari A (2006) The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 91(8):1068–1075PubMedGoogle Scholar
  2. 2.
    Valera FC, do Lago T, Tamashiro E, Yassuda CC, Silveira F, Anselmo-Lima WT (2011) Prognosis of acute invasive fungal rhinosinusitis related to underlying disease. Int J Infect Dis 15(12)Google Scholar
  3. 3.
    Lee DH, Yoon TM, Lee JK, Joo YE, Park KH, Lim SC (2014) Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol 7(3):181–187CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Horger M, Hebart H, Schimmel H, Vogel M, Brodoefel H, Oechsle K, Hahn U, Mittelbronn M, Bethge W, Claussen CD (2006) Disseminated mucormycosis in haematological patients: CT and MRI findings with pathological correlation. Br J Radiol 79(945):e88–e95CrossRefPubMedGoogle Scholar
  5. 5.
    Laury AM, DelGaudio JM (2010) Aspergillus infections in the head and neck. Curr Infect Dis Rep 12(3):217–224CrossRefPubMedGoogle Scholar
  6. 6.
    Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM (2011) Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 137(10):1005–1010CrossRefPubMedGoogle Scholar
  7. 7.
    Parikh SL, Venkatraman G, DelGaudio JM (2004) Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol 18(2):75–81PubMedGoogle Scholar
  8. 8.
    Gillespie MB, O’Malley BW (2000) An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin N Am 33(2):323–334CrossRefGoogle Scholar
  9. 9.
    Kennedy CA, Adams GL, Neglia JP, Giebink GS (1997) Impact of surgical treatment on paranasal fungal infections in bone marrow transplant patients. Otolaryngol Head Neck Surg 116(6 Pt 1):610–616CrossRefGoogle Scholar
  10. 10.
    Silverman CS, Mancuso AA (1998) Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings. AJNR Am J Neuroradiol 19(2):321–325PubMedGoogle Scholar
  11. 11.
    Aribandi M, McCoy VA, Bazan C 3rd. (2007) Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 27(5):1283–1296CrossRefPubMedGoogle Scholar
  12. 12.
    Mossa-Basha M, Ilica AT, Maluf F, Karakoc O, Izbudak I, Aygun N (2013) The many faces of fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol 19(3):195–200PubMedGoogle Scholar
  13. 13.
    Seo J, Kim HJ, Chung SK, Kim E, Lee H, Choi JW, Cha JH, Kim HJ, Kim ST (2013) Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology 55(4):467–473CrossRefPubMedGoogle Scholar
  14. 14.
    deShazo RD, Chapin K, Swain RE (1997) Fungal sinusitis. N Engl J Med 337(4):254–259CrossRefPubMedGoogle Scholar
  15. 15.
    Arunaloke C, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H et al (2011) Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. QNRS Repository 2011(1):3063Google Scholar
  16. 16.
    Safder S, Carpenter JS, Roberts TD, Bailey N (2010) The “black turbinate” sign: an early MR imaging finding of nasal mucormycosis. AJNR Am J Neuroradiol 31(4):771–774CrossRefPubMedGoogle Scholar
  17. 17.
    Ilica AT, Mossa-Basha M, Maluf F, Izbudak I, Aygun N (2012) Clinical and radiologic features of fungal diseases of the paranasal sinuses. J Comput Assist Tomogr 36(5):570–576CrossRefPubMedGoogle Scholar
  18. 18.
    Fatterpekar G, Mukherji S, Arbealez A, Maheshwari S, Castillo M (1999) Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR 20(6):391–401CrossRefPubMedGoogle Scholar
  19. 19.
    Siddiqui AA, Shah AA, Bashir SH (2004) Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: clinical spectrum and outcome in 25 cases. Neurosurgery 55(3):602–613CrossRefPubMedGoogle Scholar
  20. 20.
    Kim JH, Kang BC, Lee JH, Jang J, Lee BJ, Chung YS (2015) The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis. J Infect 70(1):88–95CrossRefPubMedGoogle Scholar
  21. 21.
    Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, Kumar AJ, Johns ME, Rosenbaum AE (1988) Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 169(2):439–444CrossRefPubMedGoogle Scholar
  22. 22.
    Phuttharak W, Hesselink JR, Wixom C (2005) MR features of cerebral aspergillosis in an immunocompetent patient: correlation with histology and elemental analysis. AJNR Am J Neuroradiol 26(4):835–838PubMedGoogle Scholar
  23. 23.
    Fellows DW, King VD, Conturo T, Bryan RN, Merz WG, Zinreich SJ (1994) In vitro evaluation of MR hypointensity in Aspergillus colonies. AJNR Am J Neuroradiol 15(6):1139–1144PubMedGoogle Scholar
  24. 24.
    Som PM, Dillon WP, Curtin HD, Fullerton GD, Lidov M (1990) Hypointense paranasal sinus foci: differential diagnosis with MR imaging and relation to CT findings. Radiology 176(3):777–781CrossRefPubMedGoogle Scholar
  25. 25.
    Gorovoy IR, Kazanjian M, Kersten RC, Kim HJ, Vagefi MR (2012) Fungal rhinosinusitis and imaging modalities. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc 26(4):419–426CrossRefGoogle Scholar
  26. 26.
    Batra K, Chhabra A, Rampure J, Tang S, Koenigsberg R, Gonzales C (2005) CT and MRI appearances of primary sphenoid melanoma: a rare case. AJNR Am J Neuroradiol 26(10):2642–2644PubMedGoogle Scholar
  27. 27.
    Nishiguchi T, Nakamura A, Mochizuki K, Tokuhara Y, Yamane H, Inoue Y (2007) Expansile organized maxillary sinus hematoma: MR and CT findings and review of literature. AJNR Am J Neuroradiol 28(7):1375–1377CrossRefPubMedGoogle Scholar
  28. 28.
    Lee EJ, Jung SL, Kim BS, Ahn KJ, Kim YJ, Jung AK, Park CS, Song SY, Park NH, Kim MS (2005) MR imaging of orbital inflammatory pseudotumors with extraorbital extension. Korean J Radiol 6(2):82–88CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ye Ra Choi
    • 1
    • 2
  • Ji-hoon Kim
    • 1
  • Hye Sook Min
    • 3
  • Jae-Kyung Won
    • 3
  • Hyun Jik Kim
    • 4
  • Roh-Eul Yoo
    • 1
  • Koung Mi Kang
    • 1
  • Sun-Won Park
    • 1
    • 2
  • Tae Jin Yun
    • 1
  • Seung Hong Choi
    • 1
  • Chul-Ho Sohn
    • 1
  • Jung Hyo Rhim
    • 2
  • Soo Chin Kim
    • 1
  • Jae Wook Ryu
    • 5
  • Dong Gyu Na
    • 6
  1. 1.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of RadiologyBoramae Medical CenterSeoulSouth Korea
  3. 3.Department of PathologySeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of OtorhinolaryngologySeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of RadiologySamsung Medical CenterSeoulSouth Korea
  6. 6.Department of RadiologyGangNeung Asan HospitalGangNeungSouth Korea

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