, Volume 60, Issue 7, pp 715–723 | Cite as

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



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.


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.


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).


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.


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



Acute invasive fungal rhinosinusitis


Lack of contrast enhancement


Signal intensity


Compliance with ethical standards


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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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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