Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis

Fulminant invasive fungal rhinosinusitis is an aggressive, destructive proc ess most commonly affecting the immunocompromised host. Although frequently fatal, prognosis is related directly to early recognition and aggressive t reatment. Various reports advocate computed tomography (CT) scanning as the study of choice in evaluating suspected invasive fungal disease, reserving magnetic resonance imaging (MRI) for select cases. Others report lack of c orrelation between CT and surgical or pathological findings. Our aim was to investigate the usefulness of CT and AIR in the diagnosis of invasive fung al rhinosinusitis. We retrospectively reviewed four cases of biopsy-proven invasive disease. Correlations between radiographic, endoscopic, and surgic al findings were investigated. Rhizopus species were detected in three case s and mixed Mucor and Aspergillus species in another. Superimposed bacteria l sinusitis was confirmed in all cases. CT findings were nonspecific, revea ling pansinusitis; no bone destruction or intracranial extension was noted. Mild orbital cellulitis was noted in one case. Anterior rhinoscopy reveale d nonviable tissue in two patients. Nasal endoscopy later confirmed tissue ischemia in a third patient, whereas a final patient had normal findings on both examus. Nonspecific findings resulted in delay of diagnosis by 48-72 hours in two patients with presumed bacterial sinusitis. MR revealed intrac ranial extension in two patients and better represented intraoperative find ings. In conclusion, CT findings in invasive fungal rhinosinusitis may be n onspecific and underestimate extent of disease. A high index of suspicion a nd early endoscopic examination with biopsy are mandatory for evaluation. M RI may better represent disease progression and should be considered early.