MRI findings in patients with rhino orbito cerebral Mucormycosis and the relationship between disease severity and severity of COVID-19 induced pulmonary involvement

Abstract

In most cases of rinoorbitocerebral mucormycosis (ROCM), a CT scan is performed as the first step of the investigation, which may not show soft tissue involvement in the early stages of fungal infection, while MRI has high sensitivity in identifying soft tissue involvement. The current study aims to examine the MRI findings in rinoorbitocerebral mucormycosis patients and the relationship between the severity of the disease and the severity of pulmonary involvement caused by COVID-19. Materials and Methods: This cross-sectional study investigated MRI findings of ROCM patients definitively diagnosed by tissue biopsy. The investigated patients include all ROCM cases referred to the imaging department of Tabriz Imam Reza (AS) hospital and underwent imaging during the last year. In addition to the MRI findings, the demographic information of the patients, history of previous diseases, and recent infection with COVID-19 were extracted from the patient's clinical records. The initial CT scan of the lungs of COVID-19 patients was examined, and the severity and extent of their lung involvement were recorded. Results: In this study, 112 patients with ROCM were examined with an average age of 55.38 ± 12.56 years and male predominance (53.6%). Paranasal sinuses were involved in all patients, and the highest frequency of involvement of paranasal sinuses was maxillary (88.4%) and then ethmoid (86.6%). 59.8% orbital involvement and 49.1% CNS involvement were observed; finally, in 28.6% of patients, all four stages were involved. Most patients (58%) had less than 25% lung involvement in CT scans. Among 28 patients with no history of current corticosteroid use, 25 patients had pulmonary involvement below 25%, one patient had 25-50% severity, and two patients had 50-75% severity.