Association between covid-19-associated- rhinocerebral mucormycosis imaging findings with non-alcoholic fatty liver disease and the subcutaneous fat’s thickness

Abstract

Mucormycosis is associated with a high risk of all-cause mortality (54%), and the diagnosis of rhino-oculo-cerebral mucormycosis (ROCM) is done by a combination of clinical and imaging parameters. The aim of this study is to evaluation of the association between covid-19-associated- rhinocerebral mucormycosis imaging findings with non-alcoholic fatty liver disease and the subcutaneous fat’s thickness. Materials and Methods: This research is a descriptive-analytical cross-sectional study and the target population was all patients with mucormycosis related to covid-19 who visited Imam Reza Hospital in Tabriz during one year from 2022 to 2023 and their files were archived (59 patients). First, by referring to the document file, the necessary information, including their demographic, clinical, and laboratory characteristics, was extracted from their files with a pre-prepared checklist. Then the imaging findings of the brain, orbits and sinuses of these patients in the MRI and CT scans available in Pacs of Imam Reza Hospital were examined according to the checklist. The severity of pulmonary involvement caused by Covid-19 was determined according to CT severity score. Then, the average of the subcutaneous fat's thickness in the upper part of the abdomen along with the average density of the liver was measured in the CT scan of the chest before hospitalization. Finally, the clinical, laboratory and imaging data were analyzed statistically. Results: In this study, the most disease history in the studied patients was diabetes mellitus with 42 cases (71.1%) and NAFLD with 18 cases (30.5%), respectively. The median (first and third quartiles) of sinus involvement and bony involvement around the sinuses were 80.0 (50.0-100.0) and 0.0 (0.0-12.5) percent, respectively. Also, the median (first and third quartiles) of soft tissue involvement around the sinuses and orbital involvement were 12.5 (0.0-25.0) and 16.7 (8.3-25.0) percent, respectively. The median (first and third quartiles) of brain vascular and parenchymal involvement and pulmonary involvement were 0.0 (0.0-16.7) percent and 6.0 (4.0-11.0), respectively. The mean (standard deviation) of subcutaneous fat's thickness in these patients was 16.95 (±5.3). In this study, none of the variables of severity of sinonasal-orbital and cerebral involvement in CT scan and MRI and severity of pulmonary involvement with subcutaneous fat's thickness and non-alcoholic fatty liver in the studied patients had statistically significant relationship (P>0.05). Also, among the variables of severity of sinonasal-orbital and brain involvement in CT scan and MRI, bony involvement around the sinuses (P=0.007) and orbital involvement (P=0.001) had a statistically significant relationship with the severity of pulmonary involvement in the studied patients; However, sinus involvement, soft tissue involvement around the sinuses, and brain vascular and parenchymal involvement did not have a statistically significant relationship with the severity of pulmonary involvement in the studied patients (P>0.05).