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

Abstract

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.

The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates

“…Common observations in our benign BT cases of thin rim enhancement around the nonenhancing areas (Figs 3 and 4) and intermediate and high signal intensity on the T2-weighted images were not consistently described in the cases of IFRS reported in the literature [1][2][3][4]7 or seen in our case of IFRS. Choi et al 4 stated that in patients with IFRS, "Although LoCE (Lack of Contrast Enhancement) showed variable signal intensity (SI), homogeneously or heterogeneously enhancing lesions showed exclusively low SI (100%, 12/12) on T2WI." Seo et al, 3 in their review of 23 patients with IFRS, found 17 patients who had nonenhancing areas in the sinonasal region (13 with extension into adjacent structures), and the signal intensity on the T2WI was variable, with most being hyperintense and many also having areas of iso-or hypointensity compared with the brain cortex.…”

“…Diffusion-weighted imaging may have little utility and is only mentioned by the authors of several series in the literature, and not necessarily with respect to the nasal turbinates. 2,4 Safder et al 2 described restricted diffusion in 2 cases; however, Choi et al 4 described facilitated diffusion in 2 of their cases. Choi et al also felt that the NE areas were due to coagulation necrosis rather than infarction, therefore explaining this imaging finding.…”

“…L ack of enhancement of a nasal turbinate on MR images (the "black turbinate [BT] sign") has been reported as highly suggestive of invasive fungal rhinosinusitis (IFRS) in immunocompromised patients (Fig 1). [1][2][3][4][5] However, we have noticed nonenhancing (NE) turbinates in patients imaged for other indications, who have essentially no possibility of having IFRS. IFRS in the at-risk population is a rapidly progressive disease that frequently progresses to involve the orbit and brain.…”

Rinosinusitis fúngica invasiva aguda: Actualización en pacientes adultos y pediátricos

“…En un estudio que evaluó las características de la RM en pacientes con RSFIA, se constató que el compromiso extranasosinusal sería frecuente, afectando en 65% de los casos a la órbita 17 . La ausencia de realce con el contraste ocurriría en casi la mitad de los pacientes 17 , lo que podría ser explicado por la naturaleza angioinvasiva de la infección fúngica 12 . Este patrón de comportamiento al contraste además se asoció significativamente a mayor mortalidad, en comparación con los patrones homogéneo y heterogéneo 17 .…”

“…La ausencia de realce con el contraste ocurriría en casi la mitad de los pacientes 17 , lo que podría ser explicado por la naturaleza angioinvasiva de la infección fúngica 12 . Este patrón de comportamiento al contraste además se asoció significativamente a mayor mortalidad, en comparación con los patrones homogéneo y heterogéneo 17 . En un estudio que evaluó las características tomográficas, se encontró que la presencia de erosión ósea, el engrosamiento de partes blandas, la extensión extrasinusal y el compromiso unilateral tienen un valor predictivo positivo (VPP) de 100%, mientras que los cambios inflamatorios mucoperiósticos de los senos paranasales tienen un valor predictivo negativo (VPN) de 100% 4 .…”