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  • MRI images reveal poor visual outcomes in acute invasive fungal rhinosinusitis

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    Review of: Magnetic resonance imaging prognostic findings for visual and mortality outcomes in acute invasive fungal rhinosinusitis

    Idowu O, Soderlund K, Laguna B, et al. Ophthalmology, November 2022

    Magnetic resonance imaging (MRI) findings were used to assess which ones predicted mortality and visual outcomes in acute invasive fungal rhinosinusitis (AIFRS).

    Study design

    This was a retrospective case series of histopathologically or microbiologically confirmed cases of AIFRS seen over a 20-year period. Clinical records and initial, preintervention MRI studies were reviewed. Seventy-eight patients (93 orbits) were included in the study; the mean age was 51.1 years.

    Outcomes

    Thirty-eight percent of patients died due to infection; median time to death was 1 month. The primary causes of immunosuppression included hematologic malignancy (38%), diabetes mellitus (36%), and solid organ transplant (13%). Fungal organisms isolated included Mucormycota and Ascomycota. All patients were treated with systemic antifungal therapy; 19% of patients received orbital injection or orbital irrigation of liposomal amphotericin B, 89% of patients received functional endoscopic sinus surgery, and 13% underwent exenteration. Based on initial MRI findings, the likelihood of poor visual outcome was associated with disease of the orbital apex and cerebral arterial involvement. Intracranial involvement, facial soft tissue, or nasolacrimal drainage apparatus involvement increased the risk of mortality, but reduced mortality risk was seen in patients with orbital soft tissue involvement.

    Limitations

    This retrospective case series spans 20 years; as treatment modalities for invasive fungal sinusitis have changed over time, this may have affected the study’s results. In addition, the patient population, cause of the immunosuppression, and the causative organism are heterogeneous.

    Clinical significance

    With the COVID-19 pandemic, there have been multiple studies examining prognostic factors in patients with invasive fungal sinusitis. Imaging findings have also been highlighted by the pandemic. Loss of contrast enhancement of sinonasal mucosa and extrasinonasal tissues has been shown to be a prognostic factor for mortality. This study adds additional preintervention MRI findings that are associated with disease prognosis.