Journal: |
Academic Radiology
Elsevier Inc
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Abstract: |
Objective: To develop a systematic approach for magnetic resonance imaging (MRI) analysis,
imaging spectrum, and classification system for the staging of post-COVID-19 head and neck
mucormycosis.
Method: The study included 63 post-COVID-19 patients with pathologically proven
mucormycosis who underwent head and neck MR imaging. Three independent radiologists
assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal
mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic
approach and a proposed categorization system. A consensus reading was considered the
reference imaging standard. The kappa statistics were used to assess the categorization system's
diagnostic reliability.
Results: The overall interreader agreement of the MR staging system was very good (k-score
= 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients,
11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients,
44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%),
sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with
cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and
brain did not have significant association with involvement of the posterior ethmoid/sphenoid
sinuses and maxillofacial regions (p > 0.05). MRI-based staging involved four stages: stage 1
(n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%).
Involvement of the bone and MR-based staging were significant predictors of patients’
mortality p = 0.012 and 0.033, respectively.
Conclusion: This study used a diagnostic-reliable staging method to define the imaging
spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extrasinus extension
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