Imaging features of rhinocerebral mucormycosis: A study of 43 patients

Background: Rhinocerebral mucormycosis is a life-threatening infection caused by saprophytic fungi seen almost exclusively in immunocompromised patients.The objective of this study was to describe the imaging findings in patients with rhinocerebral mucormycosis. Materials and methods: The case records of patients with biopsy/culture proven invasive rhinocerebral mucormycosis were reviewed. Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI) images were retrieved from the Picture Archiving and Communication System (PACS) and analyzed. Statistical analysis was performed using descriptive statistics. Results: CT and MR imaging of 43 patients showed predominant involvement of the ethmoid (37, 86%) and maxillary (34, 79%) sinuses. Extension to the orbit (32, 76%) and face (24, 57%) preceded involvement of the deep skull base (5, 12%) and brain (13, 31%). CT showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T2 isointense to mildly hypointense soft tissue thickening and heterogeneous post contrast enhancement as the main finding. Bone erosion was seen less often (17, 40%), with rest (26, 60%) of the patients showing extrasinus extension across grossly intact appearing bones on imaging. Conclusion: CT and MRI shows a spectrum of findings in rhinocerebral mucormycosis. Imaging plays a major role in assessing the extent of involvement and complications.