Magnetic resonance imaging manifestations of vascular complications in patients with acute invasive fungal rhinosinusitis

Background: Owing to significant morbidity and mortality with the development of vascular complications in patients with acute invasive fungal rhinosinusitis (AIFRS), early identification, and rapid medical or surgical interventions that are essential for improving patients’ outcomes. For the purpose of presurgical mapping and management planning, magnetic resonance imaging (MRI) is essential for the early identification and improved delineation of disease extent. Objective: To evaluate variable MRI manifestations in the detection of the vascular complications in patients with AIFRS and its impact on patients’ survival. Methods: A retrospective study, included 24 patients with histopathological proven AIFRS to review the para nasal sinus MRI findings. MRI were evaluated for the sinus involvement and the extrasinus extension into the orbit and/or the brain. Vascular structures were assessed for the development of vascular complications, like ICA for thrombosis, attenuation or pseudoaneurysm, cavernous sinus and superior ophthalmic veins for thrombosis. Results: Of the reviewed 24 patients, 16 had cavernous sinus thrombosis, 15 had ICA thrombosis, 10 had ophthalmic vein thrombosis, 4 had ICA attenuation and only two cases had pseudoaneurysm of the ICA. Vascular thrombosis was more common with mucormycosis with cavernous sinus and ophthalmic vein thrombosis which were significantly increased among non survivor patients (90%, 70%), as compared to the survivor patients (50%, 14.29%), with P = 0.04 and 0.005 respectively. Conclusions: Vascular complications are common in patients with AIFRS. MRI is helpful in accurate detection of vascular complications in patients with AIFRS.