SPECTRUM OF MAGNETIC RESONANCE IMAGING FINDINGS IN RHINO-ORBITO-CEREBRAL MUCORMYCOSIS PATIENTS DURING SECOND WAVE OF COVID-19 INFECTION IN A TERTIARY CARE HOSPITAL – A PROSPECTIVE STUDY.

Abstract

Introduction- Mucormycosis is a lethal intrusive opportunistic fungal infection with increased morbidity and mortality. Its most common form is Rhino-Orbital-Cerebral Mucormycosis (ROCM). It has been described more in immunosuppressed people and currently in patients with recent history of/ concomitant Covid-19 infection. Magnetic Resonance Imaging (MRI) has been used to delineate extent of infection and spread and preoperative planning. MRI shows varied T1 and T2 signal intensity lesions with nonenhancement in necrosed tissues and extension of infection into adjacent structures. This prospective study aimed at delineating the spectrum of MRI findings in ROCM patients. Methods and results- A prospective study of 31 patients with ROCM was done in Department of Radiology, Superspeciality hospital, Gajra Raja Medical College, Gwalior in May and June 2021 during second wave of COVID-19 pandemic. We found that 64.5% patients in study group had previously / recently diagnosed diabetes mellitus and 77.4% cases had recently treated or concomitant COVID-19 infection. All the patients had sinonasal involvement at the time of imaging. The other areas of involvement were orbit and its contents, some of adjacent soft tissues, cavernous sinus and cerebral parenchyma, hard palate and cavernous ICA in order of frequency. Conclusion- ROCM is a grave infection which readily causes perivascular, perineural and soft tissue infiltration within a short span of time, hence most of the patients in this study had extension beyond the sinuses at the time of imaging. MRI is an essential tool for early identification of extrasinus extension of disease, detection of intracranial and vascular complications and presurgical planning.