Value of computed tomography and magnetic resonance imaging in the differential diagnosis of midface complications in fungal pathologies

Abstract. Introduction. Midface lesions caused by fungal infections are one of the most challenging tasks in modern clinical practice in terms of diagnosis and treatment. In recent years, against the backdrop of increasing cases of invasive fungal diseases, such as mucormycosis, the importance of accurate and timely diagnosis has increased significantly. These infections, often developing in immunocompromised patients, affect both soft tissues and bone structures, making diagnosis particularly important. The aim of the study was to determine the diagnostic value of computed tomography and magnetic resonance imaging methods in the detection and differential diagnosis of midface complications caused by fungal infections, considering their spread to soft tissues and bone structures. Materials and Methods. During a two-year observation period, 40 cases of fungal sinusitis were diagnosed clinically. Among the patients, there were 22 men (55%) and 18 women (45%), aged 47 ± 2 years on average. Standard CT protocols were used for diagnosing with the slice thickness of 1.25 mm, including axial and coronal slices with contrast enhancement. Assessment of disease dynamics was based on changes in the volume of inflammatory processes, bone structure, and surrounding tissues. Magnetic resonance imaging diagnostics were performed on a 1.5 Tesla scanner using standard coils for head and neck. The protocol included axial T1WI, T2WI, T2GRE, FLAIR, and DWI images, as well as contrast-enhanced magnetic resonance angiography to assess vascular changes and pathologies. Results and Discussion. The study analyzed 40 cases of fungal sinusitis confirmed by computed tomography, magnetic resonance imaging, and histological examination. Clinical manifestations, the nature of paranasal sinus involvement, radiological signs, and the frequency of complications were evaluated. The most common pathogens identified were Aspergillus spp. and Penicillium spp., predominantly affecting the maxillary sinus. On computed tomography and magnetic resonance imaging methods, thickening of the mucous membrane, bone destruction, and changes in tissue density were observed. Complications, including osteomyelitis and abscesses, required differential diagnosis with malignant tumors. Conclusions. Computed tomography and magnetic resonance imaging are important diagnostic methods for fungal sinusitis, allowing the identification of changes in sinus structures, bones, and soft tissues, as well as the assessment of the infection spread, which helps prevent complications and improve treatment outcomes.