Soft-tissue Imaging Modalities and Their Clinical Relevance in Rhino-orbital-cerebral Mucormycosis

Abstract Introduction: Rhino-orbital-cerebral mucormycosis (ROCM) is an invasive fungal infection that has experienced a surge in cases during the COVID-19. Imaging plays a crucial role in assessing the extent of the disease and guiding surgical management. This study aimed to compare the clinical relevance of computed tomography (CT) and magnetic resonance imaging (MRI) in providing vital information for managing patients with ROCM. Materials and Methods: A retrospective clinical audit was conducted on 24 patients with biopsy-proven ROCM who underwent both CT and MRI. Relevant clinical data and imaging findings were analyzed. The extent of soft-tissue involvement in various head-and-neck compartments was compared between CT and MRI. Results: The mean age of the patients was 43.3 ± 6.75 years, with male predominance (75%). Diabetes was a major risk factor, present in 91.7% of the patients. Twenty-three patients (96%) showed invasive disease on both MRI and CT. Overall, MRI was better than CT in assessing the extent of involvement when suspecting orbital (45.8% vs. 22.5%) and intracranial complications (37.5% vs. 29%). Both MRI and CT showed comparable performance in assessing extensions to the deep neck spaces in masticator space (66% vs. 41.6%), premaxillary region (83% vs. 75%), retromaxillary region (75% vs. 66.7%), pterygopalatine fossa (71% vs. 66.7%), and infratemporal fossa (66% vs. 62.5%). Conclusion: In an ideal setting, both contrast-enhanced CT and MRI should be included in the imaging protocol for suspected ROCM. However, in the resource-limited settings, contrast-enhanced CT is a good diagnostic tool for assessing invasiveness.