Pre-Intervention MRI may predict visual and mortality outcomes in Acute Invasive Fungal Rhinosinusitis

Pre-intervention MRI findings have a prognostic value for visual and mortality outcomes in Acute Invasive Fungal Rhinosinusitis (AIFRS) as recently published in the Journal Ophthalmology, 2022.

Extrasinonasal involvement in Acute Invasive Fungal Rhinosinusitis indicates advanced infection. Facial soft tissues are the most frequently affected parts in the extra-sinonasal AIFRS. Poor visual acuity is the suspected outcome of the orbital apex and/or cerebral arterial involvement. Similarly, when Facial soft tissues, nasolacrimal drainage apparatus, and/or intracranial involvement occur, there is an increased mortality risk.

Idowu et al from the University of California, CA conducted a study to find out if initial, pre-intervention magnetic resonance (MR) imaging findings can be a prognostic value for visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS). They conducted a retrospective cohort study at a single, tertiary academic institution between January 2000 and February 2020. In Patients with histopathologic and/or microbiologic confirmed AIFRS, A retrospective review of MR imaging and clinical records was done to identify pre-intervention MR imaging findings associated with visual and mortality outcomes. A modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness for every radiologic characteristic. For AIFRS-specific risk factors associated with mortality, a multivariable Cox proportional hazards model was used.

Results:

78 patients with AIFRS were included of which there were 93 orbits; 63 unilateral and 15 bilateral diseases.

The mean age of patients was 51.1 years (SD = 22.2).

Hematologic malignancy (39%) and diabetes mellitus (36%) were the leading causes of Immunosuppression.

Mucormycota and Ascomycota comprised 56% & 37% of infections respectively.

39% of overall death rates were due to infections.

Risk factors for poor visual acuity outcomes as seen on initial MR imaging were involvement of the orbital apex (P = 0.026) and cerebral arteries (P < 0.001).

Increased mortality was associated with involvement of the facial soft tissues (P = 0.017), nasolacrimal drainage apparatus (P = 0.008), and intracranial space (P = 0.006).

Orbital soft tissue involvement was associated with decreased mortality (P = 0.001).

Thus the researchers concluded that the initial, pre-intervention MR imaging is a prognostic tool for visualizing poor visual acuity outcomes and mortality rates.    

To read more:

Magnetic Resonance Imaging Prognostic Findings for Visual and Mortality Outcomes in Acute Invasive Fungal Rhinosinusitis, Ophthalmology, ISSN: 0161-6420, Publication Year 2022 

https://doi.org/10.1016/j.ophtha.2022.06.020