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Chronic invasive fungal rhinosinusitis vs sinonasal squamous cell carcinoma: the differentiating value of MRI

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Abstract

Objectives

To investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC).

Methods

MRI findings of 33 patients with CIFRS and 47 patients with SNSCC were retrospectively reviewed and compared. Multivariate logistic regression analysis was performed to identify significant imaging features in distinguishing between CIFRS and SNSCC. The ROC curves and the AUC were used to evaluate diagnostic performance.

Results

There were significant differences in cavernous sinus involvement (p < 0.001), sphenoid sinus involvement (p < 0.001), meningeal involvement (p = 0.024), T2 signal intensity (p = 0.006), and enhancement pattern (p < 0.001) between CIFRS and SNSCC. Multivariate logistic regression analysis identified cavernous sinus involvement (odds ratio [OR] = 0.06, 95% confidence interval [95% CI] = 0.02–0.20) and sphenoid sinus involvement (OR = 0.14, 95% CI = 0.05–0.45) as significant indicators for CIFRS and T2 isointensity to gray matter (OR = 4.44, 95% CI = 1.22–16.22) was a significant indicator for SNSCC. ROC curve analysis showed the AUC from a combination of three imaging features was 0.95 in differentiating CIFRS and SNSCC.

Conclusions

MRI showed significant differences between CIFRS and SNSCC features. In immunocompromised patients, a sinonasal hypointense mass on T2WI with septal enhancement or loss of contrast enhancement, and involvement of cavernous sinus, sphenoid sinus, and meninges strongly suggest CIFRS.

Key Points

• Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from sinonasal squamous cell carcinomas (SNSCC) in clinical practice.

• Cavernous sinus and sphenoid sinus involvement appear to be significant indicators for CIFRS. T2 isointensity to gray matter appears to be a significant indicator for SNSCC.

• Loss of contrast enhancement and septal enhancement can be used to distinguish CIFRS from SNSCC with a high degree of specificity.

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Abbreviations

AUC:

The areas under the ROC curve

CI:

Confidence interval

CIFRS:

Chronic invasive fungal rhinosinusitis

FOV:

Field of view

FSE:

Fast spin-echo

GM tests:

Galactomannan tests

G tests:

(1,3)-β-D-Glucan tests

IFRS:

Invasive fungal rhinosinusitis

LoCE:

Loss of contrast enhancement

MRI:

Magnetic resonance imaging

NEX:

Number of excitations

OR:

Odds ratio

ROC:

Receiver operating characteristic

SNSCC:

Sinonasal squamous cell carcinomas

T1WI:

T1-weighted images

T2WI:

T2-weighted images

TE:

Echo time

TR:

Repetition time

References

  1. Eggesbø HB (2006) Radiological imaging of inflammatory lesions in the nasal cavity and paranasal sinuses. Eur Radiol 16:872–888

    Article  Google Scholar 

  2. Choi YR, Kim JH, Min HS et al (2018) Acute invasive fungal rhinosinusitis: MR imaging features and their impact on prognosis. Neuroradiology 60:715–723

    Article  Google Scholar 

  3. Chakrabarti A, Rudramurthy SM, Panda N, Das A, Singh A (2015) Epidemiology of chronic fungal rhinosinusitis in rural India. Mycoses 58:294–302

    Article  Google Scholar 

  4. Challa S, Uppin SG, Hanumanthu S et al (2010) Fungal rhinosinusitis: a clinicopathological study from South India. Eur Arch Otorhinolaryngol 267:1239–1245

    Article  Google Scholar 

  5. Burton BN, Jafari A, Asmerom B, Swisher MW, Gabriel RA, DeConde A (2019) Inpatient mortality after endoscopic sinus surgery for invasive fungal rhinosinusitis. Ann Otol Rhinol Laryngol 128:300–308

    Article  Google Scholar 

  6. Turner JH, Soudry E, Nayak JV, Hwang PH (2013) Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope 123:1112–1118

    Article  Google Scholar 

  7. Callejas CA, Douglas RG (2013) Fungal rhinosinusitis: what every allergist should know. Clin Exp Allergy 43:835–849

    Article  CAS  Google Scholar 

  8. Kim SA, Chung YS, Lee BJ (2019) Recurrence patterns of sinonasal cancers after a 5-year disease-free period. Laryngoscope 129:2451–2457

    Article  Google Scholar 

  9. Quan H, Yan L, Wang S, Wang S et al (2019) Clinical relevance and significance of programmed death-ligand 1 expression, tumor-infiltrating lymphocytes, and p16 status in sinonasal squamous cell carcinoma. Cancer Manag Res 11:4335–4345

    Article  CAS  Google Scholar 

  10. Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT (2017) Fungal rhinosinusitis: a radiological review with intraoperative correlation. Can Assoc Radiol J 68:178–186

    Article  Google Scholar 

  11. Montone KT (2013) Role of fungi in the pathophysiology of chronic rhinosinusitis: an update. Curr Allergy Asthma Rep 13:224–228

    Article  Google Scholar 

  12. Uhliarova B, Karnisova R, Svec M, Calkovska A (2014) Correlation between culture-identified bacteria in the middle nasal meatus and CT score in patients with chronic rhinosinusitis. J Med Microbiol 63:28–33

    Article  Google Scholar 

  13. Mossa-Basha M, Ilica AT, Maluf F, Karakoç Ö, Izbudak I, Aygün N (2013) The many faces of fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol 19:195–200

    PubMed  Google Scholar 

  14. Groppo ER, El-Sayed IH, Aiken AH, Glastonbury CM (2011) Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 137:1005–1010

    Article  Google Scholar 

  15. Vogl TJ, Dresel SH, Grevers G et al (1996) Sjoegren’s syndrome: MR imaging of the parotid gland. Eur Radiol 6:46–51

    Article  CAS  Google Scholar 

  16. Safder S, Carpenter JS, Roberts TD, Bailey N (2010) The “black turbinate” sign: an early MR imaging finding of nasal mucormycosis. AJNR Am J Neuroradiol 31:771–774

    Article  CAS  Google Scholar 

  17. Seo J, Kim HJ, Chung SK et al (2013) Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology 55:467–473

    Article  Google Scholar 

  18. Aribandi M, McCoy VA, Bazan C 3rd (2007) Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 27:1283–1296

    Article  Google Scholar 

  19. Payne SJ, Mitzner R, Kunchala S, Roland L, McGinn JD (2016) Acute invasive fungal rhinosinusitis: a 15-year experience with 41 patients. Otolaryngol Head Neck Surg 154:759–764

    Article  Google Scholar 

  20. Epstein VA, Kern RC (2008) Invasive fungal sinusitis and complications of rhinosinusitis. Otolaryngol Clin North Am 41:497–524

    Article  Google Scholar 

  21. Kalin-Hajdu E, Hirabayashi KE, Vagefi MR, Kersten RC (2017) Invasive fungal sinusitis: treatment of the orbit. Curr Opin Ophthalmol 28:522–533

    Article  Google Scholar 

  22. Lanza DC, Dhong HJ, Tantilipikorn P, Tanabodee J, Nadel DM, Kennedy DW (2006) Fungus and chronic rhinosinusitis: from bench to clinical understanding. Ann Otol Rhinol Laryngol Suppl 196:27–34

    Article  Google Scholar 

  23. Orlowski HLP, McWilliams S, Mellnick VM et al (2017) Imaging spectrum of invasive fungal and fungal-like infections. Radiographics 37:1119–1134

    Article  Google Scholar 

  24. DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA (2003) Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 129:236–240

  25. Finkelstein A, Contreras D, Pardo J et al (2011) Paranasal sinuses computed tomography in the initial evaluation of patients with suspected invasive fungal rhinosinusitis. Eur Arch Otorhinolaryngol 268:1157–1162

    Article  Google Scholar 

  26. Reddy CE, Gupta AK, Singh P, Mann SB (2010) Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg 143:294–300

    Article  Google Scholar 

  27. Som PM, Curtin HD (1993) Chronic inflammatory sinonasal diseases including fungal infections. The role of imaging. Radiol Clin North Am 31:33–44

    CAS  PubMed  Google Scholar 

  28. Fellows DW, King VD, Conturo T, Bryan RN, Merz WG, Zinreich SJ (1994) In vitro evaluation of MR hypointensity in Aspergillus colonies. AJNR Am J Neuroradiol 15:1139–1144

    CAS  PubMed  Google Scholar 

  29. Raz E, Win W, Hagiwara M, Lui YW, Cohen B, Fatterpekar GM (2015) Fungal sinusitis. Neuroimaging Clin N Am 25:569–576

    Article  Google Scholar 

  30. D'Anza B, Stokken J, Greene JS, Kennedy T, Woodard TD, Sindwani R (2016) Chronic invasive fungal sinusitis: characterization and shift in management of a rare disease. Int Forum Allergy Rhinol 6:1294–1300

    Article  Google Scholar 

  31. Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA (2015) Acute invasive fungal rhinosinusitis: a comprehensive update of CT findings and design of an effective diagnostic imaging model. AJNR Am J Neuroradiol 36:1529–1535

    Article  CAS  Google Scholar 

  32. Badiee P, Moghadami M, Rozbehani H (2016) Comparing immunological and molecular tests with conventional methods in diagnosis of acute invasive fungal rhinosinusitis. J Infect Dev Ctries 10:90–95

    Article  CAS  Google Scholar 

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Acknowledgments

The authors thank Shanshan Jin (Beijing Tongren Hospital) who helped with the statistics.

Funding

Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201704); Beijing Municipal Administration of Hospitals’Ascent Plan (DFL20190203); High Level Health Technical Personnel of Bureau of Health in Beijing (2014-2-005).

Author information

Authors and Affiliations

  1. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China

    Zheng Li, Xiao Wang, Hong Jiang, Xiaoxia Qu & Junfang Xian

  2. Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China

    Chengshuo Wang, Xiaohong Chen & Luo Zhang

  3. Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China

    Chengshuo Wang, Xiaohong Chen & Luo Zhang

  4. Department of Diagnostic Imaging, National University Hospital, National University of Singapore, Singapore, 117094, Singapore

    Vincent Fook-Hin Chong

  5. Department of Allergy, Beijing TongRen Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China

    Luo Zhang

Authors
  1. Zheng Li
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  2. Xiao Wang
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  3. Hong Jiang
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  7. Vincent Fook-Hin Chong
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  8. Luo Zhang
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  9. Junfang Xian
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Corresponding authors

Correspondence to Luo Zhang or Junfang Xian.

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Guarantor

The scientific guarantor of this publication is Junfang Xian.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• Retrospective

• Case-control study

• Performed at one institution

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Li, Z., Wang, X., Jiang, H. et al. Chronic invasive fungal rhinosinusitis vs sinonasal squamous cell carcinoma: the differentiating value of MRI. Eur Radiol 30, 4466–4474 (2020). https://doi.org/10.1007/s00330-020-06838-1

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  • DOI: https://doi.org/10.1007/s00330-020-06838-1

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