Magnetic Resonance Imaging pearls in the Diagnosis of Coronavirus associated rhino-orbital-cerebral fungal infection : Retrospective Imaging Analysis of 80 Patients

Background: Rhino-orbital-cerebral mucormycosis has emerged as a major opportunistic infection in patients with COVID-19 and shows tremendous increase during second wave of the COVID-19 pandemic. High clinical suspicion and prompt imaging are crucial for early diagnosis and management as it leads to pernicious morbidity /mortality result 
Objectives: This study's goal is to describe the different MRI findings of COVID-19 associated  rhino-orbital-cerebral mucormycosis (CA-ROCM) , to be familiar with the wide imaging variety which is crucial for early diagnosis and management
Patients and Methods: In this retrospective study, which included 178 patients confirmed with COVID-19 through March 2020 and February 2022.After reviewing the pateints' imaging data, only 80 patients were included. Medical records with a special emphasis on MRI were reviewed regarding the severity of sinuses and nasal cavity affection, orbital and cerebral invasion.
Results: We reported findings in 80 patients with (CA-ROCM). The study cohort had 12 patients with isolated sino-nasal involvement( stage I) , 28 patients with sino-nasal-orbital involvement ( stage II), and 40 patients with intracranial involvement (stage III).The most frequently involved sinuses were ethmoid & maxillary sinuses represented in 75 patients (93.7 %) .Black turbinate sign and non-enhancing sino-nasal mucosa were observed in 63 patients (87.7 %). Sixty two patients (77.5 %) presented with orbital extension. Thirty one (38.7 %) patients had thickening and enhancement of dura, cerebritis was reported in 24patients (30 %). Cerebral ischemic infarcts were seen in 12 (15 %) patients. Post contrast MRI results was correlated with operative data and  revealed that MRI had  higher  sensitivity and specificity in stage III disease  (100 % , 100%)   rather than stage II   (94 % , 96%) and stage I disease (85%, 89%).
Conclusions: MRI findings of CA-ROCM significantly vary from mild mucosal thickening of paranasal sinuses up to intracranial and orbital invasion. MRI with contrast can early detect subtle inflammatory changes outside the paranasal sinuses as early diagnosis of nasal/orbital/cranial invasion would reduce individuals^, mortality and  morbidity rates.