Fungal Disease of Paranasal Sinuses MRI and CT Comparative Study
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Fungal infection of the nose and sinuses is an uncommon condition, which is now being increasingly recognized. The purpose of this study is to review the sectional imaging appearance of sinonasal fungal disease, discuss the imaging differential diagnosis and to highlight its microbiological features. Of the 76 patients who underwent computed tomography ( CT ) and microbiological examination for the clinical suspicion of fungal disease, only 15 cases were diagnosed positive of having fungal disease. Four cases of the total 76 cases were found to be positive for fungal infection by micorbiological investigation but could not be diagnosed on radiological bases. For the micobiological studies both nasal swabs and sinus scrapings were obtained. Direct examination and culture of the samples were carried out. Serological examination for the presence of IgG and 1gM antaspergillus antibodies was also carried out on the diagnosed cases. On CT, the presence of a sinus mycetoma is suggested when there is a central high attenuation intrasinus mass that is separated from the sinus bony walls by a zone of mucoid attenuation secretions. On MR images, the mycetoma has either low TIweighted signal intensity, or TI-weighted and a n-weighted signal voids. This primarily reflects the semisolid composition of this cheesy or desiccated mass of mycelia. At present, CT appears to be a more reliable first examination, with MR imaging being used to help differentiate some of the Cl' look-alike. Still microbiological diagnosis is the final diagnosis.