Ji-hoon Kim MD, Presenter: Nothing to Disclose

Dong Gyu Na, Abstract Co-Author: Nothing to Disclose

Sam Soo Kim MD, Abstract Co-Author: Nothing to Disclose

Jae Wook Ryoo MD, Abstract Co-Author: Nothing to Disclose

Kee-Hyun Chang, Abstract Co-Author: Nothing to Disclose

Hyung Suk Seo MD, Abstract Co-Author: Nothing to Disclose

Hong Gee Rho, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

We evaluated CT and MR images of patients with acute invasive fungal infection of the head and neck to determine that MR sign of periosseous non-enhancing defect is a characteristic feature of acute invasive fungal infection.

We retrospectively reviewed CT and MR images of 22 patients (15 men and 7 women; mean age, 51 y; age range, 27-70 y) with pathologically proved acute invasive fungal infection of the head and neck (18 aspergillosis and 4 mucormycosis). We analyzed imaging findings with particular attention to the location, bone destruction, perilesional soft tissue infiltration, and enhancement pattern of the lesion.

The locations of acute invasive fungal infection were sinonasal cavity (n=19) and external ear (n=3). All patients were immunocompromised and underlying diseases were diabetes mellitus (n=11), leukemia (n=7), aplastic anemia (n=2), lymphoma (n=1), and Wegener’s granulomatosis (n=1). There were perilesional bony destruction on CT in 17 (77%) of 22 patients and perilesional soft tissue infiltration on CT and MR images in 21 (95%) patients. Enhanced T1-weighted MR images showed diffuse infiltrative enhancement in 20 (91%) and periosseous non-enhancing defect in 6 (27%) of 22 patients. MR sign of periosseous non-enhancing defect was characterized by non-enhancing round or ovoid lesion involving bony structure and periosseous soft tissue, and preservation of periosseous fat plane on CT and enhanced T1-weighted MR images. In one case involving maxillary sinus, the lesion with a MR sign of periosseous non-enhancing defect resulted in severe necrosis of the lesion at follow up CT.

Perilesional bony destruction and soft tissue infiltration were common CT and MR findings of the acute invasive fungal infection. MR sign of periosseous non-enhancing defect was found in 27% of patients with acute invasive fungal infection, and may suggest early early coaqulative necrosis caused by fungal angioinvasion.

Kim, J, Na, D, Kim, S, Ryoo, J, Chang, K, Seo, H, Rho, H, et al, , MR Sign of Periosseous Non-enhancing Defect in Acute Invasive Fungal Infection of the Head and Neck.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418375.html