Imaging of mucormycosis during the COVID-19 pandemic: A pictorial review

Abstract

During the second wave of the coronavirus disease 2019 (COVID-19) pandemic, there was a significant rise in cases of rhino-orbito-cerebral mucormycosis (ROCM), an invasive form of acute fungal rhinosinusitis with a propensity for rapid spread to the orbits and intracranial compartment.  Prompt diagnosis and subsequent intervention in the form of surgical debridement and administration of antifungals is the mainstay of management of ROCM. Radiology plays a key role in the diagnosis of the disease and in the assessment of the extent of spread. This article serves to elaborate on the significant computed tomography (CT) and magnetic resonance imaging (MRI) findings in patients with ROCM. It is based on imaging findings of 146 microbiologically/ histopathologically proven cases that were presented to our institute for management during the second wave (April-June 2021). While CT gives excellent details of bony anatomy, particularly of bony rarefaction, it has limitations in terms of assessment of soft tissue spread. MRI provides excellent soft tissue delineation and helps with the assessment of the involvement of orbit, particularly the orbital apex, as well as intracranial extension.