COVID-19 Associated Rhino-Orbito-Cerebral Mucormycosis : A Single Tertiary Care Center Experience of Imaging Findings in COVID-19 Associated Mucormycosis with A Special Focus on the Intracranial Manifestations of Mucormycosis. (preprint)

ABSTRACT

Context The current COVID-19 pandemic and mucormycosis epidemic in India has made research on radiological findings of COVID-19 associated mucormycosis imperative. Aim: To describe the imaging findings in COVID-19 associated mucormycosis with a special focus on the intracranial manifestations. Materials and methods: MRI scans of all patients with laboratory proven mucormycosis and post COVID-19 status, over a period of two months, at an Indian Tertiary Care Referral Centre, were retrospectively reviewed and descriptive statistical analysis was carried out. Results: 58 patients (47 men and 11 women) were evaluated. Deranged blood glucose levels were observed in 81% of cases. Intracranial invasion was detected in 31 patients (53.4%). The most common finding in cases with intracranial invasion was pachymeningeal enhancement (90.3% i.e., 28/31). This was followed by infarcts (17/31 i.e., 55%), cavernous sinus thrombosis (11/58 i.e., 18.9%), fungal abscesses (11/31 i.e., 35.4%), and intracranial hemorrhage (5/31 i.e., 16.1% cases). Perineural spread was observed in 21.6% (11/51) cases.Orbital findings included extraconal fat and muscle involvement, intraconal involvement, orbital apicitis, optic neuritis, panophthalmitis, and orbital abscess formation in decreasing order of frequency. Cohen’s kappa coefficient of inter-rater reliability for optic nerve involvement and cavernous sinus thrombosis was 0.7. Cohen’s coefficient value for all other findings was 0.8-0.9. Conclusions: COVID-19 associated Rhinocerebral mucormycosis has a plethora of orbital and intracranial manifestations. MRI, with its superior soft-tissue resolution, is the imaging modality of choice to expedite the initial diagnosis, accurately map out disease extent, and for prompt identification and scrupulous management of its complications.