Gülten TAŞKIN, Muzaffer ELMALI, Özgür KEMAL, İrem Ceren KOÇ, Mehmet ÇELEBİ
European Journal of Rhinology and Allergy - 2026;9(2):98-104
Objective: Invasive fungal rhinosinusitis (IFRS) is a rapidly progressive infection with high mortality, particularly among immunocompromised patients. Early recognition of imaging findings indicating angioinvasion and extrasinus spread is essential for timely diagnosis and management. This study aimed to evaluate CT and MRI findings in histopathologically confirmed IFRS and to assess their association with histopathological angioinvasion. Methods: Fifteen patients with histopathologically confirmed IFRS were retrospectively analyzed from January 2016 to January 2026. All patients underwent paranasal sinus CT, and eight also underwent contrast-enhanced MRI. Imaging findings were reassessed using a standardized checklist that included extrasinus extension, osseous changes, perineural spread, and features suggestive of angioinvasion. Findings were compared with histopathological results. Results: The most common findings were retroantral fat infiltration (66.7%) and bone defects (66.7%), followed by preantral fat infiltration (60%). Orbital involvement was present in 46.7%, and pterygopalatine fossa involvement in 33.3%. Devitalized, non-enhancing tissue was observed in all patients who underwent MRI, representing a consistent finding within this subgroup. Histopathological angioinvasion was present in 40% of cases. Imaging findings suggestive of angioinvasion or perineural spread were associated with histopathological angioinvasion (p = 0.028). In some cases, imaging findings suggestive of angioinvasion were present despite the absence of histopathological confirmation. Conclusion: Extrasinus extension, particularly retroantral fat infiltration, may indicate invasive disease before overt bone destruction. MRI is important for detecting devitalized tissue and assessing disease extent. Imaging may demonstrate angioinvasive features even when histopathology is negative, and it may contribute to clinical decision-making.
