title: The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis.
abstract: OBJECTIVE
  This study aimed to assess the prognostic value of gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) in acute invasive fungal rhinosinusitis (AIFRS) and offer recommendations for determining surgical extent based on loss of contrast enhancement (LoCE), which reveals tissue ischemia from fungal invasion.
  
  
  METHODS
  Preoperative and postoperative Gd-enhanced MRI was evaluated in 21 patients with confirmed AIFRS who underwent wide debridement and antifungal therapy. Patients were subdivided by AIFRS-specific survival. LoCE and contrast enhancement (CE) of intrasinonasal and extrasinonasal sites in preoperative and postoperative MRI were compared between the two groups.
  
  
  RESULTS
  All patients had preoperative intrasinonasal LoCE and CE lesions, which did not differ between survivors and non-survivors. Bone destruction on CT was detected in 8 of 16 survivors (50%) and 4 of 5 non-survivors (80%). Intrasinonasal LoCE lesions were completely removed by surgery in all cases. Postoperative extrasinonasal LoCE lesions were found in all non-survivors but no survivors (p < 0.001). However, postoperative intrasinonasal and extrasinonasal CE lesions were detected in both survivors and non-survivors (p = 0.119 and p = 0.111, respectively). In addition, remission of hematologic diseases at the time of diagnosis of AIFRS and blood sugar control in diabetic patients were significantly associated with AIFRS-specific survival (p = 0.028 and p = 0.023, respectively).
  
  
  CONCLUSIONS
  LoCE lesions, which have to be surgically removed, should be screened using Gd-enhanced MRI for an earlier diagnosis of AIFRS, determination of surgical extent, and management of follow-up. Remnant LoCE lesions after surgery, active hematologic diseases, and poorly controlled blood sugar adversely affect the AIFRS-survival.
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Ji Heui
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Kang
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Yong Ju
authors.initials: YJ
authors.lastname: Jang
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Bong-Jae
authors.initials: BJ
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: yschung@amc.seoul.kr.
authors.forename: Yoo-Sam
authors.initials: YS
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D015897:Comorbidity; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery
chemical_list: D000935:Antifungal Agents; D003287:Contrast Media; D005682:Gadolinium
keywords: Acute invasive fungal rhinosinusitis; Gadolinium; Magnetic resonance imaging