There is no relevant literature to support the use of CTA head in the initial evaluation of suspected acute invasive fungal sinusitis. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in the evaluation of acute invasive fungal sinusitis. MRA Head MRA head may be performed for the evaluation of vascular complications of invasive fungal sinusitis including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of MRA head in the initial evaluation of suspected invasive fungal sinusitis. MRI Head MRI head without and with IV contrast can delineate complications involving the intracranial compartment better than CT [5,6,43]. Combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential intracranial complications. MRI head with and without IV contrast may be complementary to CT maxillofacial to identify intracranial spread beyond the field of view of the MRI orbits, face, and neck examination. MRI Orbits, Face, and Neck A T2 signal void from fungal concretions can be confused for a pneumatized sinus, limiting evaluation of intrasinus disease with MRI [4,5]. However, MRI without and with IV contrast provides accurate evaluation of the invasion of the surrounding soft tissues, orbits, and intracranial compartment and vascular complications. One study evaluating 17 immunocompromised patients with acute invasive fungal sinusitis and 6 controls found increased sensitivity of MRI of 85% to 86% compared with CT with a sensitivity of 57% to 69% and found extrasinus invasion to be the most sensitive imaging finding [4,45]. Lack of sinonasal mucosal and nasal turbinate enhancement, the latter described as the black turbinate sign, correlates with necrosis related to the angioinvasive nature of fungal sinusitis [4].
Sinonasal Disease. There is no relevant literature to support the use of CTA head in the initial evaluation of suspected acute invasive fungal sinusitis. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in the evaluation of acute invasive fungal sinusitis. MRA Head MRA head may be performed for the evaluation of vascular complications of invasive fungal sinusitis including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of MRA head in the initial evaluation of suspected invasive fungal sinusitis. MRI Head MRI head without and with IV contrast can delineate complications involving the intracranial compartment better than CT [5,6,43]. Combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential intracranial complications. MRI head with and without IV contrast may be complementary to CT maxillofacial to identify intracranial spread beyond the field of view of the MRI orbits, face, and neck examination. MRI Orbits, Face, and Neck A T2 signal void from fungal concretions can be confused for a pneumatized sinus, limiting evaluation of intrasinus disease with MRI [4,5]. However, MRI without and with IV contrast provides accurate evaluation of the invasion of the surrounding soft tissues, orbits, and intracranial compartment and vascular complications. One study evaluating 17 immunocompromised patients with acute invasive fungal sinusitis and 6 controls found increased sensitivity of MRI of 85% to 86% compared with CT with a sensitivity of 57% to 69% and found extrasinus invasion to be the most sensitive imaging finding [4,45]. Lack of sinonasal mucosal and nasal turbinate enhancement, the latter described as the black turbinate sign, correlates with necrosis related to the angioinvasive nature of fungal sinusitis [4].