Radiologic Characterization of Invasive Fungal Infections of the Paranasal Sinuses and Skull Base: A Prospective Analysis

BACKGROUND: Invasive sinonasal and skull base fungal infections represent life-threatening conditions with increasing incidence. Early diagnosis and correct delineation of disease extent using imaging modalities are crucial for reducing morbidity and mortality. AIM AND OBJECTIVES: The aim and objectives of the study are to analyze and compare the computed tomography and magnetic resonance imaging features of acute and chronic invasive sinonasal and skull base fungal infections, correlate imaging findings with microbiological and histopathological findings, and evaluate post-treatment imaging changes on follow-up radiological findings. MATERIALS AND METHODS: This prospective study included 60 patients with proven fungal infections (30 acute invasive and 30 chronic invasive fungal infections). All patients underwent radiological examination of the paranasal sinuses, skull base, orbit, and brain. Imaging findings were meticulously noted, correlated with tissue diagnosis, and compared between both acute and chronic groups. Follow-up imaging was performed at three months (for acute infections) and six months (for chronic infections). RESULTS: Acute invasive fungal infections predominantly affected immunocompromised patients (76.7% (23/30)), while chronic invasive infections were more common in immunocompetent individuals (80% (24/30)). The maxillary sinus was the most frequently involved sinus in both groups. Orbital, skull base, cavernous sinus, and intracranial involvement were significantly more common in acute invasive infections (p < 0.05). Follow-up imaging demonstrated radiological improvement in 76.7% (23/30) of acute and 83.3% (25/30) of chronic cases, with no statistically significant difference between the two groups. CONCLUSION: Computed tomography and magnetic resonance imaging play vital and indispensable roles in the diagnosis, staging, and follow-up of invasive sinonasal and skull base fungal infections. Recognition of characteristic imaging patterns makes early diagnosis, guides surgical and medical management, and helps in determining the duration of antifungal therapy.