A radiological profile of fungal sinusitis

Objectives: To create a radiological profile of fungal sinusitis and determine the radiological differences between fungal and nonfungal sinusitis based on the presence of hyperattenuation, bony erosion, neo-osteogenesis, air-fluid level, and extrasinus extension. Methods: This is a retrospective, single-blind, case-control study involving the analysis of 119 computed tomography (CT) scans of the paranasal sinuses. Based on the histopathology, they were divided into cases comprising fungal sinusitis and controls of nonfungal sinusitis. Benign and malignant tumors and previously operated cases of fungal sinusitis were excluded from the study. The principal investigators were blinded to the diagnosis. The comparison parameters were hyperattenuation, the presence of air-fluid level, bone erosion, neo-osteogenesis, and extrasinus extension. Data was analyzed by Chi-square and Fischer exact t-test using SPSS 14.0 software and a p < 0.05 was considered significant. Results: Our study showed the presence of hyperattenuation, neo-osteogenesis, bone erosion, air-fluid level, extrasinus extension in 75.2%, 48.3%, 25.9%, 36.2%, and 6.9% of the cases and 13.1%, 16.4%, 6.6%, 9.8%, and 0 controls, respectively. All the parameters were statistically significant in cases when compared to controls. Conclusion: Hyperattenuation, neo-osteogenesis, air-fluid level, bone erosion, and extrasinus extension are the parameters on CT imaging that will help routinely assess and differentiate fungal sinusitis from nonfungal sinusitis with considerable accuracy, although, there is an overlap with malignancy when the parameter of bone erosion is considered as a differential diagnosis of chronic invasive fungal sinusitis. It reiterates the fact that history, clinical examination, and laboratory evaluation hold an important role in provisional diagnosis.