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Abstract：
Background and objective The COVID-19 pandemic and mucormycosis epidemic in India made research on the radiological findings of COVID-19-associated mucormycosis imperative. This study aims to describe the imaging findings in COVID-19-associated mucormycosis, with a special focus on the intracranial manifestations. Methodology Magnetic resonance imaging (MRI) scans of all patients with laboratory-proven mucormycosis and post-COVID-19 status, for two months, at an Indian Tertiary Care Referral Centre, were retrospectively reviewed, and descriptive statistical analysis was carried out. Results A total of 58 patients (47 men, 81%, and 11 women, 19%) were evaluated. Deranged blood glucose levels were observed in 47 (81%) cases. The intracranial invasion was detected in 31 (53.4%) patients. The most common finding in cases with intracranial invasion was pachymeningeal enhancement (28/31, 90.3%). This was followed by infarcts (17/31, 55%), cavernous sinus thrombosis (11/58, 18.9%), fungal abscesses (11/31, 35.4%), and intracranial hemorrhage (5/31, 16.1% cases). The perineural spread was observed in 21.6% (11/51) cases. Orbital findings included extraconal fat and muscle involvement, intraconal involvement, orbital apicitis, optic neuritis, panophthalmitis, and orbital abscess formation in decreasing order of frequency. Cohen\'s kappa coefficient of interrater reliability for optic nerve involvement and cavernous sinus thrombosis was 0.7. Cohen\'s coefficient for all other findings was 0.8-0.9. Conclusions COVID-19-associated rhino-orbito-cerebral mucormycosis has a plethora of orbital and intracranial manifestations. MRI, with its superior soft-tissue resolution and high interrater reliability, as elucidated in this study, is the imaging modality of choice for expediting the initial diagnosis, accurately mapping out disease extent, and promptly identifying and scrupulously managing its complications.
摘要：
背景与目的印度的COVID-19大流行和毛霉菌病流行使研究COVID-19相关毛霉菌病的放射学发现势在必行。本研究旨在描述COVID-19相关毛霉菌病的影像学表现，特别关注颅内表现。方法所有实验室证实的毛霉菌病和COVID-19后状态的患者的磁共振成像（MRI）扫描，两个月,在印度三级护理转诊中心，进行回顾性审查，进行描述性统计分析。结果共58例患者(男性47例,81%,11个女人,19%)进行了评价。在47例（81％）中观察到血糖水平紊乱。31例(53.4%)患者出现颅内侵犯。颅内侵犯最常见的发现是厚膜强化（28/31，90.3％）。其次是梗塞（17/31，55%），海绵窦血栓形成（11/58，18.9%），真菌脓肿（11/31，35.4%），颅内出血（5/31，16.1%）。在21.6％（11/51）的病例中观察到神经周围扩散。眼眶的发现包括脂肪和肌肉受累，颅内受累，眼眶炎,视神经炎,全眼炎,和眼眶脓肿形成的频率依次递减。视神经受累和海绵窦血栓形成的评估者间可靠性的Cohen\skappa系数为0.7。科恩对所有其他发现的系数为0.8-0.9。结论COVID-19相关的鼻-流脑毛霉菌病具有过多的眼眶和颅内表现。MRI,凭借其优越的软组织分辨率和较高的评分者间可靠性，正如这项研究所阐明的，是加速初步诊断的首选成像模式，准确绘制疾病范围，及时识别和严格控制并发症。
