A New Proposed Combined CT and MRI Staging System for Covid-19-Associated Rhino-Orbito-Cerebral Fungal Infection: A Multi-center Study with Pathological Correlation

Noha Yahia Ebaid; Haitham Foda; Doaa Khedr Mohamed Khedr; Ahmed Ebeed; Mahmoud Ahmed Ebada; Rabab Mohamed Abdelhay; Ali Awad; Amany Abd Al Badea; Basma Hamed Ibrahim; Emad Hassan Emara

doi:10.1016/j.acra.2023.08.033

A New Proposed Combined CT and MRI Staging System for Covid-19-Associated Rhino-Orbito-Cerebral Fungal Infection: A Multi-center Study with Pathological Correlation

Acad Radiol. 2024 Mar;31(3):1055-1068. doi: 10.1016/j.acra.2023.08.033. Epub 2023 Sep 26.

Affiliations

¹ Radiology department, Faculty of Medicine, Zagazig University, Zagazig, Egypt (N.Y.E., R.M.A.); Medical Research Group of Egypt (MRGE), Egypt (N.Y.E.). Electronic address: nohayahiaradio@gmail.com.
² Diagnostic and Interventional Radiology Department, Faculty of Medicine, Kafrelsheikh University, Kafr Elsheikh, Egypt (H.F., A.E., E.H.E.).
³ Radiology department, Faculty of Medicine, Mansoura University, Mansoura, Egypt (D.K.M.K.).
⁴ Resident Physician, Egyptian Fellowship of Neurology, Nasr City Hospital for Health Insurance, Cairo, Egypt (M.A.E.); Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt (M.A.E.).
⁵ Radiology department, Faculty of Medicine, Zagazig University, Zagazig, Egypt (N.Y.E., R.M.A.).
⁶ Otolaryngology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt (A.A., A.A.A.B.).
⁷ Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt (B.H.I.).

PMID: 37770371
DOI: 10.1016/j.acra.2023.08.033

Abstract

Rationale and objectives: To propose a combined computed tomography (CT) and magnetic resonance imaging (MRI) based classification system in the management of COVID-19-associated rhino-orbito-cerebral (C-ROC) fungal infection and to assess the reliability of such proposed staging system.

Materials and methods: This was a multi-center prospective study conducted on 122 adults with previously confirmed COVID-19 infection. CT and contrast-enhanced MRI (CE-MRI) were performed for all patients. Three radiologists (with experience of 8, 10, and 14 years) independently assessed all images. Then, each patient was assigned a radiological stage based on the five stages of the proposed system according to the radiological extent of the fungal infection. The intra-class correlation coefficient (ICC) test assessed the inter-rater agreement. Based on the pathological evaluation of post-operative specimens, a diagnosis of fungal infection was documented.

Results: The most prevalent severity stage among all raters was stage IV in 29.5-31.1% patients. The overall inter-rater agreement of the proposed staging system was excellent (ICC 0.971, 95% CI;0.960-0.979). Moreover, the most common detected pathogen was Mucormycosis (n = 87, 71.3%). Furthermore, there was a statistically significant association between the patients' outcome and the severity stage (P value 0.001) and there was no statistically significant association between ethmoid and sphenoid sinus affection and cranial extension (P value 0.081).

Conclusion: Our proposed combined CT and MRI severity staging system has a high inter-rater agreement. Moreover, it can aid in the early detection of the C-ROC fungal infection, improve preoperative planning, and subsequently improve the patient's outcome.

Keywords: COVID-19; Fungal; Prognosis; Reliability; Rhino-orbito-cerebral.

Publication types

Multicenter Study

MeSH terms

Adult
COVID-19*
Humans
Magnetic Resonance Imaging / methods
Prospective Studies
Reproducibility of Results
Tomography, X-Ray Computed / methods