{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:46Z","timestamp":1787027926585,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T00:00:00Z","timestamp":1682380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research, Najran University, Kingdom of Saudi Arabia","award":["NU\/RC\/MRC\/11\/5"],"award-info":[{"award-number":["NU\/RC\/MRC\/11\/5"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications.<\/jats:p>","DOI":"10.3390\/diagnostics13091546","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T01:16:25Z","timestamp":1682471785000},"page":"1546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-7967","authenticated-orcid":false,"given":"Rania Mostafa","family":"Hassan","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7046-5311","authenticated-orcid":false,"given":"Yassir Edrees","family":"Almalki","sequence":"additional","affiliation":[{"name":"Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9075-8020","authenticated-orcid":false,"given":"Mohammad Abd Alkhalik","family":"Basha","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai Ahmed","family":"Gobran","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3871-6747","authenticated-orcid":false,"given":"Saad Misfer","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Pathology, College of Medicine, Najran University Hospital, Najran University, Najran 61441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3910-5793","authenticated-orcid":false,"given":"Abdullah M.","family":"Assiri","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, Najran University, Najran 61441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0810-9337","authenticated-orcid":false,"given":"Sharifa Khalid","family":"Alduraibi","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervat","family":"Aboualkheir","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8383-1624","authenticated-orcid":false,"given":"Ziyad A.","family":"Almushayti","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim S.","family":"Aldhilan","sequence":"additional","affiliation":[{"name":"Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh Abdelaziz","family":"Aly","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha 13511, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa A.","family":"Alshamy","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021, May 22). Coronavirus. Available online: https:\/\/www.who.int\/health-topics\/coronavirus#tab=ta."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1148\/rg.2020200159","article-title":"Chest CT in COVID-19: What the Radiologist Needs to Know","volume":"40","author":"Kwee","year":"2020","journal-title":"Radiographics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e241663","DOI":"10.1136\/bcr-2021-241663","article-title":"COVID-19 triggering mucormycosis in a susceptible patient: A new phenomenon in the developing world?","volume":"14","author":"Revannavar","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2652","DOI":"10.1002\/lary.29632","article-title":"Invasive Fungal Sinusitis in Post COVID-19 Patients: A New Clinical Entity","volume":"131","author":"Khafagy","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103080","DOI":"10.1016\/j.amjoto.2021.103080","article-title":"The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis","volume":"42","author":"Ismaiel","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e126","DOI":"10.15190\/d.2021.5","article-title":"High mortality co-infections of COVID-19 patients: Mucormycosis and other fungal infections","volume":"9","author":"Bhatt","year":"2021","journal-title":"Discoveries"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ijregi.2021.12.009","article-title":"Rhino-orbito-cerebral mucormycosis: An epidemic in a pandemic","volume":"2","author":"Sekaran","year":"2022","journal-title":"IJID Reg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s11908-012-0272-6","article-title":"Rhino-orbital-cerebral mucormycosis","volume":"14","author":"Gamaletsou","year":"2012","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/0971-7749.159700","article-title":"Rhino-orbito-cerebral mucormycosis: Magnetic resonance imaging","volume":"21","author":"Lone","year":"2015","journal-title":"Indian J. Otol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1001\/archoto.2011.170","article-title":"Computed tomography and magnetic resonance imaging characteristics of acute invasive fungal sinusitis","volume":"137","author":"Groppo","year":"2011","journal-title":"Arch. Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4103\/0972-2327.116921","article-title":"Perineural spread of rhino-orbitocerebral mucormycosis caused by Apophysomyces elegans","volume":"16","author":"Parsi","year":"2013","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.4193\/Rhino14.183","article-title":"Current therapeutic protocols for chronic granulomatous fungal sinusitis","volume":"53","author":"Rupa","year":"2015","journal-title":"Rhinology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.3389\/fimmu.2020.01949","article-title":"Overview of immune response during SARS-CoV-2 infection: Lessons from the past","volume":"11","author":"Shah","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1097\/IOP.0000000000001889","article-title":"Acute invasive rhino-orbital mucormycosis in a patient with COVID-19-associated acute respiratory distress syndrome","volume":"37","author":"Mekonnen","year":"2021","journal-title":"Ophthalmic Plast. Reconstruct. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1139\/cjc-2021-0247","article-title":"Post COVID-19 complications, adjunct therapy explored, and steroidal after effects","volume":"100","author":"Sonkar","year":"2022","journal-title":"Can. J. Chem."},{"key":"ref_16","first-page":"e10726","article-title":"Rhino-Orbital Mucormycosis Associated With COVID-19","volume":"12","author":"Mehta","year":"2020","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0030-6665(00)80010-9","article-title":"Mucormycosis of the nose and paranasal sinuses","volume":"33","author":"Ferguson","year":"2000","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"264.e5","DOI":"10.1016\/j.ajem.2020.09.032","article-title":"Mucormycosis with orbital compartment syndrome in a patient with COVID-19","volume":"42","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"A005","DOI":"10.1055\/s-2008-1093099","article-title":"Imaging Findings of Rhinocerebral Mucormycosis","volume":"18","author":"Herrera","year":"2008","journal-title":"Skull Base"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.ejrnm.2018.01.001","article-title":"Imaging features of rhinocerebral mucormycosis: A study of 43 patients","volume":"49","author":"Therakathu","year":"2018","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3174\/ajnr.A1808","article-title":"The \u201cBlack Turbinate\u201d sign: An early MR imaging finding of nasal mucormycosis","volume":"31","author":"Safder","year":"2010","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100222","DOI":"10.1016\/j.xocr.2020.100222","article-title":"Black Turbinate sign: MRI finding in acute invasive fungal sinusitis","volume":"17","author":"Taylor","year":"2020","journal-title":"Otolaryngol. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1177\/194589240101500407","article-title":"Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis","volume":"15","author":"Howells","year":"2001","journal-title":"Am. J. Rhinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4466","DOI":"10.1007\/s00330-020-06838-1","article-title":"Chronic invasive fungal rhinosinusitis vs sinonasal squamous cell carcinoma: The differentiating value of MRI","volume":"30","author":"Li","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.sjopt.2012.08.009","article-title":"Fungal rhinosinusitis and imaging modalities","volume":"26","author":"Gorovoy","year":"2012","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1183\/09059180.00000709","article-title":"Inflammatory pseudotumoural endotracheal mucormycosis with cartilage damage","volume":"18","author":"Luo","year":"2009","journal-title":"Eur. Respir. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1128\/IAI.73.2.778-783.2005","article-title":"Rhizopus oryzae adheres to, is phagocytosed by, and damages endothelial cells in vitro","volume":"73","author":"Ibrahim","year":"2005","journal-title":"Infect. Immun."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1546\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:23:29Z","timestamp":1760124209000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,25]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13091546"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13091546","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,25]]}}}