{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T11:31:13Z","timestamp":1770291073211,"version":"3.49.0"},"reference-count":40,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Acute invasive fungal rhinosinusitis (AIFR) is a rare, severe, and life-threatening opportunistic infection associated with high mortality and morbidity. Rapid and accurate diagnosis and treatment are crucial for survival and effective disease management. Diagnosing AIFR is challenging because no single pathognomonic feature exists other than surgical biopsy showing fungal angioinvasion and necrosis. This narrative review focuses on the diagnostic challenges and pitfalls, emphasizing the critical clinical value of magnetic resonance imaging (MRI) for early diagnosis of AIFR. It includes selected cases that illustrate the significance of MRI. When AIFR is suspected, clinical symptoms, nasal endoscopy, blood samples, and facial computed tomography all provide non-specific information. In contrast, MRI can identify signs of devitalized sinonasal mucosa consistent with AIFR. The absence of mucosal enhancement on T1-weighted images, combined with restricted diffusivity, are characteristic MRI features of AIFR. The cases presented underscore the usefulness of MRI in supporting clinical suspicion of AIFR and accurately determining its topography, thereby guiding early surgical biopsies and debridement. In suspected cases of AIFR, MRI serves as a valuable supplementary, non-invasive tool to help determine whether prompt surgical biopsy or debridement is necessary, thereby enhancing early diagnosis and improving survival rates. Therefore, the threshold for conducting an MRI in these cases should be low.<\/jats:p>","DOI":"10.3390\/diagnostics15030311","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T03:26:10Z","timestamp":1738121170000},"page":"311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Importance of MRI in the Early Diagnosis of Acute Invasive Fungal Rhinosinusitis"],"prefix":"10.3390","volume":"15","author":[{"given":"Fran\u00e7ois","family":"Voruz","sequence":"first","affiliation":[{"name":"Rhinology\u2013Olfactology Unit, Department of Clinical Neurosciences, Clinic of Otorhinolaryngology\u2014Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionysios","family":"Neofytos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Service of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Van Delden","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Service of Infectious Diseases, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Lobrinus","sequence":"additional","affiliation":[{"name":"Diagnostic Department, Division of Pathology, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4966-1278","authenticated-orcid":false,"given":"Claudio","family":"De Vito","sequence":"additional","affiliation":[{"name":"Diagnostic Department, Division of Pathology, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Macario","sequence":"additional","affiliation":[{"name":"Rhinology\u2013Olfactology Unit, Department of Clinical Neurosciences, Clinic of Otorhinolaryngology\u2014Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3618-9776","authenticated-orcid":false,"given":"Dimitrios","family":"Daskalou","sequence":"additional","affiliation":[{"name":"Rhinology\u2013Olfactology Unit, Department of Clinical Neurosciences, Clinic of Otorhinolaryngology\u2014Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien W.","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Rhinology\u2013Olfactology Unit, Department of Clinical Neurosciences, Clinic of Otorhinolaryngology\u2014Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minerva","family":"Becker","sequence":"additional","affiliation":[{"name":"Diagnostic Department, Division of Radiology, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6034-3724","authenticated-orcid":false,"given":"Basile N.","family":"Landis","sequence":"additional","affiliation":[{"name":"Rhinology\u2013Olfactology Unit, Department of Clinical Neurosciences, Clinic of Otorhinolaryngology\u2014Head and Neck Surgery, Geneva University Hospitals, University of Geneva, 1211 Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"104143","DOI":"10.1016\/j.amjoto.2023.104143","article-title":"Invasive fungal sinusitis: A comparison of pediatric versus adult cases","volume":"45","author":"Dacey","year":"2024","journal-title":"Am. J. Otolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20210749","DOI":"10.1259\/bjr.20210749","article-title":"Utilizing CT soft-tissue markers as a screening tool for acute invasive fungal sinusitis","volume":"95","author":"John","year":"2022","journal-title":"Br. J. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00005792-199707000-00003","article-title":"Invasive Aspergillus sinusitis in patients with human immunodeficiency virus infection. Report of 2 cases and review","volume":"76","author":"Mylonakis","year":"1997","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.2147\/JAA.S398686","article-title":"Epidemiological Characteristics, Pathogenesis and Clinical Implications of Sinusitis in the Era of COVID-19: A Narrative Review","volume":"16","author":"Alotaibi","year":"2023","journal-title":"J. Asthma Allergy."},{"key":"ref_6","first-page":"1","article-title":"Post COVID-19 Mucormycosis-The Horizon","volume":"75","author":"Reddy","year":"2022","journal-title":"Indian. J. Otolaryngol. Head. Neck Surg."},{"key":"ref_7","first-page":"427","article-title":"Rhino-orbito-cerebral mucormycosis: Patient characteristics in pre-COVID-19 and COVID-19 period","volume":"60","author":"Cherian","year":"2022","journal-title":"Rhinology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1182\/blood-2011-03-316430","article-title":"How I treat mucormycosis","volume":"118","author":"Kontoyiannis","year":"2011","journal-title":"Blood"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1111\/coa.13175","article-title":"A meta-analysis of survival factors in rhino-orbital-cerebral mucormycosis-has anything changed in the past 20 years?","volume":"43","author":"Vaughan","year":"2018","journal-title":"Clin. Otolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1002\/lary.23912","article-title":"Survival outcomes in acute invasive fungal sinusitis: A systematic review and quantitative synthesis of published evidence","volume":"123","author":"Turner","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4193\/Rhin17.153","article-title":"The significance of Computed Tomography in invasive paranasal mucormycosis","volume":"56","author":"Slonimsky","year":"2018","journal-title":"Rhinology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1148\/rg.275065189","article-title":"Imaging features of invasive and noninvasive fungal sinusitis: A review","volume":"27","author":"Aribandi","year":"2007","journal-title":"Radiographics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"336","DOI":"10.4193\/Rhino15.186","article-title":"Clinical implications of serum galactomannan measurement in patients with acute invasive fungal rhinosinusitis","volume":"54","author":"Cho","year":"2016","journal-title":"Rhinology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1002\/alr.22547","article-title":"A multi-institutional review of outcomes in biopsy-proven chronic invasive fungal sinusitis","volume":"10","author":"Humphreys","year":"2020","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"myad020","DOI":"10.1093\/mmy\/myad020","article-title":"Microbial and clinical epidemiology of invasive fungal rhinosinusitis in hospitalized COVID-19 patients, the divergent causative agents","volume":"61","author":"Erami","year":"2023","journal-title":"Med. Mycol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and outcome of zygomycosis: A review of 929 reported cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Erami, M., Aboutalebian, S., Hezaveh, S.J.H., Matini, A.H., Momen-Heravi, M., Ahsaniarani, A.H., Arani, S.S., Ganjizadeh, M., and Mirhendi, H. (2023). Invasive Fusarium rhinosinusitis in COVID-19 patients: Report of three cases with successful management. Front. Cell Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1247491"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1093\/cid\/cir867","article-title":"Healthcare-associated mucormycosis","volume":"54","author":"Rammaert","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1148\/rg.220059","article-title":"Deadly Fungi: Invasive Fungal Rhinosinusitis in the Head and Neck","volume":"42","author":"Kurokawa","year":"2022","journal-title":"Radiographics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: An initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"387","DOI":"10.4193\/Rhin21.070","article-title":"Efficacy and safety of retrobulbar amphotericin B injection in invasive fungal rhinosinusitis with orbital invasion patients","volume":"59","author":"Arreenich","year":"2021","journal-title":"Rhinology"},{"key":"ref_22","first-page":"425","article-title":"Retrobulbar Injection of Amphotericin B in Patients With COVID-19 Associated Orbital Mucormycosis: A Systematic Review","volume":"38","author":"Sharifi","year":"2022","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Smith, C., and Lee, S.C. (2022). Current treatments against mucormycosis and future directions. PLoS Pathog., 18.","DOI":"10.1371\/journal.ppat.1010858"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1086\/590004","article-title":"Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis","volume":"47","author":"Chamilos","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","first-page":"561","article-title":"Impact of azole antifungal treatment on outcome in acute invasive fungal rhinosinusitis with orbitocranial involvement: A surgical perspective","volume":"61","author":"Tessler","year":"2023","journal-title":"Rhinology"},{"key":"ref_26","unstructured":"Gnepp, D.R., and Bishop, J.A. (2020). Gnepp\u2019s Diagnostic Surgical Pathology of the Head and Neck, Elsevier. [3rd ed.]."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/MOO.0000000000000507","article-title":"Updates in management of acute invasive fungal rhinosinusitis","volume":"27","author":"Craig","year":"2019","journal-title":"Curr. Opin. Otolaryngol. Head. Neck Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.2500\/ajra.2013.27.3892","article-title":"Chapter 8: Invasive fungal rhinosinusitis","volume":"27","author":"Duggal","year":"2013","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1159\/000380761","article-title":"Basilar artery territory stroke secondary to invasive fungal sphenoid sinusitis: A case report and review of the literature","volume":"7","author":"Fu","year":"2015","journal-title":"Case Rep. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1080\/00365540410020794","article-title":"Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy","volume":"36","author":"Thajeb","year":"2004","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1001\/archotol.124.5.520","article-title":"An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host","volume":"124","author":"Gillespie","year":"1998","journal-title":"Arch. Otolaryngol. Head. Neck Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hassan, R.M., Almalki, Y.E., Basha, M.A.A., Gobran, M.A., Alqahtani, S.M., Assiri, A.M., Alqahtani, S., Alduraibi, S.K., Aboualkheir, M., and Almushayti, Z.A. (2023). Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation. Diagnostics, 13.","DOI":"10.3390\/diagnostics13091546"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.3174\/ajnr.A4298","article-title":"Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model","volume":"36","author":"Middlebrooks","year":"2015","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_34","first-page":"321","article-title":"Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings","volume":"19","author":"Silverman","year":"1998","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jinf.2014.07.027","article-title":"The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis","volume":"70","author":"Kim","year":"2015","journal-title":"J. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1177\/02841851221132788","article-title":"Magnetic resonance imaging of rhino-orbito-cerebral mucormycosis: A pictorial review","volume":"64","author":"Dixit","year":"2023","journal-title":"Acta Radiol."},{"key":"ref_37","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_38","doi-asserted-by":"crossref","first-page":"855","DOI":"10.3174\/ajnr.A6037","article-title":"The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates","volume":"40","author":"Han","year":"2019","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s13244-016-0498-1","article-title":"The pterygopalatine fossa: Imaging anatomy, communications, and pathology revisited","volume":"7","author":"Tashi","year":"2016","journal-title":"Insights Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ejrad.2009.09.029","article-title":"Imaging of the optic nerve","volume":"74","author":"Becker","year":"2010","journal-title":"Eur. J. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/3\/311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:37:57Z","timestamp":1759919877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/3\/311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,28]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["diagnostics15030311"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15030311","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,28]]}}}