NASAL ENDOSCOPY VS CONTRAST ENHANCED MRI PARANASAL SINUS, BETTER MODALITY FOR DIAGNOSING MUCORMYCOSIS

Abstract

Background: Mucormycosis is a rapidly progressing, life-threatening fungal infection most commonly affecting immunocompromised individuals, especially those with uncontrolled diabetes or a history of corticosteroid use. Timely diagnosis is critical to reduce mortality and improve outcomes. In resource-constrained settings, identifying a single reliable diagnostic modality becomes essential to initiate prompt treatment. This study compares the diagnostic accuracy of nasal endoscopy and contrast-enhanced magnetic resonance imaging (MRI) against histopathology as the gold standard.

Objective: To compare the diagnostic accuracy of nasal endoscopy and contrast-enhanced MRI in the diagnosis of mucormycosis using histopathology as the reference standard.

Methods: This cross-sectional validation study was conducted at Combined Military Hospital (CMH), Rawalpindi, from January 2022 to 2024. A total of 82 patients aged ≥18 years presenting with clinical suspicion of mucormycosis were enrolled through non-probability consecutive sampling. All patients underwent nasal endoscopy, contrast-enhanced MRI of the brain, paranasal sinuses and orbits, and tissue biopsy for histopathological confirmation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for both modalities. Data analysis was performed using SPSS version 22.

Results: The mean age of patients was 51.34 ± 11.54 years; 57 (69.51%) were male, and 25 (30.49%) were female. The mean BMI was 33.84 ± 4.54 kg/m², and mean HbA1c was 7.46 ± 1.63%. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of nasal endoscopy were 57.63%, 69.57%, 82.93%, 39.02%, and 60.98%, respectively. For contrast-enhanced MRI, these values were 83.05%, 78.26%, 90.74%, 64.29%, and 81.71%, respectively.

Conclusion: Contrast-enhanced MRI demonstrated significantly higher diagnostic accuracy than nasal endoscopy and should be preferred as the initial investigation in patients with suspected mucormycosis.