Akut invaziv fungal sinüzitlerde radyolojik görüntüleme bulgularının retrospektif değerlendirilmesi
Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Akut invaziv fungal sinüzit (AİFS) çoğunlukla immünsüprese, nadiren immünkompetan bireylerde görülür. Sinonazal bölgeye komşu orbita, kavernöz sinüs ve kafa tabanına günler içinde yayılır. Agresif ve hızlı seyri yüksek mobidite ve mortalite ile sonuçlanır. Biz bu tez çalışmasında AİFS ve ekstrasinüs tutulumunun (EST) radyolojik görüntüleme bulgularını ve EST için olası risk faktörlerlerinin belirlenmesini amaçladık. Çalışmamıza 2012- 2020 tarihleri arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesinde patolojik ve mikrobiyolojik olarak AİFS tanısı konulan ve departmanımızda değerlendirmeye uygun radyolojik görüntülemesi bulunan 62 olgu çalışmaya dahil edildi. Olguların klinik ve radyolojik bulguları değerlendirildi. EST’nin ve periantral kirlenmenin (PAK) değerlendirilmesinde MR altın standart olarak kabul edildi. EST tutulumu için PAK’ın 10.71 kat (p=0.005, %95 güven aralığı [CI]: 2.02-56.74), maksiller sinüs tutulumunun (MST) 5.42 kat (p=0.012, %95 CI: 1.45-20.24), mukorales grubu mantarların 21.99 kat (p=0.025, %95 CI: 1.48-325.71) ve nötrofilinin 14.05 kat (p=0.014, %95 CI: 1.71-115.4) risk faktörü olduğunu saptandı. Kemik destrüksiyonu ile PAK arasında (p=0.005) ve komorbit hastalık ile üreyen fungus türü arasında (p=0.002) istatistiksel olarak anlamlı farklılık mevcuttur. BT’nin PAK saptama duyarlılığı %76.9, EST saptamada BT ile MR arasında düşük düzeyde uyumluluk bulundu (%51.5, K=0.264, p=0.010). Nondiyabetik hastalarda ölümün diyabetik olanlara kıyasla fazla olduğu izlendi (HR:4.34, p=0.044, %95 CI: 1.04-18.08). AİFS’lerde görülen EST’yi öngörmede birtakım klinik ve BT görüntüleme bulguları rol oynayabilir. BT görüntülemelerde PAK ve MST, klinik olarak mukorales grubu fungal etken ve nötrofili saptanması EST için işaret edici olabilir. Bu hastaların erken dönemde MR ile tetkiki hasta morbidite ve mortalite açısında olumlu yönde katkı sağlayabilir.
Acute invasive fungal sinusitis (AIFS) primarily affects immunosuppressed patients; however, it may also affect immunocompetent individuals. AIFS generally infiltrates orbita, cavernous sinuses, and skull base since these structures are adjacent to the sinonasal cavity. Unfortunately, AIFS is an aggressive pathology with high morbidity and mortality rates. In this thesis study, we investigated the factors associated with extra-sinusoidal extension (ESE) of the AIFS, and we also examined the radiological findings of AIFS. All AIFS diagnoses at Bursa Uludag University Hospital between 2012 and 2020 retrospectively screened. Patients who did not undergo computed tomography (CT) or magnetic resonance imaging (MRI) scans and patients with no follow-ups were excluded from the study. Consequently, sixty-two AIFS cases with pathological and microbiological confirmation were included in this study. Clinical and radiological findings of the cases were evaluated. Then, statistical analyses were performed to determine the association between ESE and potential predictor variables. In these analyses, MR was accepted as the gold standard in the evaluation of ESE and periantral infiltration (PI). ESE involvement was associated with several factors such as PI (OR:10.71, p=0.005, 95% confidence interval [CI]: 2.02-56.74), maxillary sinus infiltration (MSI) (OR:5.42, p=0.012, %95 CI: 1.45-20.24), mucorales pathogens (OR: 21.99, p=0.025, %95 CI: 1.48-325.71) and neutrophilia (14.05, p=0.014, %95 CI: 1.71-115.4). Moreover, there were significant associations between bone destruction and PI (p=0.005), between comorbidity and pathogen (p=0.002). The PI detection sensitivity of BT was 76.9% and a low level of compatibility between CT and MR in EST detection (%51.5, K=0.264, p=0.010). Another important finding was that mortality rates of non-diabetic iv patients were significantly higher compared to diabetic cases (HR:4.34, p=0.044, %95 CI: 1.04-18.08). A number of clinical characteristics and imaging factors can play a key role in predicting EST of AIFS. Our results suggest that a physician should be particularly alert in the case of PI, MSI, Mucorales pathogens, and neutrophilia. Therefore, in such cases, an MRI scan can significantly improve the prognosis by allowing early diagnosis.
Acute invasive fungal sinusitis (AIFS) primarily affects immunosuppressed patients; however, it may also affect immunocompetent individuals. AIFS generally infiltrates orbita, cavernous sinuses, and skull base since these structures are adjacent to the sinonasal cavity. Unfortunately, AIFS is an aggressive pathology with high morbidity and mortality rates. In this thesis study, we investigated the factors associated with extra-sinusoidal extension (ESE) of the AIFS, and we also examined the radiological findings of AIFS. All AIFS diagnoses at Bursa Uludag University Hospital between 2012 and 2020 retrospectively screened. Patients who did not undergo computed tomography (CT) or magnetic resonance imaging (MRI) scans and patients with no follow-ups were excluded from the study. Consequently, sixty-two AIFS cases with pathological and microbiological confirmation were included in this study. Clinical and radiological findings of the cases were evaluated. Then, statistical analyses were performed to determine the association between ESE and potential predictor variables. In these analyses, MR was accepted as the gold standard in the evaluation of ESE and periantral infiltration (PI). ESE involvement was associated with several factors such as PI (OR:10.71, p=0.005, 95% confidence interval [CI]: 2.02-56.74), maxillary sinus infiltration (MSI) (OR:5.42, p=0.012, %95 CI: 1.45-20.24), mucorales pathogens (OR: 21.99, p=0.025, %95 CI: 1.48-325.71) and neutrophilia (14.05, p=0.014, %95 CI: 1.71-115.4). Moreover, there were significant associations between bone destruction and PI (p=0.005), between comorbidity and pathogen (p=0.002). The PI detection sensitivity of BT was 76.9% and a low level of compatibility between CT and MR in EST detection (%51.5, K=0.264, p=0.010). Another important finding was that mortality rates of non-diabetic iv patients were significantly higher compared to diabetic cases (HR:4.34, p=0.044, %95 CI: 1.04-18.08). A number of clinical characteristics and imaging factors can play a key role in predicting EST of AIFS. Our results suggest that a physician should be particularly alert in the case of PI, MSI, Mucorales pathogens, and neutrophilia. Therefore, in such cases, an MRI scan can significantly improve the prognosis by allowing early diagnosis.
Description
Keywords
Akut invaziv fungal sinüzit, Mukor, Mukormukozis, Acute invasive fungal sinusitis, Mucor, Mucormycosis
Citation
Korkmaz, B. (2020). Akut invaziv fungal sinüzitlerde radyolojik görüntüleme bulgularının retrospektif değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.