# Correlation Between Endoscopic and Radiological Data in Rhino-Orbital-Cerebral Mucormycosis (ROCM)

## TL;DR

This study compares CT and MRI imaging with endoscopic findings in mucormycosis, showing high agreement but highlighting the need for endoscopy in hidden areas.

## Contribution

The study provides empirical evidence on the correlation between radiological and endoscopic findings in ROCM, emphasizing the importance of endoscopic exploration for early disease detection.

## Key findings

- CT and MRI showed high sensitivity and specificity (>90%) in most anatomical sites compared to endoscopic findings.
- The maxillary sinus was the most commonly involved site, with the middle turbinate being the most affected among the turbinates.
- Imaging had reduced sensitivity in the superior turbinate and other concealed areas, suggesting the need for endoscopic confirmation.

## Abstract

Background

The invasive fungal illness known as rhino-orbito-cerebral mucormycosis (ROCM) is associated with significant morbidity and fatality rates. The increasing burden of the disease and lack of uniformity in guidelines related to its management have led to an increasing case fatality rate. The main objective of the study was to compare and corroborate the cross-sectional imaging findings of CT and MRI scans with those of intra-operative endoscopic findings.

Methods

This retrospective study was conducted at a tertiary care centre of Mahatma Gandhi Memorial Hospital in Aurangabad, India. Each patient was treated with systemic antifungal therapy and surgical debridement following cross-sectional imaging. The findings on radiology and intraoperative endoscopies were compared, and data were analysed.

Results

Radiological assessment demonstrated high sensitivity, specificity, and positive predictive value (generally >90%) across most anatomical sites when compared with intra-operative endoscopic findings. The maxillary sinus was the most commonly involved sinus in almost 97% of cases, followed by the ethmoid sinuses. The middle turbinate was the most commonly involved among the three turbinates. Diagnostic performance was lower for the superior turbinate, with a positive predictive value (PPV) of 79.3%. Chi-square analysis showed no statistically significant difference between radiological and endoscopic detection across the anatomical sites assessed.

Discussion

Cross-sectional imaging plays a vital role in the preoperative assessment and management of mucormycosis. MRI scan gives better delineation of orbital involvement and soft tissue extension, as mucormycosis is well known for angioinvasion. However, despite overall concordance between imaging and endoscopic findings, reduced sensitivity in specific anatomical subregions, including the superior turbinate, intraconal compartment, and select maxillofacial soft-tissue spaces, indicates that early disease may be under-represented on imaging alone. These findings support the role of targeted endoscopic exploration to detect occult disease during surgical management. Imaging is also a useful tool in the follow-up of the disease after the patient's discharge on step-down therapy.

Conclusion

Cross-sectional imaging with CT and MRI provides a valuable adjunct for preoperative mapping in ROCM and works synergistically to delineate disease extent, including orbital and deep soft-tissue involvement that may not be clinically apparent. As imaging guides surgical planning and identifies anatomically high-risk regions that would otherwise not be explored, CT and MRI should be performed in all cases of ROCM. However, early disease involvement in several anatomically concealed areas may be missed on cross-sectional imaging; therefore, endoscopic correlation of hidden regions remains essential to ensure complete disease clearance.