The radiology of cerebral and paranasal sinus fungal lesions

Pulmonary fungal infections have been increasingly reported in the patients with hematologic malignancies treated with aggressive chemotherapy and therefore presenting chemotherapy-induced leukopenia. The diagnosis of fungal infections in these severely immunocompromised hosts is of great importance, enabling the administration of an antifungal treatment to prevent potentially fatal fungal dissemination. This retrospective study was carried out to assess the most valuable conventional radiologic and CT features in the diagnosis of sinusal and cerebral mycosis infections. The authors reviewed their personal series of 71 patients with malignant hematologic diseases who developed a fungal lesion: twenty-eight cases were selected, 10 of them with an autoptic diagnosis of cerebral fungal lesions and 18 with a bioptic diagnosis of paranasal fungal lesions. In 10 patients with encephalic lesions, CT enabled four main types of tomodensitometric alterations with fungine etiology to be singled out--i.e., ischemic lesions, brain abscesses, granulomatoses and meningitis with possible brain parenchyma involvement. In 18 patients with fungal sinusitis, radiography and CT showed three main types of alterations: sinus opacities, pseudocystic images within the sinus and bone erosions. We conclude that in sinusal and cerebral fungal lesions no "specific criteria" can be established for the radiologic differential diagnosis between different fungine species and between fungine lesions with different etiologic agents.