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Radiologic characteristics of sinonasal fungus ball: an analysis of 119 cases

 Young-Joon Seo  ;  Jinna Kim  ;  Kyubo Kim  ;  Jeung-Gweon Lee  ;  Chang-Hoon Kim  ;  Joo-Heon Yoon 
 ACTA RADIOLOGICA, Vol.52(7) : 790-795, 2011 
Journal Title
Issue Date
Adult ; Aged ; Contrast Media ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Middle Aged ; Mycoses/diagnosis* ; Paranasal Sinus Diseases/diagnosis* ; Paranasal Sinus Diseases/diagnostic imaging ; Paranasal Sinus Diseases/microbiology* ; Tomography, X-Ray Computed*
Sinonasal fungus ball ; radiologic features ; contrast computed tomography ; magnetic resonance imaging
BACKGROUND: It is important to differentiate sinonasal fungus ball from non-fungal sinusitis and other forms of fungal sinusitis in order to determine the optimal treatment. In particular, a sinonasal fungus ball, a non-invasive fungal sinusitis, can be characterized by radiologic findings before surgery.

PURPOSE: To differentiate a sinonasal fungus ball from other types of sinusitis and determine optimal treatment on the basis of radiologic findings before surgery.

MATERIAL AND METHODS: We studied 119 patients with clinically and pathologically proven sinonasal fungus balls. Their condition was evaluated radiologically with contrast-enhanced CT (99 patients), non-contrast CT (18 patients) and/or MRI (17 patients) prior to sinonasal surgery.

RESULTS: Calcifications were found in 78 of 116 (67.2%) patients who underwent CT scans for fungus ball. As opposed to non-contrast CT scans, contrast CT scans revealed hyperattenuating fungal ball in 82.8% and enhanced inflamed mucosa in 65.5% of the patients, respectively. On MRI, most sinonasal fungal balls showed iso- or hypointensity on T1-weighted images and marked hypointensity on T2-weighted images. Inflamed mucosal membranes were noted and appeared as hypointense on T1-weighted images (64.7%) and hyperintense on T2-weighted images (88.2%).

CONCLUSION: When there are no calcifications visible on the CT scan, a hyperattenuating fungal ball located in the central area of the sinus with mucosal thickening on enhanced CT scans is an important feature of a non-invasive sinonasal fungus ball. On MRI, a sinonasal fungus ball has typical features of a marked hypointense fungus ball with a hyperintense mucosal membrane in T2-weighted images. A contrast-enhanced CT scan or MRI provides sufficient information for the preoperative differentiation of a sinonasal fungus ball from other forms of sinusitis.
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1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyu Bo(김규보)
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Kim, Chang Hoon(김창훈) ORCID logo https://orcid.org/0000-0003-1238-6396
Yoon, Joo Heon(윤주헌)
Lee, Jeung Gweon(이정권)
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