rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2022-103-4-6-36-51rentrad-739Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHРиноцеребральный мукормикоз у пациентов с сахарным диабетом после перенесенной новой коронавирусной инфекции (COVID-19): данные рентгеновской компьютерной и магнитно-резонансной томографииRhinocerebral Mucormycosis in Patients with Diabetes Mellitus After a New Coronavirus Infection (COVID-19): СT and MRI Patterns Datahttps://orcid.org/0000-0001-8058-0102ГабдулганиеваИ. С.GabdulganievaI. S.

Габдулганиева Ирина Сергеевна, врач-рентгенолог отделения томографии

ул. Оренбургский Тракт, 138, Казань, 420064

Irina S. Gabdulganieva, Radiologist, Department of Tomography

ul. Orenburgskiy Trakt, 138, Kazan, 420064

9050265297@mail.ruhttps://orcid.org/0000-0002-4581-4986МунироваН. Р.MunirovaN. R.

Мунирова Наиля Ренатовна, врач-рентгенолог отделения томографии

ул. Оренбургский Тракт, 138, Казань, 420064

Nailya R. Munirova, Radiologist, Department of Tomography

ul. Orenburgskiy Trakt, 138, Kazan, 420064

https://orcid.org/0000-0003-3144-554XЗариповаА. Р.ZaripovaA. R.

Зарипова Айгуль Рашидовна, к.м.н., врач-рентгенолог отделения томографии

ул. Оренбургский Тракт, 138, Казань, 420064

Aygul R. Zaripova, Cand. Med. Sc., Radiologist, Department of Tomography

ul. Orenburgskiy Trakt, 138, Kazan, 420064

https://orcid.org/0000-0001-8955-1965АнисимовВ. И.AnisimovV. I.

Анисимов Владимир Иванович, врач-рентгенолог, заведующий отделением томографии

ул. Оренбургский Тракт, 138, Казань, 420064

Vladimir I. Anisimov, Radiologist, Head of Department of Tomography

ul. Orenburgskiy Trakt, 138, Kazan, 420064

ГАУЗ «Республиканская клиническая больница» Минздрава Республики ТатарстанТаджикистанRepublican Clinical Hospital, Ministry of Health of the Republic of TatarstanTajikistan2022261020221034-63651Copyright © Габдулганиева И.С., Мунирова Н.Р., Зарипова А.Р., Анисимов В.И., 20222022Габдулганиева И.С., Мунирова Н.Р., Зарипова А.Р., Анисимов В.И.Gabdulganieva I.S., Munirova N.R., Zaripova A.R., Anisimov V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/739

Цель: изучение проявлений риноцеребрального мукормикоза (РЦМ) на рентгеновской компьютерной томографии (РКТ) и магнитно-резонансной томографии (МРТ) у пациентов с сахарным диабетом, перенесших новую коронавирусную инфекцию, для выработки клинико-диагностической настороженности, раннего выявления данной патологии, своевременного оперативного лечения и наблюдения в динамике.Материал и методы. Всего выполнено 53 РКТ- и МРТ-исследований головы (лицевой череп, мягкие ткани лица и головной мозг) 13 пациентам с РЦМ. В зависимости от тяжести состояния и клинических показаний одному больному проводили от 1 до 9 РКТ- и МРТ-исследований, период наблюдения составил 1–4 мес. Все пациенты получили хирургическое пособие, верификцию диагноза осуществляли методом микроскопии хирургических образцов (иссеченных некротических тканей). Выполнен подробный описательный анализ совокупности патологических изменений на РКТ и МРТ, характерных для РЦМ, описана последовательность проявления патологических признаков в динамике, оценена распространенность поражения для планирования объема хирургического вмешательства. Проведен сравнительный анализ выявленных признаков РЦМ и литературных данных.Результаты. Поражение полости носа и околоносовых пазух при РЦМ встречалось в 100% наших наблюдений при примерно равных одно- и двусторонних поражениях (54% и 46% соответственно). Поражение передней периантральной и ретроантральной жировой клетчатки и крылонебной ямки определялось у 77% пациентов, одностороннее поражение орбит – у 23%, тромбоз верхней глазничной вены и кавернозного синуса – у 31%, поражение мягких тканей лица – у 15,5%, интракраниальное распространение по периневральным пространствам – у 7,7%, артериит внутренней сонной артерии – у 15,5%. Вовлечение в патологический процесс вещества и оболочек головного мозга наблюдалось в виде церебрита у 23% больных и менингита у 46%. В динамике у 15,5% пациентов отмечено формирование абсцесса головного мозга, остеомиелит костей черепа был диагностирован в 46% случаев. Летальность составила 15%. В случаях длительного наблюдения выявлена последовательность проявления патологических изменений начиная с полости носа, далее в перимаксиллярной жировой клетчатке и орбите с последующим развитием интракраниальных осложнений.Заключение. Наработанный опыт по выявлению совокупности РКТ- и МРТ-признаков, характерных для РЦМ, в сочетании с клинико-анамнестическими данными позволяет повысить настороженность врачей-клиницистов и диагностов для более раннего установления диагноза и выбора оптимального объема хирургического вмешательства.

Objective: to study the computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of rhinocerebral mucormycosis (RCM) in patients with diabetes mellitus and new coronavirus infection, to develop attentive attitude of radiologists for early detection of this pathology, rapid surgery and followup examinations.Material and methods. Totally 53 head (facial skull, soft facial tissues and brain) CT and MRI studies were performed in 13 patients with RCM. The number of CT and MRI studies varied from 1 to 9 per one patient, depending on the severity of his condition and clinical indications; the follow-up period was 1–4 months. All patients received surgical aid; diagnosis was verified by microscopy of surgical samples of excised necrotic tissues. A detailed descriptive analysis of pathological changes on CT and MRI characterizing RCM was carried out. The sequence of pathological signs manifestations was described, the prevalence of the lesion was estimated for planning the scope of surgical intervention. A comparative analysis of the identified RCM signs with the literature data was performed.Results. Lesions of the nasal cavity and paranasal sinuses in RCM were found in 100% of our observations, with approximately equal single and bilateral lesions of 54% and 46%, respectively. Lesions of the perimaxillar fatty tissue and pterygoid fossa were determined in 77% of patients, unilateral orbital lesions – in 23%, superior orbital vein and cavernous sinus thrombosis – in 31%, facial soft tissue lesion – in 15.5%, intracranial spread through the perineural spaces – in 7.7%, internal carotid artery arteritis – in 15.5%. Brain substance and meninges involvement in the pathological process was observed in the form of cerebritis in 23% of patients and meningitis in 46%. The formation of brain abscess was noted in follow up examinations in 15.5% of patients, skull bones osteomyelitis was diagnosed in 46%. The mortality rate was 15%. In cases of long-term observation, the manifestations of pathological changes started from the nasal cavity, then spreaded in the perimaxillary adipose tissue and orbit, and were followed by the development of intracranial complications.Conclusion. The accumulated experience in identifying the combination of CT and MRI signs and patterns of RCM combined with clinical and anamnestic data allows to increase the alertness of clinicians and radiologists for earlier diagnosis and selection of the optimal volume of surgical intervention.

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The authors declare that there are no conflicts of interest present.