MR findings of fungus ball: Significance of high signal intensity on T1-weighted images

Soo Chin Kim, Inseon Ryoo, Jae Min Shin, Sangil Suh, Hye Na Jung, Sung Ui Shin

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    9 Citations (Scopus)


    Background: Central dark-signal intensity with high-signal, hypertrophic mucosal wall of paranasal sinuses on T2-weighted images (T2WI) is a characteristic magnetic resonance imaging (MRI) feature of sinonasal fungus ball. However, this finding is usually interpreted as non-fungal chronic sinusitis with central normal sinus air. In addition, T1-weighted images (T1WI) and T2WI are basic sequences of all magnetic resonance (MR) examinations. Therefore, we evaluated the usefulness of T1WI for detecting fungus balls comparing with computed tomography (CT) findings and T2-weighted MRI findings. Methods: This retrospective study was approved by the Institutional Review Board of Korea University Guro Hospital. Two reviewers assessed preoperative CT and MR images of 55 patients with pathologically confirmed fungus balls. Reviewers evaluated the presence and patterns of calcifications on CT. Overall signals and the presence and extent of certain signals of fungus balls on MRI were also assessed. The relationship between calcifications and MRI signals was also evaluated. Results: Of the patients, 89.1% had calcifications on CT. All had dark signal portions with high signal, hypertrophic mucosal walls on T2WI. Most (92.7%) patients showed iso-to hyper-intense overall signals on T1WI and 89.1% had T1-weighted high signal portions on MRI. The presence, patterns, and location of calcifications had no significant correlation with T1-weighted high-signal intensity portion. Conclusion: Fungus ball can be suggested by the presence of the hyper-signal intensity portions in the fungal mass on T1WI in conjunction with dark-signal lesions surrounded by high-signal, hypertrophic mucosal walls in paranasal sinuses on T2WI.

    Original languageEnglish
    Article numbere22
    JournalJournal of Korean medical science
    Issue number3
    Publication statusPublished - 2020 Jan 20

    Bibliographical note

    Publisher Copyright:
    © 2020 The Korean Academy of Medical Sciences.


    • Aspergillosis
    • Fungus ball
    • Mycetoma
    • Sinusitis

    ASJC Scopus subject areas

    • General Medicine


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