ABSTRACT

Purpose

To report and validate an objective staging system for COVID-related Rhino-Orbito-Cerebral mucormycosis (ROCM).

Methods

Proof of concept of a new ROC staging system was devised for COVID-related ROCM. The staging system was based on data points drawn from a comprehensive ophthalmic examination, diagnostic endoscopy, and appropriate imaging of orbit, paranasal sinuses and brain in post-COVID ROCM patients to formulate the final staging expressed as R⁰⁻³O⁰⁻³C⁰⁻³. Each stage in the sinus, orbit and brain was graded into three levels of severity of disease. Progressive stages necessitated more active and urgent intervention and poorer prognosis. Finally, ten consecutive ROCM patients were independently staged by two blinded clinicians by examining clinical photographs and radiological images and the results matched for concordance.

Results

Each component of the staging: Rhino, Orbital, and Cerebral were graded 0–3 based on severity. Each stage was matched with a recommended management plan. The final ROC grading by two independent clinicians showed a high degree of concordance – maximum for orbit grade (100%) followed by brain (90%) and sinuses (80%). Overall R⁰⁻³O⁰⁻³C⁰⁻³ staging had 70% concordance. Extrapolation of final ROC staging of two clinicians showed 60% match. When we allowed for one-point difference in the ROC staging system the concordance between two clinicians improved to 100% and the management plan matched in 90%.

Conclusion

The proposed ROC staging system based on objectively defined clinico-radiological criteria of the three components of COVID-related ROCM is simple-to-use and has high concordance when validated by independent clinicians. The staging helps devise a management plan and has prognostic value.

中文翻译：

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COVID 相关的鼻-眶-脑毛霉菌病 ROC 分期系统

摘要

目的

报告和验证与 COVID 相关的犀牛眼眶脑毛霉菌病 (ROCM) 的客观分期系统。

方法

为 COVID 相关的 ROCM 设计了新的 ROC 分期系统的概念证明。该分期系统基于从全面眼科检查、诊断内窥镜检查以及对 COVID 后 ROCM 患者的眼眶、鼻旁窦和大脑进行适当成像得出的数据点，以制定最终分期，表示为 R ^0-3 O ^0-3 C ⁰⁻³。鼻窦、眼眶和大脑的每个阶段都被分为三个疾病严重程度。进展阶段需要更积极和紧急的干预和较差的预后。最后，两名不知情的临床医生通过检查临床照片和放射图像，对 10 名连续的 ROCM 患者进行独立分期，结果符合一致性。

结果

分期的每个组成部分：Rhino、Orbital 和 Cerebral 根据严重程度分为 0-3 级。每个阶段都与推荐的管理计划相匹配。两位独立临床医生的最终 ROC 分级显示出高度的一致性——眼眶分级最高 (100%)，其次是脑 (90%) 和鼻窦 (80%)。总体 R ⁰⁻³ O ⁰⁻³ C ⁰⁻³分期具有 70% 的一致性。外推两名临床医生的最终 ROC 分期显示 60% 匹配。当我们在 ROC 分期系统中允许一个点的差异时，两位临床医生之间的一致性提高到 100%，管理计划匹配率达到 90%。

结论

基于 COVID 相关 ROCM 的三个组成部分的客观定义的临床放射学标准，所提出的 ROC 分期系统易于使用，并且在独立临床医生验证时具有很高的一致性。分期有助于制定管理计划并具有预后价值。