Recurrent attacks of headache and post nasal discharge
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Mucoperiosteal reaction of both maxillary, ethmoidal and left frontal sinuses with obliteration of both osteomeatal complexes. It exhibits variable signal intensity; on the left side the mucoperiosteal reaction displays low T1 bright T2 signal with marginal enhancement. On the right side there is low T1 yet loss of signal on T2 owing to paramagnetic effect of iron and manganese particles in fungal hyphae.
T2 WI is helpful in fungal sinusitis as the presence of iron and manganese particles in mycetoma causes signal loss on T2 WI due to paramagnetic effect.