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Two blinded neuroradiologists retrospectively graded 23 prespecified imaging abnormalities in the craniofacial region on CT examinations from 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients. A 7-variable model (periantral fat, bone dehiscence, orbital invasion, septal ulceration, pterygopalatine fossa, nasolacrimal duct, and lacrimal sac) was synthesized on the basis of multivariate analysis. The presence of abnormality involving a single variable in the model had an 87% positive predictive value, 95% negative predictive value, 95% sensitivity, and 86% specificity.