Imaging for juvenile angiofibroma

Abstract

Juvenile angio broma presents characteristic imaging signs, many of which allow diagnosis and accurate estimation of extent without recourse to the dangers of biopsy. The diagnosis by computed tomography (CT) is based upon the site of origin of the lesion in the pterygopalatine fossa. There are two constant features: (1) a mass in the posterior nasal cavity and pterygopalatine fossa; (2) erosion of bone behind the sphenopalatine foramen with extension to the upper medial pterygoid plate. Good bone imaging on CT is essential to show invasion of the cancellous bone of the sphenoid. This is the main predictor of recurrence: the deeper the extension, the larger the potential tumour remnant likely to be left following surgery. The characteristic features on magnetic resonance imaging (MRI) are due to the high vascularity of the tumour causing signal voids and strong post-contrast enhancement. MRI shows the pre-operative soft tissue extent of angio broma optimally, but its more important application is to provide post-operative surveillance: to show any residual or recurrent tumour, record tumour growth or natural involution and monitor the effects of radiotherapy.

Apparent Diffusion Coefficient Mapping for Sinonasal Diseases: Differentiation of Benign and Malignant Lesions

“…A convoluted cerebriform pattern is a reliable MR imaging feature of sinonasal inverted papillomas, but it is lacking in many cases (such an imaging feature was seen in 2 of the 7 present cases). 17 Signal-intensity voids are characteristic MR imaging features of angiofibromas with high vascularity, 18 but they also may be absent (seen in 2 of the 3 present cases). Finally, in the present study, there were no significant differences in overall ADCs or ADC mapping between inverted papillomas, angiofibromas, and hemangiomas (On-line Tables 1 and 2).…”

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign

“…Involvement of various areas as seen on preoperative imaging forms the basis for all the staging systems for JNA Diagnosis of Juvenile nasopharyngeal angiofibroma is based on history, clinical examination and imaging studies. Nasopharyngeal angiofibroma presents with typical radiological signs that aids in preoperative diagnosis without subjecting the patients to the perils of a biopsy [6]. Lloyd et al [6] reported two characteristic features suggesting a diagnosis of JNA, a soft tissue mass in the posterior nasal cavity and pterygopalatine fossa with erosion of posterior osseous margin of the sphenopalatine foramen extending to the base of the medial pterygoid plate.…”

“…Nasopharyngeal angiofibroma presents with typical radiological signs that aids in preoperative diagnosis without subjecting the patients to the perils of a biopsy [6]. Lloyd et al [6] reported two characteristic features suggesting a diagnosis of JNA, a soft tissue mass in the posterior nasal cavity and pterygopalatine fossa with erosion of posterior osseous margin of the sphenopalatine foramen extending to the base of the medial pterygoid plate. The finding of the anterior bowing of the posterior wall of the maxillary sinus on plain X-ray, was described by Holman and Miller as 'antral sign'(Holman Miller sign).…”

Angiofibroma from the Tail of the Inferior Turbinate

“…Preoperative investigations include imaging and endoscopy [5]. Computerized tomography, MRI and arteriography are valuable diagnostic procedures in the evaluation of angiofibromas [10]. Arteriography clearly demonstrates vascular pattern and blood flow dynamics and allows preoperative selective embolization to reduce intraoperative bleeding.…”