DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20191689

Magnetic resonance imaging in evaluation of juvenile nasopharyngeal angiofibroma in term of its diagnosis and pattern of spread

Puran ., Narendra Kumar Kardam

Abstract


Background: Juvenile nasopharyngeal angiofibroma (JNA) is a tumor that shows a predictable spreading pattern. This study showed the characteristic MRI findings and its pattern of spread of JNA for diagnosis.

Methods: This study consisted of 6 cases of JNA for diagnosis and pattern of spreading by using MRI as modality of choice.

Results: The total patients included in study were 6 with age range from 9-20 years and all were male. The classification system used in the study was Radkowski and Onerci system. The tumor showed isointensity to muscle and hyperintensity on T1 and T2 sequences respectively on MR imaging. All lesions had internal signal void regions and showed intense enhancement after IV contrast administration. Diffusion restriction was not an associated features however high values of ADC were noted. The MR angiography of three patients showed blood supply of tumor was mainly from the internal maxillary branch of external carotid artery. The treatment was surgical excision of tumor which was decided on MRI Diagnosis and pattern of Extension described in Radiological report.

Conclusions: MRI is a modality of choice for diagnosis and extension of JNA based on clinical and radiological findings, without performing a biopsy.


Keywords


Angiography, Juvenile nasopharyngeal anfiofibroma, Nasopharynegeal mass, Spread pattern

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References


Szymanska, A, Szymanski, M, Czekajska-chehab, E and Szczerbo-Trojanowska, M. Invasive growth patterns of juvenile nasopharyngeal angiofibroma: radiologicl imaging and clinical implications. Acta Radiol. 2014;55(6):725-31.

Elhammady, MS Johnson, JN, Peterson, EC Aziz-sultan, MA. Preoperative embolization of juvenile nasopharyngeal angiofibromas: transarterial versus direct tumoral puncture. World Neurosurg. 2011 Sep 1;76(3-4):328-34.

Mishra S, Praveena NM, Panigrahi RG, Gupta YM. Imaging in the diagnosis of juvenile nasopharyngeal angiofibroma. J Cli Imaging Sci. 2013;3(Suppl 1).

Álvarez FL, Suárez V, Suárez C, Llorente JL. Multimodality approach for advanced‐stage juvenile nasopharyngeal angiofibromas. Head & Neck. 2013 Feb;35(2):209-13.

Schick B, Rippel C, Brunner C, Jung V, Plinkert PK, Urbschat S. Numerical sex chromosome aberrations in juvenile angiofibromas: genetic evidence for an androgen-dependent tumor?. Oncology reports. 2003 Sep 1;10(5):1251-5.

Schick B, Kahle G. Radiological findings in angiofibroma. Acta Radiologica. 2000 Nov;41(6):585-93.

Parikh V, Hennemeyer C. Microsphers embolization of juvenile nasopharyngeal angiofibroma in adult. Int J Surg Case Report. 2014;5(12):1203-6.

Madhavan RN, Veeravarmal V, Santha AD, Ramachandran CR. Unusual presentation of nasopharyngeal (juvenile) angiofibroma in a 45 year old female. Indian J Dent Res: Pub Indian Society Den Res. 2004;15(4):145-8.

Patrocinio JA, Patrocinio LG, Borba BH, Bonatti Bde S, Guimaraes AH. juvenile nasopharyngeal angiofibroma in an elderly woman. Am J Otolaryngol. 2005;26(3):198-200.

Makek MS, Andrews JC, Fisch U. Malignant transformation of a nasopharyngeal angiofibroma. The Laryngoscope. 1989 Oct;99(10):1088-92.

Ballah D, Rabinowitz D, Vossough A, Rickert S, Dunham B, Kazahaya K, et al. Preoperative angiography and external carotid artery embolization of juvenile nasopharyngeal angiofibromas in a tertiary referral paediatric centre. Clinical Radiol. 2013 Nov 1;68(11):1097-106.

Iovanescu G, Ruja S, Cotulbea S. Juvenile nasopharyngeal angiofibroma: Timisoara ENT Department’s experience. Int J Pediat Otorhinol. 2013;77(7):1186-89.

Lloyd C, McHugh K. The role of radiology in head and neck tumours in children. Cancer Imaging. 2010;10:49-61.

Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Two types of lateral extension in juvenile nasopharyngeal angiofibroma: diagnostic and therapeutic management. European Arch Oto-Rhino-Laryngol. 2015;272(1):159-66.

Lloyd G, Howard D, Phelps P, Cheesman A. Juvenile angiofibroma: the lessons of 20 years of modern imaging. J Laryngol Otol. 1999;113(2):127-34.

Elsharkawy AA, Kamal EM, Tawfik A, Zaher A, Kasem M. Juvenile nasopharyngeal angiofibroma with intracranial extension: analysis of 23 Egyptian patients. Int J Pediatr Otorhinolaryngol. 2010;74(7):755-59.

Holman, CBMW. Juvenile nasopharyngeal fibroma. Am J Roentgenol. 1965:292-98.

Griffiths PD Coley SC, Romanowski CA, Hodgson T, Wilkinson ID. Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR. 2003;24(4):719-23.

Radkowski D, McGill T, Healy GB, Ohlms L, Jones DT. Angiofibroma: changes in staging and treatment. Arch Otolaryngol Head Neck Surg. 1996;122(2):122-9.

Fisch U. The infratemporal fossa approach for nasopharyngeal tumors. Laryngoscope. 1983;93(1):36-44.

Andrews JC, Fisch U, Aeppli U, Valavanis A, Makek MS. The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach. The Laryngoscope. 1989 Apr;99(4):429-37.

Onerci M, Oğretmenoğlu O, Yücel T. Juvenile nasopharyngeal angiofibroma: a revised staging system. Rhinology. 2006 Mar;44(1):39-45.