Juvenile angiofibroma

Preliminary Diagnosis: Juvenile Angiofibroma

I. What imaging technique is first-line for this diagnosis

• CT soft tissue neck with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of juvenile angiofibroma.

Advantages

• Relatively inexpensive and fast imaging modality

• Able to differentiate soft tissue masses from surrounding osseous structures, vasculature, and lymph nodes with great sensitivity and specificity

• Able to assess for any surrounding osseous extension

Disadvantages

• Exposes the patient to ionizing radiation

• Less adept for detailing the exact extension of the soft tissue abnormality (i.e., perineural spread, involvement of the pterygopalatine fossa).

III. What are the contraindications for the first-line imaging technique?

• May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

• Fat saturated MR of the neck with and without contrast

• Cerebral catheter angiography with specific injection of the external carotid arteries

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of juvenile angiofibroma.

Fat saturated MR of the neck with and without contrast

Advantages

• Better adept for evaluating for any perineural spread of disease and detailing the peripheral margins of the juvenile angiofibroma

• Does not expose the patient to ionizing radiation

Disadvantages

• Less sensitive and specific in detailing any osseous involvement

• May be subject to motion artifact due to length of exam and susceptibility weighted artifact in those with adjacent metallic hardware

Cerebral catheter angiography with specific injection of the external carotid arteries

Advantages

• Better able to detail the true vascular supply of the juvenile angiofibroma, which is paramount in surgical planning for preoperative embolization

Disadvantages

• Catheter angiography exposes the patient to larger amounts of ionizing radiation.

• Invasive procedure is associated with more morbidity and mortality compared to CT and MR imaging.

VI. What are the contraindications for the alternative imaging techniques?

Fat saturated MR of the neck with and without contrast

• Contraindicated in patients with non-MR compatible hardware

Cerebral catheter angiography with specific injection of the external carotid arteries

• Contraindicated in patients with a severe hypocoagulable state (platelets <50k, INR >2.0)

• Relative contraindication in patients with renal failure