Imaging
Juvenile angiofibroma
- Preliminary Diagnosis: Juvenile Angiofibroma
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of juvenile angiofibroma.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of juvenile angiofibroma.
- VI. What are the contraindications for the alternative imaging techniques?
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
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