Juvenile Nasopharyngeal Angiofibroma

Clinical History:
16 year-old male presenting with difficulty breathing through his nose, nightly snoring, stridor and recurrent infections of the upper airway. Inspection shows a red, tumor-like lesion along the posterior wall of the nasopharynx.

Diagnosis:
Juvenile nasopharyngeal angiofibroma

MR Technique:
Images were acquired on a 1.5 T 8 channel MR System (Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany) using standard head and neck coils and a body array coil. T1- and T2-weighted images in the axial plane as well as T1-weighted images in the sagittal plane were acquired prior to contrast agent administration. After acquisition of static and dynamic contrast enhanced MRA scans, additional T1-weighted images in both the axial and sagittal orientation were acquired post-contrast. Sequence details are as follows: T1w axial: TR/TE 708/16, 80Hz/Px bandwidth, 200×230 mm2 field of view, 448×512 matrix, 0.5×0.5×3 mm3 spatial resolution, 3:13 min acquisition time; T2w axial: TR/TE 5800/94, 130Hz/Px bandwidth, 200×230 mm2 field of view, 245×512 matrix, 0.8×0.5×3 mm3 spatial resolution, 3:17 min acquisition time; CE MRA coronal: TR/TE 3.8/1.2, 340Hz/Px bandwidth, 165×330 mm2 field of view, 175×448 matrix, 0.9×0.7×1 mm3 spatial resolution, 0:26 min acquisition time; dynamic MRA: TR/TE 2.3/0.9, 815Hz/Px bandwidth, 338×360 mm2 field of view, 168×256 matrix, 2×1.4×2 mm3 spatial resolution, 2.5 sec/frame temporal resolution.

 

 Imaging Findings:
T1-weighted images reveal a low signal intensity pre-contrast mass lesion filling the posterior nasopharynx (A&B) with substantial arterial enhancement post-contrast (D&E). T2-weighted images show a mildly heterogeneous, intermediate signal intensity, lesion (C). Static and dynamic MRA of the cervical and cranial vessels show substantial, early arterial enhancement in the region of the nasopharynx typical for a juvenile nasopharyngeal angiofibroma (F&G). In distinction, prominent adenoidal soft tissue, which could have similar imaging findings pre-contrast, demonstrates only mild enhancement in the venous phase.