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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 26:82-88, January 2005
© 2005 American Society of Neuroradiology

HEAD AND NECK

Early Postoperative CT Scanning for Juvenile Nasopharyngeal Angiofibroma: Detection of Residual Disease

Romain E. Kania^a, Elisabeth Sauvaget^a, Jean-Pierre Guichard^b, René Chapot^b, Patrice Tran Ba Huy^a and Philippe Herman^a

^a Department of Otorhinolaryngology-Head and Neck Surgery, Assistance Publique-Hôpitaux de Paris, Paris VII University, Lariboisière Hospital, France
^b Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris VII University, Lariboisière Hospital, France

Address reprint requests to Romain E. Kania, MD, Service d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France

BACKGROUND AND PURPOSE: High recurrence rates and early recurrence have been reported for juvenile nasopharyngeal angiofibroma (JNA) involving the skull base. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced CT scanning for the detection of residual disease (RD) in the early postoperative course after surgical excision of JNA.

METHODS: We retrospectively reviewed data in 20 male patients (mean age ± SD, 15.4 ± 5 years; range, 10–32 years) who underwent enhanced helical CT in the days after apparent complete surgical excision of JNA with initial expansion in the skull base. Four independent, blinded readers evaluated the occurrence of RD. Final diagnoses were rendered on the basis of histologic examination of excised specimens of RD or clinical and radiologic follow-up. The Cohen test was performed to examine interreader agreement.

RESULTS: Postoperative contrast-enhanced CT had a sensitivity of 75%, a specificity of 83%, a positive predictive value of 75% and a negative predictive value of 83% for the detection of RD. The prevalence of RD was 40%. The base of pterygoids was the most frequent location of RD. Interreader agreement was high for the detection of putative RD ( = 0.83). Variabilities in readers’ interpretations were encountered for false-positive results and for disease in the foramen lacerum. False-negative results involved the base of pterygoids. Early postoperative CT scanning was well tolerated by all patients.

CONCLUSION: Contrast-enhanced helical CT is an accurate tool to evaluate excision of JNA in the days after surgery.

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