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FIG 2. 39-year-old woman with neurofibrosarcoma of the nasopharynx and central skull base after resection and placement of a rectus abdominis free flap. This case illustrates persistent enhancement and absence of atrophy of a muscular graft over several years.
A, Contrast-enhanced, fat-suppressed T1-weighted (600/16/1.5) image obtained several months postoperatively shows bright enhancement of the graft in the nasopharyngeal region (arrows).
B–D were obtained 3 years after surgery.
B, Axial noncontrast T1-weighted (500/9/2) image shows a soft-tissue structure representing a nearly purely myogenous graft in the central skull base (arrows). Striations are only faintly seen centrally.
C, Contrast-enhanced, fat-suppressed T1-weighted (583/9/2) image shows bright enhancement of the graft. Internal heterogeneity is caused largely by striations. Because of the enhancement, this graft was repeatedly misinterpreted as persistent tumor over the course of several years by numerous radiologists. No tumor recurrence has ever been documented in this operative site. Note the similarity with A, obtained 3 years earlier.
D, Axial fast spin-echo T2-weighted (4733/98/2) image with fat suppression shows only moderate signal hyperintensity of the graft. Striations are apparent on this sequence.
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