Janakiram Trichy Narayanan, Sharma Shilpee Bhatia, Samavedam Udaya Chanukya, Deshmukh Onkar, Rajalingam Bavaharan
Royal Pearl Hospital, Tiruchirapalli, Tamilnadu India.
Magnum Imaging and Diagnostics Pvt. Ltd., Tiruchirapalli, Tamilnadu India.
Indian J Otolaryngol Head Neck Surg. 2017 Mar;69(1):81-87. doi: 10.1007/s12070-016-1039-4. Epub 2016 Dec 23.
Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor. We evaluated the clinical significance of pterygoid wedge in preoperative and postoperative imaging and thus elucidating two new radiological signs. Retrospective analysis of the pre operative and post operative imaging data of 242 patients with JNA. The findings in the scan were clinically correlated with the endoscopic intraoperative findings. Preoperative evaluation of the pterygoid wedge revealed widening on the involved side in 99.1% of our cases which is 1.8 times greater compared to the uninvolved side. The possibility of residual/recurrent tumor was found to be significantly higher in those where the pterygoid wedge was not removed by drilling ( < 0.001) Drilling of the pterygoid wedge intra operatively, reduced the rate of residual/recurrence from 31.9 to 3.07%. Widening of the pterygoid wedge seen in the preoperative CECT, referred as RAM HARAN sign occurs in JNA. It has a significant diagnostic value as a radiological sign in JNA. Drilling of the pterygoid wedge intraoperatively reduces the rate of recurrence of JNA. Appearance of the two pterygoid plates on postoperative CECT, as two parallel lines, referred as Chopstick sign, has a remarkable prognostic value as a radiological sign in JNA.
影像学在青少年鼻咽血管纤维瘤（JNA）的诊断、分期及预后评估中发挥着重要作用。在我们的病例系列中观察到，CT增强扫描（CECT）上出现的某些影像学改变是一致的。本研究分析了大量JNA患者术前和术后的CECT，以评估肿瘤的扩散部位和方式。我们评估了翼突楔形征在术前和术后影像学中的临床意义，从而阐明了两个新的影像学征象。对242例JNA患者的术前和术后影像学数据进行回顾性分析。扫描结果与内镜术中所见进行临床相关性分析。术前对翼突楔形征的评估显示，在我们的病例中，99.1%的患侧出现增宽，是未受累侧的1.8倍。发现未通过钻孔去除翼突楔形征的患者，残留/复发肿瘤的可能性显著更高（<0.001）。术中对翼突楔形征进行钻孔，可将残留/复发率从31.9%降至3.07%。术前CECT上所见的翼突楔形征增宽，在JNA中称为RAM HARAN征。它作为JNA的一种影像学征象具有重要的诊断价值。术中对翼突楔形征进行钻孔可降低JNA的复发率。术后CECT上出现的两个翼突板呈两条平行线，称为筷子征，作为JNA的一种影像学征象具有显著的预后价值。
