Juvenile angiofibroma: imaging by magnetic resonance, CT and conventional techniques.

Thirty patients with histologically verified angiofibromata have been investigated over a period of 14 years. They have been examined by conventional radiographic techniques and computerized tomography, and more recently 4 patients have been scanned by magnetic resonance. CT studies of patients with small tumours have shown that the point of origin is at the sphenopalatine foramen. The tumour enlarges the foramen and erodes bone locally giving rise to characteristic signs both on plain X-ray and on CT scan. The value of magnetic resonance imaging is assessed and it is concluded that in the presence of the characteristic 'antral sign' on plain X-ray, 3-plane magnetic resonance is now the method of choice to show the extent of the tumour pre-operatively. Magnetic resonance can also show the vascular nature of the angiofibroma by the demonstration of large vessels, shown as dark areas of negative signal within the tumour mass. With this new method of investigation available, angiography should now only be performed if embolization is deemed necessary prior to surgical removal of the angiofibroma.