Four-dimensional CT angiography (4D-CTA) in the evaluation of juvenile nasopharyngeal angiofibromas: comparison with digital subtraction angiography (DSA) and surgical findings.

OBJECTIVES: To explore the value of four-dimensional CT angiography (4D-CTA) in the preoperative evaluation of juvenile nasopharyngeal angiofibromas (JNAs) using 320-row volume CT.

METHODS: 4D-CTA and DSA data of 18 patients with histopathologically proven JNAs were retrospectively reviewed. The location, extent, feeding vessels and stage of JNAs were assessed by two radiologists independently and blindly. The agreements between both reviewers and between 4D-CTA and surgical findings for assessing the above indicators were analysed, respectively. The radiation dose and the number of feeding arteries between 4D-CTA and digital subtraction angiography (DSA) were also compared.

RESULTS: 4D-CTA showed high diagnostic consistency with surgical pathology for JNAs with consistent rates of 96.2 and 100% in both reviewers, respectively. The effective dose of 4D-CTA was significantly less than that of DSA (p < 0.001). Good agreements between 4D-CTA and surgical findings and between the two reviewers were found in the assessment of the location, extent and stage of JNAs. 4D-CTA showed that 15 lesions were supplied strictly by the external carotid artery circulation and 3 by the external and internal carotid artery supply, which was in accordance with DSA. There were no significant differences in the main arterial feeder number obtained by 4D-CTA and DSA between different observers (all p > 0.05).

CONCLUSIONS: 4D-CTA can provide a reliable preoperative diagnosis and assessment of JNAs, which is useful for determining the surgical strategy and management of this condition.