Pterygoid Base Pneumatization Simulating Residual Disease-A Pitfall of Structural Imaging in Juvenile Nasal...

Area of Science:

• Oncology
• Radiology
• Otolaryngology

Background:

• Juvenile nasopharyngeal angiofibroma (JNA) universally expresses prostate-specific membrane antigen (PSMA).
• PSMA is utilized to distinguish recurrent JNA from post-surgical reparative tissues.
• Ambiguous findings on imaging can lead to diagnostic challenges and potential morbidities.

Purpose of the Study:

• To evaluate the utility of postoperative 68Ga-PSMA PET/CT in diagnosing residual JNA.
• To assess the role of 68Ga-PSMA PET/CT in differentiating tumor recurrence from post-surgical changes in the pterygoid base.

Main Methods:

• Postoperative contrast-enhanced MRI was performed.
• Postoperative 68Ga-PSMA PET/CT imaging was utilized.
• Preoperative PET/CT findings were retrospectively compared with postoperative imaging.

Main Results:

• Contrast-enhanced MRI indicated residual disease in the left pterygoid base.
• However, 68Ga-PSMA PET/CT showed no uptake at the same site.
• Retrospective analysis revealed enhancement on MRI corresponded to pterygoid base pneumatization, not functional PSMA-avid disease.

Conclusions:

• Postoperative 68Ga-PSMA PET/CT is a useful tool in managing ambiguous diagnostic scenarios following JNA surgery.
• This imaging modality can help avoid unnecessary interventions and associated morbidities by accurately identifying residual disease.
• The study highlights the importance of correlating imaging findings with anatomical and functional information for precise diagnosis.