Question

What is the investigation of choice for nasopharyngeal angiofibroma?

• A. X-ray
• B. MRI
• C. Plain CT
• D. CT with contrast

Hint:

JNA is vascular; CECT shows enhancement, bone erosion and Holman-Miller sign.

Answer 1

The Correct Option is D

Step 1: Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, locally invasive benign tumour seen in adolescent males. Imaging must show both bony extent and the vascular nature of the lesion.

Step 2: Contrast-enhanced CT (CT with contrast) of the head is the investigation of choice. It demonstrates intense enhancement of the vascular mass, bony erosion, and the characteristic anterior bowing of the posterior maxillary sinus wall (Holman-Miller sign). This makes option (d) correct.

Step 3: A plain CT shows bone well but does not bring out the marked vascular enhancement, and a plain X-ray is too non-specific, so options (a) and (c) are inadequate.

Step 4: MRI is excellent for soft tissue and intracranial extension and is a useful complement, but the single best initial investigation of choice quoted for JNA is contrast-enhanced CT.