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Sclerosis of the Pterygoid Process in Untreated Patients with Nasopharyngeal Carcinoma¹

¹ From the Department of Radiology, New York University Medical Center, New York, NY. From the 2004 RSNA Annual Meeting. Received December 22, 2004; revision requested February 23, 2005; revision received April 1; accepted April 25; final version accepted June 17. Address correspondence to D.R.S., Department of Radiology, St Lukes-Roosevelt Hospital Center, 1000 Tenth Ave, New York, NY 10019 (e-mail: DShatzkes{at}chpnet.org).

Purpose: To retrospectively evaluate the prevalence of pterygoid process sclerosis in patients with untreated nasopharyngeal carcinoma.

Materials and Methods: This retrospective HIPAA-compliant study was performed after the institutional review board deemed it to be exempt from review and patient informed consent. Contrast material–enhanced computed tomographic (CT) scans of the neck obtained in 31 patients (22 men, nine women; mean age, 42 years; age range, 27–68 years) with untreated nasopharyngeal carcinoma and in 31 control subjects (17 men, 14 women; mean age, 43 years; age range, 19–62 years) were evaluated independently by two neuroradiologists. The presence of sclerosis of the pterygoid process—defined as increased attenuation in the medullary cavity and/or thickening of the cortical bone—was assessed. Other findings noted included pterygoid process erosion, enhancing tumor adjacent to the pterygoid process, and CT evidence of parapharyngeal extension of the tumor. The data were evaluated by using generalized estimating equations based on a binary logistic regression model.

Results: The prevalence of pterygoid process sclerosis averaged for the two readers was 60% (37 of 62 subjects) among the patients with nasopharyngeal carcinoma but only 3% (two of 62 subjects) among the control subjects, indicating a highly significantly increased prevalence (P < .001) of this finding in the patients with nasopharyngeal carcinoma. The overall prevalences of pterygoid process erosion, parapharyngeal extension of tumor, and enhancing tumor adjacent to the pterygoid process were 27% (17 of 62 subjects), 47% (29 of 62 subjects), and 77% (48 of 62 subjects), respectively. Pterygoid process sclerosis was the sole skull base abnormality in 36% (11 of 31) of the patients with nasopharyngeal carcinoma.

Conclusion: Sclerosis of the pterygoid process, which was present in about half of the patients with untreated nasopharyngeal carcinoma, may reflect tumor proximity to or tumor invasion of the pterygoid process.

© RSNA, 2006

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