Head and Neck Paragangliomas: Improved Tumor Detection Using Contrast-Enhanced 3D Time-of-Flight MR Angiography As Compared with Fat-Suppressed MR Imaging Techniques
René van den Berga,
Berit M. Verbista,
Bart J. A. Mertensc,
Andel G. L. van der Meyb and
Mark A. van Buchema
a Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
b Department of Otolaryngology, Leiden University Medical Center, Leiden, the Netherlands
c Department of Medical Statistics, University of Leiden, Leiden, the Netherlands
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FIG 1. Bar graph shows sensitivity (mean for both observers) for detection of carotid body tumors, vagal paragangliomas, and jugulotympanic paragangliomas for each MR imaging technique. T2W-FSE, T2-weighted fast spin-echo imaging; T2W-FS-FSE, T2-weighted fat-suppressed fast spin-echo imaging; CE-T1W-FS-SE, contrast-enhanced T1-weighted fat-suppressed spin-echo imaging; CE-3DTOF, contrast-enhanced 3D time-of-flight imaging.
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FIG 2. Images of a 51-year-old woman with a small right-sided carotid body tumor (confirmed angiographically) and a large left-sided vagal paraganglioma (not shown).
A and B, Axial view dual T2-weighted fast spin-echo image (3750/28/120 [TR/TE1/TE2]) shows only slight splaying of the carotid bifurcation (double arrow).
C, On the axial view T2-weighted fat-suppressed fast spin-echo image (5500/100 [TR/TE]), neither the carotid bifurcation nor a carotid body tumor is visible. High signal intensity in the carotid region is reflecting slow venous flow (arrow).
D, On the axial view contrast-enhanced T1-weighted fat-suppressed spin-echo image (625/17 [TR/TE]), enhancement of veins surrounding the normal left-sided carotid bifurcation (arrow) constrains detection of the small carotid body tumor (arrow).
E, Splaying of the carotid bifurcation (double arrow) can be noticed on the axial view unenhanced 3D time-of-flight MR angiogram (25/6.9/20 [TR/TE/flip angle]).
F, Enhancement of a small carotid body tumor (arrow) is depicted on the axial view contrast-enhanced 3D time-of-flight MR angiogram (25/6.9/20).
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FIG 3. Images of a 35-year-old man after surgical resection of a left-sided jugulotympanic paraganglioma with a small residual lesion in the left cerebellopontine angle.
A, Residual paraganglioma in the left cerebellopontine angle is not clearly depicted with the T2-weighted fat-suppressed fast spin-echo sequence (5500/100 [TR/TE]).
B, Contrast-enhanced T1-weighted fat-suppressed spin-echo image (625/17 [TR/TE) clearly shows a small residual paraganglioma (arrow).
C, Contrast-enhanced 3D time-of-flight MR angiogram (25/6.9/20 [TR/TE/flip angle]) clearly shows a small residual paraganglioma (arrow).
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FIG 4. Unenhanced 3D time-of-flight MR angiogram (25/6.9/20 [TR/TE/flip angle]) of a 39-year-old woman with a left-sided jugulotympanic paraganglioma clearly shows the highly vascular nature of the lesion (arrow).
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