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AJNR - American Journal of Neuroradiology

Published ahead of print on March 13, 2008
doi: 10.3174/ajnr.A0948

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Head and Neck Paragangliomas: Value of Contrast-Enhanced 3D MR Angiography

F. Neves^a, L. Huwart^a, G. Jourdan^a, D. Reizine^a, P. Herman^b, E. Vicaut^c and J.P. Guichard^a

^a Department of Neuroradiology, Groupe Hospitalier Lariboisière-Fernand-Widal AP-HP, Paris, France
^b Department of Otorhinolaryngology, Groupe Hospitalier Lariboisière-Fernand-Widal AP-HP, Paris, France
^c Department of Statistics, Groupe Hospitalier Lariboisière-Fernand-Widal AP-HP, Paris, France

View larger version (88K): [in this window] [in a new window]   Fig 1. A 57-year-old woman with 2 paragangliomas: a residual vagal paraganglioma (solid arrow) and a retrothyroidian paraganglioma (open arrow). The second one was missed by DSA (because the feeding artery was not opacified) and by SE imaging (because it was situated out of the FOV, under the carotid bifurcation). They were depicted by CE-MRA and were both pathologically confirmed. CE-MRA coronal MIP image shows the 2 paragangliomas as intense tumor blush.

View larger version (63K): [in this window] [in a new window]   Fig 2. A 52-year-old woman with a characteristic vagal paraganglioma. A, Axial T2-weighted fat-saturated image shows a high-signal-intensity left-sided mass with prominent vascular flow voids. B, Axial contrast-enhanced fat-saturated T1-weighted image shows an intensely enhancing mass. C and D, CE-MRA axial MPR image (C) and CE-MRA coronal MIP image (D) show a typical tumor blush in the arterial phase (small arrow). Note the early draining internal jugular vein (large arrow).

View larger version (40K): [in this window] [in a new window]   Fig 3. A 36-year-old woman with a primary jugular foramen meningioma. A, Axial T2-weighted fat-saturated image shows a mass centered in the right-sided jugular foramen with vascular flow voids mimicking a paraganglioma. B, Axial contrast-enhanced fat-saturated T1-weighted image shows strong enhancement of this mass. The tumor is difficult to differentiate from a paraganglioma on SE sequences. C, CE-MRA axial MPR image does not show the typical tumor blush in the arterial phase, which indicates that this tumor is probably not a paraganglioma.

View larger version (54K): [in this window] [in a new window]   Fig 4. A 37-year-old woman with a cervical schwannoma. A, Axial contrast-enhanced fat-saturated T1-weighted image shows intensely enhancing well-circumscribed right-sided cervical mass. Differentiation with a paraganglioma is difficult. B, CE-MRA axial MPR image does not show the typical tumor blush in the arterial phase, which indicates that this tumor is probably not a paraganglioma. Note the anterior displacement of both the internal and external carotid arteries due to the schwannoma.