AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on April 16, 2008
doi: 10.3174/ajnr.A1092
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Carotid Body Tumors: Objective Criteria to Predict the Shamblin Group on MR Imaging

S. Aryaa, V. Raob, S. Juvekara and A.K. Dcruzb

a Departments of Radiology, Tata Memorial Hospital, Mumbai, India
b Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India


Figure 1
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  		Fig 1. Shows a schematic diagram of the Shamblin grouping of CBTs into I, II, and III, as well as IIIb (as proposed in the modification to Shamblin's classification by Luna-Ortiz et al4). The surgical grouping is chiefly based on the relationship of the tumor to the carotid vessels, ICA and ECA. The class IIIb tumors include tumors of any size that are intimately adherent to the carotid vessels. The oblique lines shown represent the X and XII nerves, which are intimately related to the tumors and have to be carefully dissected along with the vessels.


Figure 2
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  		Fig 2. A schematic diagram demonstrating the measurement of the degree of circumferential contact between ICA and the tumor. Two intersecting lines are drawn between the center of ICA and the points of contact of the circumference of the vessel with the edges of the tumor to obtain the angle (A). A, Type I tumor: the angle "A" is depicted between the 2 intersecting lines. B, Type II and III tumors: the angle measurement tool automatically measures the smaller angle (less than 180°) between the intersecting lines. The actual angle A is the difference between 360° and measured angle "a" (360°–a), as shown here.


Figure 3
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  		Fig 3. Type I CBT. A, Axial T2-weighted MR image showing a left-sided CBT splaying the ICA (arrow) and ECA (arrowhead) anteroposteriorly. The tumor has an angle of contact of 150° with the ICA. B, Sagittal T2-weighted MR image showing the CBT (*) splaying the ICA (arrow) and ECA (arrowhead) anteroposteriorly.


Figure 4
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  		Fig 4. Type II CBT. A, Axial T2-weighted MR image showing a type II right-sided carotid body tumor (star) splaying the ICA posteriorly and ECA (arrow) anteriorly. The circumferential degree of contact of the tumor with the ICA is the difference between 360° and the measured angle (150°) in the figure, that is, 210°. B, Line diagram illustrating the tumor-ICA circumference of contact of the type II CBT in A.


Figure 5
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  		Fig 5. A bulky type III CBT. Axial T2-weighted MR image showing a type III right-sided CBT as a brightly hyperintense mass with multiple flow voids. The ICA and ECA are both completely encased (360° circumference of contact).


Figure 6
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  		Fig 6. Small-volume type III CBT. Axial T2-weighted MR image showing a left-sided CBT (*) with complete encasement of ICA and ECA.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X