Radiographic evaluation and assessment of paragangliomas (original) (raw)
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Paragangliomas of the head and neck: imaging assessment
Ear, nose, & throat journal, 2014
Paragangliomas are uncommon tumors that arise from the parasympathetic neuroectodermal ganglionic cells and have been described in numerous anatomic locations, most commonly in the abdomen. Head and neck paragangliomas are classified into carotid body (most common), vagal, and jugulotympanic types. Computed tomography is the initial imaging modality of choice for the preoperative assessment of the extent of paragangliomas. Magnetic resonance imaging and selective angiography provide more detail of the surrounding tissues and vasculature. Surgical resection is the treatment of choice.
Head and neck paragangliomas: A two-decade institutional experience and algorithm for management
Laryngoscope investigative otolaryngology, 2017
Paragangliomas of the head and neck and cranial base are typically benign, slow-growing tumors arising within the jugular foramen, middle ear, carotid bifurcation, or vagus nerve proper. The objective of this study was to provide a comprehensive characterization of our institutional experience with clinical management of these tumors and posit an algorithm for diagnostic evaluation and treatment. This was a retrospective cohort study of patients undergoing treatment for paragangliomas of the head and neck and cranial base at our institution from 2000-2017. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic work-up, pre-treatment cranial nerve palsy, treatment modality, utilization of preoperative angiographic embolization, complications of treatment, tumor control and recurrence, and hereditary status (ie, succinate dehydrogenase mutations) were collected and summarized. The mean (SD) age of our cohort was 51.8 (±16.1) years with 123...
The value of MR angiography techniques in the detection of head and neck paragangliomas
2004
Objective: The objective of this study was to compare three-dimensional phase-contrast angiography (3D PCA), 2D time-of-flight (2D TOF), and 3D TOF magnetic resonance (MR) angiography and a proton density weighted technique in terms of their ability to detect head and neck paragangliomas. Materials and methods: 14 patients with 29 paragangliomas were examined at 1.5 T. Three MR angiography sequences (3D PCA, 2D TOF, and multi-slab 3D TOF) and a proton density (PD) weighted sequence were reviewed by four neuroradiologists. The gold standard was digital subtraction angiography. Presence of tumor was assessed in five grades of confidence. Sensitivity and specificity were calculated after dichotomizing the results. Data was analyzed using the logistic regression method. Results: Mean sensitivity and specificity for the four observers were for PD: 72%/97%, for 3D PCA: 75%/90%, for 2D TOF: 66%/93%, and for 3D TOF: 90%/92%. Sensitivity was significantly better for 3D TOF MRA (P < 0.001). No substantial between-observer variation for tumor detection was present. Conclusion: Our results demonstrate that, using 3D TOF MRA, paragangliomas in the head and neck region can be detected with high sensitivity and specificity. Further investigation is necessary to judge the value of 3D TOF MR angiography against fat suppressed contrast enhanced T1 weighted and fat suppressed T2 weighted MR sequences to find the optimal imaging sequence for paragangliomas.
European Archives of Oto-Rhino-Laryngology, 2013
The purpose of this study was to determine the efficiency of Multidetector Computed Tomography (MDCT) versus MRI in detection and characterization of paragangliomas and differentiating them from other vascular mimicking conditions in the neck and skull base in comparison with histo-pathological results as a gold standard. A prospective study included 30 patients with vascular neck lesions. They were susceptible for MDCT and MRI for characterization of the nature of the lesions. Histo-pathological evaluation was performed in all lesions for confirmation. As a result of this study included 30 patients: 22 males and 8 females. Paragangliomas were the commonest detectable lesions; 12/30 patient had glomus tumor (1 glomus tympanicum, 2 glomus vegale, 4 glomus jugulo-tempanicum, and 5 glomus jugular), 6 carotid body tumor, 2 hemangiopericytoma, 3 vegal Schwanoma, 4 lymphadenopathy, 2 juvenile angiofibroma, and one neurofibroma. The sensitivity of MDCT was higher than MRI in differentiation of paragangliomas from other mimicking lesions, where MDCT sensitivity was 83.33 % and the NPV was 80 % while that of MRI was 77.7 % and the NPV 75 %, but both techniques have moderate agreement between them in differentiating paragangliomas from other mimicking vascular lesion. MDCT with its new utilities has near degree of accuracy in detection and localization of paragangliomas as the same that of MRI. Both techniques have moderate agreement between them in differentiating paragangliomas from other mimicking vascular lesions. So, it is better to use both of them as complementary techniques for accurate diagnosis and grading of paraganglioma.
Contemporary presentation and evolution of management of neck paragangliomas
Journal of Vascular Surgery, 2009
Background: The aim of the present study was to review the contemporary presentation and evolution of management of neck paragangliomas. Methods: Forty-one neck paragangliomas operated on in 36 patients over a 44 year period were included in the current report. The study period was divided into two parts, the first three decades (1964-1989), during which the current management techniques were evolved, and the last two decades (1990-2008). Results: Patients presented with a palpable neck mass (n ؍ 17), cranial nerve (CN) palsy (n ؍ 3) or both (n ؍ 6), or the lesion was an incidental finding (n ؍ 14). The use of cross-section imaging modalities (n ؍ 24) increased from 35% during the first part of the study to 95% during the second part of the study (P < .001). Preoperative embolization (introduced in 1979) was performed in 60% (median size 4.3 cm for embolized vs 3 cm [P ؍ .02], for non-embolized tumors). During the first study period, the frequency of Shamblin group II/III tumors was 95% compared with a frequency of 42% during the second study period (P < .001, odds ratio 25), median blood loss was 600 ml and 150 ml, respectively (P ؍ .001) and the transfusion rate was 44% and 5%, respectively (P ؍ .008). The incidence of temporary and permanent new CN deficits postoperatively was 22.5% and 10%, respectively, and was similar during the two study periods. Three tumors were malignant, based on lymph node involvement (n ؍ 1) or development of late metastases (n ؍ 2). Conclusions: In the modern era, neck paragangliomas can be managed with a low incidence of long-term sequelae. Smaller, asymptomatic, and incidentally detected tumors are currently the most common presentation pattern.
Paragangliomas of the head and neck
South African Journal of Radiology, 2006
Paragangliomas of the head and neck are ubiquitous in their distribution, originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen and numerous other locations. 1 Imaging studies depict the location and extent of tumour involvement, help determine the surgical approach and help predict operative morbidity and mortality. The imaging features of common paragangliomas of the head and neck are illustrated in this article.
Paragangliomas of the Head & Neck: the KMC experience
2011
To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin’s Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.
Benign Paragangliomas: Clinical Presentation and Treatment Outcomes in 236 Patients
The Journal of Clinical Endocrinology & Metabolism, 2001
Paragangliomas are rare tumors that arise from extraadrenal chromaffin cells. We examined the clinical characteristics, location, treatment, and outcome of 236 patients (141 females, 60%) with 297 benign paragangliomas evaluated at the Mayo Clinic during 1978-1998. The mean age (؎SD) at diagnosis was 47 ؎ 16 yr. Of the 297 paragangliomas, 205 were in the head and neck region, and 92 were below the neck. Paragangliomas were discovered and diagnosed incidentally on imaging studies in 9% of patients. Biochemical screening was performed in 128 patients; 40 patients (17% of the total and 31% of those screened) had hyperfunctional tumors. Of the 40 patients with tumoral catecholamine excess, 38 had documented hypertension. In patients identified with catecholamine-secreting paragangliomas, the sensitivities achieved by measurements in the 24-h urine collection were 74% for total metanephrines, 84% for norepinephrine, 18% for dopamine, and 14% for epinephrine. Multiple imaging modalities were used for tumor localization. The false negative rates were 0% for magnetic resonance imaging, 5.8% for computed tomography, 3.4% for angiography, 10.7% for ultrasonography, and 39% for radioactive iodine-labeled metaiodobenzylguanidine scintigraphy. Of 192 patients (81.4%) with follow-up data (mean, 43.9 months; range, 0.5-240), operative cure was achieved in 133 (69%). Of the 59 patients without cure, 23 had persistent disease, 5 had recurrent disease, 16 had multiple persistent synchronous tumors, and 15 subsequently developed metachronous tumors. In conclusion, most paragangliomas are nonhypersecretory and located in the head and neck region. Magnetic resonance imaging was associated with the lowest false negative rate, and metaiodobenzylguanidine was the least sensitive imaging study. A significant proportion of patients (31%) has persistent or recurrent disease, and long-term follow-up is important.
The management of head-and-neck paragangliomas
Endocrine Related Cancer, 2013
Paragangliomas (PGLs) are tumours originating from neural crest-derived cells situated in the region of the autonomic nervous system ganglia. Head-and-neck PGLs (HNPGLs) originate from the sympathetic and parasympathetic paraganglia, most frequently from the carotid bodies and jugular, tympanic and vagal paraganglia, and are usually non-catecholamine secreting. Familial PGLs are considered to be rare, but recently genetic syndromes including multiple PGLs and/or phaeochromocytomas have been more thoroughly characterised. Nowadays, genetic screening for the genes frequently implicated in both familial and sporadic cases is routinely being recommended. HNPGLs are mostly benign, generally slow-growing tumours. Continuous growth leads to the involvement of adjacent neurovascular structures with increased morbidity rates and treatment-related complications. Optimal management mostly depends on tumour location, local involvement of neurovascular structures, estimated malignancy risk, pati...