Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography

Abstract

The management of cervical paragangliomas (PGs) depends on their specific type and their relation to adjacent vessels. The purpose of this study was to evaluate the potential of magnetic resonance imaging (MRI) and color duplex sonography (CDS) to classify PGs according to topography and vascularization. Sixteen patients harboring 22 PGs were studied retrospectively. With digital subtraction angiography as reference, the topographic relation of the tumors to the carotid arteries and the internal jugular vein and the patterns of vascularization were assessed. On MRI and CDS the typical feature of 15 carotid PGs was splaying of the carotid bifurcation, with the external carotid displaced anteriorly and the internal carotid artery and internal jugular vein located posteriorly. In five vagal PGs both modalities showed unidirectional anterior displacement of the external and internal carotid arteries. Two jugular PGs were found to extend within the lumen of the internal jugular vein. CDS completely depicted carotid body tumors but failed to delineate the high cervical portion of vagal and jugular PGs. MRI allowed us to assess the entire extent of all PGs. Nineteen lesions showed flow voids corresponding to abundant flow signal on CDS: three carotid body tumors appeared hypovascular on CDS and MRI. On CDS, intratumoral flow was directed cranially in carotid and inferiorly in vagal and jugular PGs. CDS and MRI are suitable for classification of cervical PGs as carotid, vagal or jugular PGs based on the topographic relation to the carotid arteries and internal jugular vein. Visualization of the intrinsic tumor vasculature proved an additional distinguishing criterion on CDS.

Imaging findings of malignant bilateral carotid body tumors: A case report and review of the literature

“…Larger tumors are frequently inhomogeneous due to necrotic and hemorrhagic regions (23). The ECA is usually displaced anteromedially and the ICA is typically displaced posterolaterally, which strongly indicates a diagnosis of CBT (24). These features were characteristically identified in the images of the present study.…”

Imaging and management of head and neck paragangliomas

“…Delineation of high cervical vagal and jugular paragangliomas is cumbersome and concomitant lesions in the skull base region remain undetected, while such lesions are important in future treatment planning [38].…”

“…Angiography will show the specific vascular supply of the paraganglioma [38][39][40]. The ascending pharyngeal artery can be considered "the artery of the paraganglioma", because its branches can supply tympanic, jugular, vagal, carotid, and even laryngeal paragangliomas (Fig.…”

Case report of a rare glomus jugulare tumor extended within the extracranial internal jugular vein: emphasis on initial ultrasound findings and literature review

“…Due to the rarity of a giant GJT extended into the IJV, at the time of this manuscript writing, our search of the English language literature revealed only 2 individual cases reporting ultrasonographic findings of GJT [8,9]. Until now, the characteristic ultrasonographic appearance of GJT has not been systematically summarized.…”

“…The most common type of jugular foramen tumor elongated into the IJV are meningioma and schwannoma. Hypervascularity has been considered to be a helpful criterion for establishing the diagnosis of a GJT by ultrasonography [8]. MRI is much more reliable in the differential diagnosis of jugular foramen tumors.…”