Imaging Jugulotympanic Glomus Tumors

Abstract

Traditionally, jugulotympanic tumors, also called chemodectomas or paragangliomas, have been evaluated by conventional imaging to show bone erosion and angiography for the definitive diagnosis, location, and extent. More recently, computed tomography has been used to show these features as well as the intracranial extension. Magnetic resonance imaging has added a new dimension, particularly for assessment of intracranial spread and growth downward into the neck. We examined 20 jugulotympanic glomus tumors by computed tomography and magnetic resonance imaging with gadolinium enhancement and believe that these two imaging modalities, combined with clinical assessment, can provide all the necessary information regarding diagnosis, situation, and extent in the majority of jugulotympanic glomus tumors. Gadolinium-enhanced magnetic resonance imaging was particularly effective for the detection of small tumors confined to the middle ear and for confirmation that the jugular bulb was not involved. Consequently, angiography is no longer a first-line imaging investigation but rather a preoperative evaluation only in those tumors in which preoperative embolization is required or occasionally when the extent of the tumor, especially in the jugular bulb, cannot be confidently predicted by noninvasive imaging.

Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

“…CT and MRI are effective for the diagnosis of paragangliomas [10,34,35]. When the diagnosis cannot be established by these two techniques, SRS may be helpful in differentiating paragangliomas from common tumours of the parapharyngeal space, as neuromas do not demonstrate tracer uptake on SRS [21], and this may be important in defining the appropriate surgical approach [10].…”

Octreotide Scintigraphy for the Detection of Paragangliomas

“…CT, MRI, and conventional angiography have been the primary imaging modalities for head and neck paragangliomas. 4 Valuable information may be obtained from these studies, including tumor size and location, bone destruction, cranial nerve or vascular invasion, and intracranial extension. Although CT and MRI are quite accurate for imaging head and neck paragangliomas, the differential diagnosis may be difficult in certain cases because these neoplasms may mimic branchial cleft cysts, metastatic tumors, neuromas, lymphomas, vascular lesions, middle ear tumors, and middle ear infections.…”

“…Although CT and MRI are quite accurate for imaging head and neck paragangliomas, the differential diagnosis may be difficult in certain cases because these neoplasms may mimic branchial cleft cysts, metastatic tumors, neuromas, lymphomas, vascular lesions, middle ear tumors, and middle ear infections. 4 Also, CT and MRI primarily focus on the anatomic region of the presenting paraganglioma. Although whole-body scans can be obtained with these modalities, it is often impractical (for financial or radiation dosage reasons) to use them to look for synchronous tumors.…”

Rezidivdiagnostik von Glomus jugulare-Tumoren mittels dynamischer Kontrastmittel-Anflutung in der MRT

“…Das Charakteristikum des kernspintomo-graphischen Bildes ist ein inhomogenes Signal (Salz-und Pfeffer-Muster) im nativen T 1und T 2 -gewichteten Bild. Bedingt durch flow void Effekte (Blutfluss in intratumoralen Gefäûen) ist das Enhancement nach Kontrastmittelgabe inhomogen [9,10,12]. Bildern, Kontrastmittelgabe) nicht immer eine sichere Unterscheidung zwischen operationsbedingten Veränderungen und einem Residualtumor [13].…”

“…das Rezidiv sind stark vaskularisiert und kommen im MRT intensiv Kontrastmittel aufnehmend zur Darstellung. Phelps et al [9] berichten, dass die stärkste von ihnen beobachtete Signalintensität im Mittelohr nicht von Tumorgewebe stammte, sondern von postoperativem Granulationsgewebe. Auch nach Strahlentherapie kann stark vaskularisiertes Gewebe mit hohem Signal in der MRT beobachtet werden.…”