Role of Pseudo-Continuous Arterial Spin Labeling and 4D MR Angiography in the Diagnosis of Neck Paragangliomas

Figures

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  Figure 1. The bar graph shows sensitivity (mean for all readers) for the detection of carotid body tumours, vagal paragangliomas, and neurinomas for each MR imaging technique.

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  Figure 2. Carotid bifurcation paraganglioma. Patient 14, with a familiar predisposition. MR demonstrates the presence of a small solid lesion at the right carotid bifurcation characterised by T2 hyperintensity (A) and homogeneous enhancement after contrast medium administration (B) (red circle). Only perfusion ASL imaging, co-registered with fat-suppressed, T1-WI after gadolinium easily shows a marked increase in the TBF parameter within the lesion ((C), axial plane and (D), sagittal plane). This tissue also demonstrates early enhancement during contrast passage as observed in dynamic contrast-enhanced angiographic acquisitions ((E–G), red circle).

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  Figure 3. Carotid bifurcation paraganglioma. Patient 18. A solid mass located at the left carotid bifurcation with T2 hyperintensity and flow voids (A), homogeneous enhancement after gadolinium (B), and a high level of TBF parameter (C). This tissue demonstrates early enhancement during contrast passage as observed on dynamic contrast-enhanced angiographic acquisitions (D–H).

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  Figure 4. Vagal paraganglioma. Patient 4. A solid mass located in the left lateral-cervical region with anterior displacement of the internal carotid artery. The lesion exhibits a heterogeneous T1 and T2 signal (A,B) and homogenous enhancement after contrast medium administration (C) with some lesional flow-voids (red circle). The lesion presents a pathological increase in the perfusion parameter TBF following ASL acquisition (D) and early enhancement during dynamic contrast-enhanced angiographic phases ((E–I), white arrows).

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  Figure 5. Vagal paraganglioma. Patient 8. A small latero-cervical lesion mimicking a lymph node on FS T2 and T1CE, located close to the left internal carotid artery ((A,B), red circles). ASL images (C) and co-registered images ASL+T1CE (D) correctly identified the small paraganglioma, with typical early enhancement during dynamic contrast-enhanced angiographic phases ((E–H), white arrows).

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  Figure 6. Neck schwannoma. Patient 26. A solid lesion on the right side located close to the internal carotid artery. The lesion showed T2 hyperintensity (A) and heterogeneous enhancement after gadolinium (B). No TBF increase (C) or early enhancement during dynamic contrast-enhanced angiographic phases (D–G) were evident.