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Head and neck paragangliomas: improved tumor detection using contrast-enhanced 3D time-of-flight MR angiography as
René van den Berg1, Berit M Verbist, Bart J A Mertens
1Department of Radiology, Leiden University Medical Center, The Netherlands.
Background And Purpose:
MR imaging techniques have proved their efficacy in imaging the head and neck region. In this study, we compared T1-weighted, dual T2-weighted, and fat-suppressed MR imaging and unenhanced and contrast-enhanced 3D time-of-flight MR angiography sequences for detection of head and neck paragangliomas.
Methods:
Thirty-one patients with 70 paragangliomas were examined. Four combinations of MR images were reviewed by two neuroradiologists: T1-weighted and dual T2-weighted fast spin-echo images, T1- and T2-weighted fat-suppressed fast spin-echo images, T1-weighted and contrast-enhanced T1-weighted fat-suppressed spin-echo images, and unenhanced and contrast-enhanced 3D time-of-flight MR angiograms. The randomized examinations were independently evaluated for image quality, presence of tumor, tumor size, and intratumoral flow signal intensity. The standard of reference for presence of tumor was digital subtraction angiography. Data were analyzed by using the logistic regression method.
Results:
Mean sensitivity, specificity, and negative predictive values, respectively, were assessed by the two observers to be as follows: for dual T2-weighted fast spin-echo, 74%/99%/86%; for T2-weighted fat-suppressed fast spin-echo, 70%/100%/85%; for contrast-enhanced T1-weighted fat-suppressed spin-echo, 73%/100%/86%; and for unenhanced and contrast-enhanced 3D time-of-flight MR angiography, 89%/99%/93%. Sensitivity was significantly better for unenhanced and contrast-enhanced 3D time-of-flight MR angiography (P =.000028). More intratumoral flow signal intensity was depicted with unenhanced and contrast-enhanced 3D time-of-flight MR angiography.
Conclusion:
A combination of unenhanced and contrast-enhanced 3D time-of-flight MR angiography is superior for detecting paragangliomas and should be added to a standard imaging protocol, especially for patients with familial paragangliomas because they are more susceptible to multicentric disease.
Insights
Unenhanced and contrast-enhanced 3D time-of-flight MR angiography significantly improves the detection of head and neck paragangliomas. This advanced MR angiography technique should be incorporated into standard imaging protocols for better diagnostic accuracy.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Magnetic Resonance (MR) imaging is effective for head and neck region visualization.
- Paragangliomas are tumors that require accurate imaging for diagnosis and management.
Purpose of the Study:
- To compare the efficacy of various MR imaging sequences in detecting head and neck paragangliomas.
- To evaluate T1-weighted, dual T2-weighted, fat-suppressed MR imaging, and 3D time-of-flight MR angiography (MRA) sequences.
Main Methods:
- Seventy paragangliomas in 31 patients were analyzed using four MR imaging combinations.
- Evaluated sequences included T1-weighted, dual T2-weighted, fat-suppressed fast spin-echo, and unenhanced/contrast-enhanced 3D time-of-flight MRA.
- Image quality, tumor presence, size, and intratumoral flow signal intensity were assessed; digital subtraction angiography served as the reference standard.
Main Results:
- Unenhanced and contrast-enhanced 3D time-of-flight MRA demonstrated superior sensitivity (89%) compared to other sequences.
- This MRA technique also showed higher negative predictive values (93%) and depicted more intratumoral flow signal.
- Statistical analysis confirmed the significant advantage of 3D time-of-flight MRA (P =.000028).
Conclusions:
- A combination of unenhanced and contrast-enhanced 3D time-of-flight MR angiography is the optimal method for detecting head and neck paragangliomas.
- This advanced MRA technique should be integrated into standard imaging protocols.
- It is particularly recommended for patients with familial paragangliomas due to their predisposition to multicentric disease.
