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The value of MR angiography techniques in the detection of head and neck paragangliomas
René van den Berg1, Abbey Schepers, Francisca T de Bruïne
1Department of Radiology, C2-S Leiden University Medical Center, Albinusdreef 2, Leiden 2300, RC, The Netherlands. rvdberg@lumc.nl
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.
Insights
Three-dimensional time-of-flight (3D TOF) MR angiography demonstrated superior sensitivity and specificity for detecting head and neck paragangliomas compared to other MR techniques. This method offers high accuracy for diagnosing these tumors.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Paragangliomas are rare neuroendocrine tumors that can occur in the head and neck region.
- Accurate detection and characterization of these tumors are crucial for effective management.
- Various magnetic resonance (MR) angiography techniques are available for imaging head and neck lesions.
Purpose of the Study:
- To compare the diagnostic performance of three-dimensional phase-contrast angiography (3D PCA), 2D time-of-flight (2D TOF), and 3D TOF MR angiography, along with a proton density (PD) weighted sequence.
- To evaluate the ability of these MR techniques in detecting head and neck paragangliomas.
Main Methods:
- Four neuroradiologists reviewed MR angiography data from 14 patients with 29 paragangliomas.
- Sequences included 3D PCA, 2D TOF, multi-slab 3D TOF, and PD-weighted imaging at 1.5 T.
- Digital subtraction angiography served as the gold standard; sensitivity and specificity were calculated.
Main Results:
- Three-dimensional TOF MR angiography achieved the highest mean sensitivity (90%) and specificity (92%).
- Proton density weighted imaging showed high specificity (97%) but lower sensitivity (72%).
- No significant variation in tumor detection was observed among the four radiologists.
Conclusions:
- Three-dimensional TOF MR angiography is a highly sensitive and specific technique for detecting head and neck paragangliomas.
- Further research is needed to compare 3D TOF MR angiography with contrast-enhanced fat-suppressed T1 and T2 weighted MR sequences for optimal imaging protocols.
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