Diagnosis of a tympanic paraganglioma with CT perfusion imaging: a technical note and case description

Paragangliomas can be diagnosed accurately using magnetic resonance imaging and dynamic four-dimensional magnetic resonance angiography. Four-dimensional imaging uses the highly vascularised structure of these tumours, which results in a homogenous capillary blush and usually, due to the arteriovenous shunting, in an early draining vein. By these features the tumour can be differentiated from other neoplasms. The authors describe a case of a paraganglioma localised in the middle ear of an elderly patient. Magnetic resonance contraindications led to preoperative diagnostics with high resolution computed tomography of the temporal bone and additionally computed tomography perfusion imaging instead of magnetic resonance imaging with four-dimensional magnetic resonance angiography. Using the computed tomography perfusion dataset, regions of interest were placed in the carotid artery, the sigmoid sinus and the tympanic mass. In the computer-assisted analysis the tumour showed late arterial enhancement and delayed wash-out compared to the enhancement curves of the carotid artery and the sigmoid sinus. This corresponded to the highly vascularised nature of a paraganglioma. On postoperative follow-up imaging computed tomography perfusion showed almost no enhancement of a small residual tympanic mass, which was then considered to be granulation tissue. In conclusion, in the case of magnetic resonance contraindications the preoperative diagnosis of tympanic paraganglioma can be made using computed tomography imaging criteria alone. Computed tomography perfusion imaging may be helpful in these cases to detect residual or recurrent tumour.