Multimodality Imaging of Cardiac Paragangliomas

Area of Science:

• Cardiology
• Oncology
• Radiology

Background:

• Paragangliomas are rare neuroendocrine tumors originating from extra-adrenal autonomic paraganglia.
• Cardiac involvement is exceptionally rare, accounting for less than 1% of primary cardiac tumors.
• Often detected incidentally or during workup for high catecholamine levels.

Purpose of the Study:

• To review the characteristics of cardiac paragangliomas.
• To highlight the role of multimodality imaging in diagnosis and treatment planning.
• To discuss surgical considerations, particularly coronary artery involvement.

Main Methods:

• Review of imaging characteristics across modalities including MRI, CT angiography, and functional imaging (PET/CT).
• Emphasis on preoperative assessment of tumor vascularization and relationship with coronary arteries.
• Discussion of diagnostic confirmation and screening for metastatic disease.

Main Results:

• Cardiac paragangliomas typically show low-intermediate T1 and high T2 signal on MRI.
• Strong vascularization is evident on perfusion imaging with heterogeneous late gadolinium enhancement.
• Functional imaging is crucial for diagnosis and staging.

Conclusions:

• Multimodality imaging is essential for characterizing cardiac paragangliomas.
• Preoperative delineation of vascular supply, especially from coronary arteries, is critical for surgical planning.
• Surgical excision remains the only curative treatment for these primary heart neoplasms.