Localization Of Paragangliomas Research Articles

Diagnostic efficiency of multidetector computed tomography versus magnetic resonance imaging in differentiation of head and neck paragangliomas from other mimicking vascular lesions: comparison with histopathologic examination

The purpose of this study was to determine the efficiency of Multidetector Computed Tomography (MDCT) versus MRI in detection and characterization of paragangliomas and differentiating them from other vascular mimicking conditions in the neck and skull base in comparison with histo-pathological results as a gold standard. A prospective study included 30 patients with vascular neck lesions. They were susceptible for MDCT and MRI for characterization of the nature of the lesions. Histo-pathological evaluation was performed in all lesions for confirmation. As a result of this study included 30 patients: 22 males and 8 females. Paragangliomas were the commonest detectable lesions; 12/30 patient had glomus tumor (1 glomus tympanicum, 2 glomus vegale, 4 glomus jugulo-tempanicum, and 5 glomus jugular), 6 carotid body tumor, 2 hemangiopericytoma, 3 vegal Schwanoma, 4 lymphadenopathy, 2 juvenile angiofibroma, and one neurofibroma. The sensitivity of MDCT was higher than MRI in differentiation of paragangliomas from other mimicking lesions, where MDCT sensitivity was 83.33 % and the NPV was 80 % while that of MRI was 77.7 % and the NPV 75 %, but both techniques have moderate agreement between them in differentiating paragangliomas from other mimicking vascular lesion. MDCT with its new utilities has near degree of accuracy in detection and localization of paragangliomas as the same that of MRI. Both techniques have moderate agreement between them in differentiating paragangliomas from other mimicking vascular lesions. So, it is better to use both of them as complementary techniques for accurate diagnosis and grading of paraganglioma.

Comparison of 18F-Fluoro-L-DOPA, 18F-Fluoro-Deoxyglucose, and 18F-Fluorodopamine PET and 123I-MIBG Scintigraphy in the Localization of Pheochromocytoma and Paraganglioma

Besides (123)I-metaiodobenzylguanidine (MIBG), positron emission tomography (PET) agents are available for the localization of paraganglioma (PGL), including (18)F-3,4-dihydroxyphenylalanine (DOPA), (18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG), and (18)F-fluorodopamine ((18)F-FDA). The objective of the study was to establish the optimal approach to the functional imaging of PGL and examine the link between genotype-specific tumor biology and imaging. This was a prospective observational study. There were no interventions. Fifty-two patients (28 males, 24 females, aged 46.8 +/- 14.2 yr): 20 with nonmetastatic PGL (11 adrenal), 28 with metastatic PGL (13 adrenal), and four in whom PGL was ruled out; 22 PGLs were of the succinate dehydrogenase subunit B (SDHB) genotype. Sensitivity of (18)F-DOPA, (18)F-FDG, and (18)F-FDA PET, (123)I-MIBG scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) for the localization of PGL were measured. Sensitivities for localizing nonmetastatic PGL were 100% for CT and/or MRI, 81% for (18)F-DOPA PET, 88% for (18)F-FDG PET/CT, 78% for (18)F-FDA PET/CT, and 78% for (123)I-MIBG scintigraphy. For metastatic PGL, sensitivity in reference to CT/MRI was 45% for (18)F-DOPA PET, 74% for (18)F-FDG PET/CT, 76% for (18)F-FDA PET/CT, and 57% for (123)I-MIBG scintigraphy. In patients with SDHB metastatic PGL, (18)F-FDA and (18)F-FDG have a higher sensitivity (82 and 83%) than (123)I-MIBG (57%) and (18)F-DOPA (20%). (18)F-FDA PET/CT is the preferred technique for the localization of the primary PGL and to rule out metastases. Second best, equal alternatives are (18)F-DOPA PET and (123)I-MIBG scintigraphy. For patients with known metastatic PGL, we recommend (18)F-FDA PET in patients with an unknown genotype, (18)F-FDG or (18)F-FDA PET in SDHB mutation carriers, and (18)F-DOPA or (18)F-FDA PET in non-SDHB patients.

Carney's Triad: Guidelines for Management

Carney's triad--gastric leiomyosarcoma, pulmonary chondroma, and extra-adrenal paraganglioma--is a syndrome that occurs primarily in young women. To date, 28 patients with at least two of these individually unusual or rare neoplasms have been described. This updated case report of one of the originally described patients with Carney's triad highlights several clinically important features of this unusual syndrome: (1) the multicentricity of both the paragangliomas and the epithelioid leiomyosarcomas, (2) the often indolent progression of metastatic leiomyosarcoma, (3) the potential for late recurrences, and (4) the importance of distinguishing intra-adrenal from periadrenal catecholamine-producing tumors (paragangliomas). Localization of paragangliomas is facilitated by two relatively new techniques--131I-metaiodobenzylguanidine scanning (a scintigraphic technique with high specificity for catecholamine-producing tumors) and two-dimensional echocardiography (which can noninvasively localize and demonstrate the anatomic relationships of aorticopulmonary paragangliomas). In patients with this syndrome, new or recurrent tumors frequently manifest after unusually long asymptomatic intervals. We outline an approach for continued follow-up of patients with one or more of the three neoplasms that constitute the syndrome. Rigorous long-term screening of these patients should not only lead to early recognition and resection of recurrent or new tumors but also enhance our understanding of this intriguing syndrome.