Role of ultrasound and color Doppler imaging in the detection of carotid paragangliomas

Abstract

KEYWORDSCarotid body paraganglioma; Carotid-body tumor; Ultrasound; Color Doppler ultrasound.Abstract Introduction: Carotid body paragangliomas (PGLs) are highly vascularized lesions that arise from the paraganglia located at the carotid bifurcation. Purpose: To evaluate the usefulness of gray-scale ultrasound (US) and color Doppler ultrasound (CDUS) in the detection and follow-up of carotid PGLs of the neck. Materials and methods: The authors retrospectively reviewed US and CDUS examinations of the neck performed in 40 patients with PGL syndrome type 1 and single or bilateral neck PGLs confirmed by CT or MRI; the patients had a total of 60 PGLs of the neck. US and CDUS outcome was compared to the outcome of second-line imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT). The following findings were considered: presence/absence of focal lesions at US imaging and difference in maximum diameter of the lesion measured at US and MRI/CT. Results were compared using the Student's t-test. Results: Of the 60 PGLs of the neck only 5 (8.3%) were not visualized at US or CDUS examination. The difference in maximum diameter of these lesions measured at CT/MRI and US/CDUS ranged between À5 mm and þ16 mm (mean difference 2.2 AE 6.0). This difference was statistically significant (p Z 0.008). Conclusions: US and CDUS are useful methods for identifying carotid PGLs also measuring less than 10 mm in diameter. However, diagnostic accuracy of US and CDUS is reduced in the measurement of the exact dimensions of the lesions.Sommario Introduzione: I paragangliomi (PGLs) carotidei sono lesioni altamente vascolarizzate che originano dai paragangli localizzati a livello della biforcazione carotidea. Scopo: Valutare l'utilità dell'ecografia (US) e dell'Eco color Doppler (USD) del collo nella diagnosi e nel follow-up dei PGLs carotidei. Materiali e metodi: Abbiamo visionato retrospettivamente tutte le US e gli USD del collo, eseguiti nell'Ospedale Santa Chiara di Trento tra il 2007 e il 2011, di soggetti affetti da sindrome paraganglioma di tipo 1 con sicuri paragangliomi del collo singoli o bilaterali. Abbiamo quindi confrontato i risultati con quelli di metodiche di imaging di secondo livello, Risonanza Magnetica (RM) o Tomografia Computerizzata (TC). Sono stati calcolati i casi discordanti in termini di presenza/assenza della lesione focale alle immagini ecografiche e in termini di differenze del diametro maggiore rilevate tra le due metodiche. Risultati: Sono stati revisionati i dati di imaging (US e/o USD, RM o TC) eseguiti tra il 2007 e il 2011 di 40 pazienti aventi 60 sicuri paragangliomi del collo. Di questi solo 5/60 (8,3%) non sono stati visualizzati mediante US e/o USD. La differenza nella misura del diametro maggiore di tali lesioni rilevate dalle due tecniche di imaging, è risultata compresa tra -5 e þ16 mm (media di 2,2 AE 6,0). Tale differenza è risultata statisticamente significativa (p Z 0,008) (test-Student). Conclusioni: L'US e l'USD del collo risultano metodiche di imaging utili nell'...

Surgical Management of Carotid Body Tumors: A 15-Year Single Institution Experience Employing an Interdisciplinary Approach

“…Paragangliomas may be initially detected during ultrasound or Doppler ultrasound of the neck; however CT and MRI are more sensitive for accurate tumor measurement (22). Th e typical radiologic fi ndings include a hypervascular, hypoechoic tumor with splaying of the carotid bifurcation.…”

Color Doppler Ultrasound in Diagnosis and Assessment of Carotid Body Tumors: Comparison with Computed Tomography Angiography

“…CBT generally occurred in patients of 30-60 y and was seen in equal frequency in males and females, except at high altitude, where females tend to predominate (Dematt e et al 2012). They may have had a familial occurrence, and bilateral and multiple tumors are found more so in familial cases than in sporadic cases.…”

Neck paraganglioma: Head rotation maneuver on transcranial Doppler ultrasonography

“…Carotid body PGLs, also known as carotid body tumor or chemodectoma, are highly vascularized lesions of the parasympathetic nervous system, which derive from the paraganglion cells (embryonic neural crest cells) of the carotid body [1,2]. Symptoms, if present, are usually caused by cranial nerves and/or sympathetic chain compression resulting in neuropathy or paralysis of the vagus or hypoglossal nerves.…”

“…murmur near the mass is rare, but may be a sign of carotid artery compression [2,3]. It is well known that compression maneuvers of the ICA and jugular vein, as well as carotid surgical procedures, can induce TCDcerebral hemodynamic changes, evidenced by changes in the spectral waveforms of CBFV and pulsatility index, as described in the literature [3][4][5].…”

“…On transcranial Doppler (TCD) examination, cerebral blood flow velocities (CBFV) decreased significantly during the cervical rotation maneuver to the right, and increased (reactive hyperemia) when the head returned to the neutral position. Physiological variables, such as mean arterial blood pressure and heart rate were also recorded to supplement the cerebral hemodynamic assessment (Table 1).Carotid body PGLs, also known as carotid body tumor or chemodectoma, are highly vascularized lesions of the parasympathetic nervous system, which derive from the paraganglion cells (embryonic neural crest cells) of the carotid body [1,2]. Symptoms, if present, are usually caused by cranial nerves and/or sympathetic chain compression resulting in neuropathy or paralysis of the vagus or hypoglossal nerves.…”