Radiologic approach to jugular bulb paragangliomas

Background: Paragangliomas are highly vascular neoplasms that derive from neuroendocrine tissue. They account for about 0.6% of all head and neck tumors and most commonly occur in the carotid bifurcation, tympanic cavity, jugular foramen and in the area of vagal ganglia below the skull base. The aim of the study was retrospective evaluation of radiological features of jugular bulb paragangliomas in the group of 22 patients. Material/Methods: In the analyzed group, there were 16 females and 7 males, aged 14-81. All the patients underwent CT and MRI, in 12 cases carotid angiography and in 3 cases Doppler sonography was performed. We evaluated typical radiological features of jugular bulb paragangliomas and usefulness of various imaging methods in diagnosis and assessment of this pathology. Results: Computed tomography in all patients showed widening of the jugular foramen. MR images in 19 cases revealed the presence of intra-tumoral signal-void areas representing tumor vessels. Both methods showed intensive post-contrast enhancement of all tumors. Carotid angiography presented high vascularity and arterio-venous fistulas in all tumors. In the performed Doppler ultrasound studies, the tumors were not visible. In all cases, increased blood flow in the ipsilateral carotid artery and vein was observed, and in 2 patients with a coexisting carotid body paraganglioma was diagnosed. Conclusions: CT and MRI allow best evaluation of tumor extension and present features characteristic of jugular bulb paraganglioma. Carotid angiography confirms the diagnosis of a vascular tumor and is used for its preoperative embolization. Ultrasonography is a useful technique for exclusion of coexisting carotid body paraganglioma.