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Research ArticleHead & Neck
Open Access

Assessment of MR Imaging and CT in Differentiating Hereditary and Nonhereditary Paragangliomas

Y. Ota, S. Naganawa, R. Kurokawa, J.R. Bapuraj, A. Capizzano, J. Kim, T. Moritani and A. Srinivasan
American Journal of Neuroradiology July 2021, 42 (7) 1320-1326; DOI: https://doi.org/10.3174/ajnr.A7166
Y. Ota
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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S. Naganawa
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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R. Kurokawa
bDepartment of Radiology (R.K.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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J.R. Bapuraj
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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A. Capizzano
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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J. Kim
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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T. Moritani
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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A. Srinivasan
aFrom the Division of Neuroradiology (Y.O., S.N., J.R.B., A.C., J.K., T.M., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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  • FIG 1.
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    FIG 1.

    A 48-year-old woman positive for the SDHC mutation with a paraganglioma in the left jugular foramen. A and B, Axial T2-weighted and contrast-enhanced T1-weighted images demonstrate a heterogeneously enhancing, irregularly shaped tumor with flow voids in the left jugular foramen. C, An ROI is placed on the lesion on the ADC map. The mean ADC, maximum ADC, and minimum ADC values of reader 1 are 1.06, 1.47, and 0.53 × 10–3 mm2/s, respectively. D, Another ROI for an internal standard is placed on the medulla as an internal control (mean ADC, 0.75 × 10–3 mm2/s). The mean nADC, maximum nADC, and minimum nADC are 1.41, 1.96, and 0.71 × 10–3 mm2/s, respectively.

  • FIG 2.
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    FIG 2.

    Comparison of mean and maximum ADC values between the SDH mutation–negative group and the SDH mutation–positive group (A and C, result of reader 1; B and D, result of reader 2).

  • FIG 3.
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    FIG 3.

    A 62-year-old woman negative for the SDH mutation with a paraganglioma in the right carotid space. A, Axial T2-weighted image demonstrates a heterogeneous well-defined tumor with flow voids in the right carotid space. B, The freehand ROI is placed on the lesion on the ADC map. Mean ADC, maximum ADC, and minimum ADC values of reader 1 are 1.31, 1.61, and 0.71 × 10–3 mm2/s, respectively. C, The resection specimen shows chief cells forming variable-size clusters in the zellballen pattern (H&E,  ×40).

  • FIG 4.
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    FIG 4.

    A 52-year-old woman positive for the SDHD mutation with a paraganglioma in the left carotid space. A, Axial T2-weighted image demonstrates a heterogeneous tumor with flow voids. B, The freehand ROI is placed on this lesion on the ADC map. The mean ADC, maximum ADC, and minimum ADC of reader 1 are 1.13, 1.57, and 0.51 × 10–3 mm2/s, respectively. C, The resection specimen shows a large and irregular cell nest and prominent vascularity (H&E, ×40).

Tables

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    Table 1:

    Demographic and tumor characteristics patients with head and neck paragangliomas

    SDH Mutation–PositiveSDH Mutation–NegativeP Value
    No. of lesions3018NA
    Sex (male/female)7:162:15.37
    Age (mean) (yr)43.9 (SD, 16.2) (23 patients)56.9 (SD, 10.7) (17 patients).007
    Maximum diameter (median) (IQR) (mm)26.5 (20.6–33.0)24.4 (21.2–36.0).68
    Salt-and-pepper appearance24/3013/18.72
    Ratio of head/neck region13:1713:5.07
    Adjacent osseous erosive changes of head region13:1312:131
    Necrotic or cystic changes18/3010/18.77
    • Note:—NA indicates not applicable; IQR, interquartile range.

    • View popup
    Table 2:

    Diagnostic performance of ADC values in differentiating groups positive for the SDH mutation from those negative for it (both readers’ results)

    ADC Mean (× 10–3
    mm2/s)
    ADC Maximum (× 10–3
    mm2/s)
    nADC MeannADC Maximum
    Cutoff1.15/1.171.80/1.621.52/1.532.32/2.07
    Sensitivity0.90/0.950.93/0.790.90/0.950.93/0.68
    Specificity0.83/0.780.94/0.940.83/0.830.94/1.00
    PPV0.90/0.820.97/0.940.90/0.860.97/1.00
    NPV0.83/0.930.90/0.810.83/0.940.90/0.75
    Accuracy0.88/0.870.94 /0.870.88/0.890.94/0.84
    AUC0.87/0.910.94/0.940.87/0.910.94/0.94
    • Note:—PPV indicates positive predictive value; NPV, negative predictive value; AUC, area under the curve.

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American Journal of Neuroradiology: 42 (7)
American Journal of Neuroradiology
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Y. Ota, S. Naganawa, R. Kurokawa, J.R. Bapuraj, A. Capizzano, J. Kim, T. Moritani, A. Srinivasan
Assessment of MR Imaging and CT in Differentiating Hereditary and Nonhereditary Paragangliomas
American Journal of Neuroradiology Jul 2021, 42 (7) 1320-1326; DOI: 10.3174/ajnr.A7166

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Assessment of MR Imaging and CT in Differentiating Hereditary and Nonhereditary Paragangliomas
Y. Ota, S. Naganawa, R. Kurokawa, J.R. Bapuraj, A. Capizzano, J. Kim, T. Moritani, A. Srinivasan
American Journal of Neuroradiology Jul 2021, 42 (7) 1320-1326; DOI: 10.3174/ajnr.A7166
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