3D contrast-enhanced ultrasound of carotid body tumor: A promising tool?

Introduction

In the head and neck region, paraganglionic tissue is located in close proximity to vascular structures, as summarized in a recent review by Valero et al. 2022. (Valero et al. J oral Pathol Med. 2022;51(10):897–903). These paravascular tissues can develop into neuroendocrine tumours, most notably at the carotid bifurcation tumour. (i.e. carotid body tumours, CBT). The Shamblin classification (grades I–III) describes the tumour’s relationship to adjacent vascular and neural structures. (Berger et al. Pol Przegl Chir. 2020;92(6):39–44). Differential diagnoses include aneurysms, cervical lymphadenopathy, Schwannomas, and accessory thyroid glands.

In the majority of cases, CBTs are asymptomatic (rarely presenting as a palpable mass); however, symptoms such as headache, palpitations, and flushing may occur, possibly due to catecholamine secretion. Malignancy rates are reported to range from 2% to 19%. (Valero et al. J oral Pathol Med. 2022;51(10):897–903) In routine clinical practice, tomographic modalities are primarily used. In computed tomography (CT), the tumours typically appear well-demarcated and isodense relative to the surrounding musculature. On magnetic resonance imaging (MRI), paragangliomas are typically isointense on T1-weighted images and hyperintense on T2-weighted images. Their post-contrast appearance may vary depending on the extent of necrosis. A characteristic MRI finding is the “salt and pepper” pattern, which results from a combination of enhancing tumour tissue and flow voids. Contrast-enhanced ultrasound (CEUS) has also been adopted by various working groups due to its high resolution, real-time imaging capacities and minimal contraindications. (Schwarze V et al. Quant Imaging Med Surg. 2020;10(9):1739–47).

Publication History

Received: 05 January 2025

Accepted after revision: 18 February 2025

Article published online:
27 March 2025