title: MR diagnosis of paraganglioma of the head and neck: value of contrast enhancement.
abstract: OBJECTIVE
  Contrast enhancement with gadopentetate dimeglumine has been advocated to increase the efficacy of MR imaging for paragangliomas of the head and neck. However, contrast media are expensive, time-consuming to use, and involve minimal but not negligible risks. The purpose of this study was to determine if the use of contrast material is warranted in patients undergoing MR imaging for the diagnosis of paragangliomas of the head and neck.
  
  
  METHODS
  Unenhanced MR images were compared with images obtained after administration of gadopentetate dimeglumine in 23 healthy subjects and 37 patients who had a total of 71 tumors. Three combinations of sequences were reviewed independently and in a random order by four observers who had no clinical information. Combination A comprised enhanced and unenhanced T1-weighted sequences, combination B comprised unenhanced T1- and T2-weighted sequences, and combination C was a combination of all sequences. A four-point scale of certainty was used. CT, scintigraphic, angiographic, and surgicopathologic findings were used as the standard of reference. Results were subjected to alternative free-response receiver-operating-characteristic (AFROC) scoring and statistical analysis.
  
  
  RESULTS
  The mean areas under the AFROC curve for combinations A, B, and C were 0.761, 0.856, and 0.827, respectively. Mean sensitivity/specificity values after dichotomizing the scoring results were 0.73/0.94, 0.79/0.95, and 0.78/0.94 for combinations A, B, and C, respectively. The performance of combinations B and C did not differ markedly, but both combinations were significantly better than combination A. In a relatively large percentage (36%) of small postoperative tumor residues not detected on unenhanced images, however, gadopentetate dimeglumine allowed detection.
  
  
  CONCLUSIONS
  The results of this study indicate that, in general, the use of gadopentetate dimeglumine is not necessary for the detection of head and neck paragangliomas. The addition of contrast-enhanced imaging does not increase the sensitivity or specificity compared with imaging without enhancement. Only when searching for small postoperative tumor residues is the addition of gadopentetate dimeglumine warranted.
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Leiden University Hospital, The Netherlands.
authors.forename: A P
authors.initials: AP
authors.lastname: van Gils
authors.forename: R
authors.initials: R
authors.lastname: van den Berg
authors.forename: T H
authors.initials: TH
authors.lastname: Falke
authors.forename: J L
authors.initials: JL
authors.lastname: Bloem
authors.forename: H J
authors.initials: HJ
authors.lastname: Prins
authors.forename: E H
authors.initials: EH
authors.lastname: Dillon
authors.forename: A G
authors.initials: AG
authors.lastname: van der Mey
authors.forename: E K
authors.initials: EK
authors.lastname: Pauwels
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D004338:Drug Combinations; D019786:Gadolinium DTPA; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D010235:Paraganglioma / Q000175:diagnosis* / Q000473:pathology; D004369:Pentetic Acid / Q000031:analogs & derivatives*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; D009942:Organometallic Compounds; D008536:Meglumine; D004369:Pentetic Acid; D019786:Gadolinium DTPA