Head and Neck Paragangliomas

  • Alexander Stephan KroissEmail author
  • Irene Johanna Virgolini


Head and neck paragangliomas (HNPGLs) are neuroendocrine tumors (NETs) usually characterized by benign features and slow progression. This chapter summarizes the main imaging methods used to evaluate HNPGL. In particular, the advantages of hybrid functional and morphological imaging, such as positron emission tomography/computed tomography (PET/CT), are described. About functional imaging methods, several PET radiopharmaceuticals could be used in this setting, evaluating different metabolic pathways or somatostatin receptor expression. Lastly, some example cases of HNPGL evaluated with different imaging methods are illustrated.


Paraganglioma Neuroendocrine Functional imaging PET/CT Nuclear medicine Somatostatin receptor Glomus tumors 


  1. 1.
    Taïeb D, Neumann H, Rubello D et al (2012) Modern nuclear imaging for paragangliomas: beyond SPECT. J Nucl Med 53:264–274CrossRefPubMedGoogle Scholar
  2. 2.
    Martin TP, Irving RM, Maher ER (2007) The genetics of paragangliomas: a review. Clin Otolaryngol 32:7–11CrossRefPubMedGoogle Scholar
  3. 3.
    Schwaber MK, Glasscock ME, Nissen AJ et al (1984) Diagnosis and management of catecholamine secreting glomus tumors. Laryngoscope 94:1008–1015CrossRefPubMedGoogle Scholar
  4. 4.
    Van Gils AP, van Erkel AR, Falke TH et al (1994) Magnetic resonance imaging or metaiodobenzylguanidine scintigraphy for the demonstration of paragangliomas? Correlations and disparities. Eur J Nucl Med 21:239–253CrossRefPubMedGoogle Scholar
  5. 5.
    Maurea S, Cuocolo A, Reynolds JC et al (1996) Diagnostic imaging in patients with paragangliomas. Computed tomography, magnetic resonance and MIBG scintigraphy comparison. Q J Nucl Med 40:365–371PubMedGoogle Scholar
  6. 6.
    Quint LE, Glazer GM, Francis IR et al (1987) Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy. Radiology 165:89–93CrossRefPubMedGoogle Scholar
  7. 7.
    Timmers HJ, Chen CC, Carrasquillo JA et al (2009) Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma. J Clin Endocrinol Metab 94:4757–4767PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Koopmans KP, Jager PL, Kema IP et al (2008) 111In-octreotide is superior to 123I-metaiodobenzylguanidine for scintigraphic detection of head and neck paragangliomas. J Nucl Med 49:1232–1237CrossRefPubMedGoogle Scholar
  9. 9.
    Hoegerle S, Ghanem N, Altehoefer C et al (2003) 18F-DOPA positron emission tomography for the detection of glomus tumours. Eur J Nucl Med Mol Imaging 30:689–694CrossRefPubMedGoogle Scholar
  10. 10.
    Rufini V, Treglia G, Castaldi P et al (2011) Comparison of 123I-MIBG SPECT-CT and 18F-DOPA PET-CT in the evaluation of patients with known or suspected recurrent paraganglioma. Nucl Med Commun 32:575–582CrossRefPubMedGoogle Scholar
  11. 11.
    Brink I, Hoegerle S, Klisch J et al (2005) Imaging of pheochromocytoma and paraganglioma. Fam Cancer 4:61–68CrossRefPubMedGoogle Scholar
  12. 12.
    Bergström M, Eriksson B, Oberg K et al (1996) In vivo demonstration of enzyme activity in endocrine pancreatic tumors: decarboxylation of carbon-11-DOPA to carbon-11-dopamine. J Nucl Med 37:32–37PubMedGoogle Scholar
  13. 13.
    Treglia G, Cocciolillo F, de Waure C et al (2012) Diagnostic performance of 18F-dihydroxyphenylalanine positron emission tomography in patients with paraganglioma: a meta-analysis. Eur J Nucl Med Mol Imaging 39:1144–1153CrossRefPubMedGoogle Scholar
  14. 14.
    Gabriel M, Decristoforo C, Kendler D et al (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518CrossRefPubMedGoogle Scholar
  15. 15.
    Kroiss A, Putzer D, Frech A et al (2013) A retrospective comparison between 68Ga-DOTA-TOC PET/CT and 18F-DOPA PET/CT in patients with extra-adrenal paraganglioma. Eur J Nucl Med Mol Imaging 40:1800–1808CrossRefPubMedGoogle Scholar
  16. 16.
    Sharma P, Thakar A, Suman KCS et al (2013) 68Ga-DOTANOC PET/CT for baseline evaluation of patients with head and neck paraganglioma. J Nucl Med 54:841–847CrossRefPubMedGoogle Scholar
  17. 17.
    Treglia G, Cardillo G, Stefanelli A et al (2013) Multifocal extra-adrenal paraganglioma evaluated with different PET tracers: comparison between 18F-FDG, 18F-DOPA and 68Ga DOTANOC PET/CT. Clin Nucl Med 38:e458–e462CrossRefPubMedGoogle Scholar
  18. 18.
    Kroiss A, Shulkin BL, Uprimny C et al (2015) (68)Ga-DOTATOC PET/CT provides accurate tumour extent in patients with extra adrenal paraganglioma compared to (123)I-MIBG SPECT/CT. Eur J Nucl Med Mol Imaging 42:33–41CrossRefPubMedGoogle Scholar
  19. 19.
    Eisenhofer G (2001) The role of neuronal and extraneuronal plasma membrane transporters in the inactivation of peripheral catecholamines. Pharmacol Ther 91:35–62CrossRefPubMedGoogle Scholar
  20. 20.
    King KS, Chen CC, Alexopoulos DK et al (2011) Functional imaging of SDHx-related head and neck paragangliomas: comparison of 18F-fluorodihydroxyphenylalanine, 18F-fluorodopamine, 18F-fluoro-2-deoxy-D-glucose PET, 123I-metaiodobenzylguanidine scintigraphy, and 111In-pentetreotide scintigraphy. J Clin Endocrinol Metab 96:2779–2785PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Fottner C, Helisch A, Anlauf M et al (2010) 6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression. J Clin Endocrinol Metab 95:2800–2810CrossRefPubMedGoogle Scholar
  22. 22.
    Kroiss A, Putzer D, Uprimny C et al (2011) Functional imaging in phaeochromocytoma and neuroblastoma with 68Ga-DOTA-Tyr 3-octreotide positron emission tomography and 123I-metaiodobenzylguanidine. Eur J Nucl Med Mol Imaging 38:865–873CrossRefPubMedGoogle Scholar
  23. 23.
    Blanchet EM, Martucci V, Pacak K (2012) Pheochromocytoma and paraganglioma: current functional and future molecular imaging. Front Oncol 1:58PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Alexander Stephan Kroiss
    • 1
    Email author
  • Irene Johanna Virgolini
    • 1
  1. 1.Department of Nuclear MedicineMedical University InnsbruckInnsbruckAustria

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