An Analysis of Computed Tomography Imaging Features and Predictive Factors for Postoperative Recurrence and Metastasis of Abdominal Paragangliomas

Abstract

Methods: We studied 51 abdominal PGL patients at the First Affiliated Hospital of Bengbu Medical College, Tongde Hospital, and Sir Run Shaw Hospital, Hangzhou, Zhejiang Province, China, from June 2009 to May 2019. Thereafter, the clinical research data, tumor biomarkers, and CT features were compared between the aggressive PGLs and the nonaggressive PGLs using independent-samples t-tests and chi-square tests.

Results: Of the 51 cases, 43 were benign and 8 had malignant tendencies. Postoperative recurrence and metastasis were more likely to occur when the tumor diameter was >8 cm or/and the enhancement degree was not obvious. Clinical symptoms, tumor markers, sex, age, and CT image characteristics including morphology, presence of cystic degeneration, "pointed peach" sign, calcification, hemorrhage, enlarged lymph nodes, and peritumor and intratumor blood vessels were not significantly different between the two groups (p > 0.05).

Conclusion: Our findings suggest that CT features, including size >8 cm and enhancement degree, could provide important evidence to assess risk factors for aggressive PGLs.

Figure 1

One case of a surgery confirmed retroperitoneal paraganglioma in a 77-year-old male that located in the left paraaortic area. (a) Nonenhanced CT scan presented a low heterogeneity density with an irregular shape tumour size of about 97 mm × 69 mm. The presence of multiple-size varied cystic degeneration and speckled calcification. (b, c) Dynamic enhanced CT scans revealed an obvious heterogeneously enhanced tumour for solid components. Peritumor and intratumor blood vessels (arrow). CT values were 32, 154, and 134 Hounsfield units (HU), respectively, in the nonenhanced, arterial, and venous phases.

Figure 2

One case of a pathologically confirmed liver paraganglioma in a 60-year-old female. (a) Noncontrast CT scan showed a well-defined lesion in the liver segment IV with a mean diameter of 22 mm. (b, c) Contrast-enhanced CT scans showed homogenous and significant enhancement with the “halo sign,” peritumor feeding, or draining enlarged vessels (arrow). The CT values of the noncontrast, arterial, and venous phases were 35, 199, and 120 HU, respectively. The lesion was misdiagnosed as benign hemangioma or FNH tumour following preoperative CT. (d) The tumor cells were arranged in nests, surrounded by fibrovascular stroma.

Figure 3

One case of a 65-year-old female that had a slightly higher-level CA199, CA125. (a) Noncontrast CT scan showed an irregular tumour size of about 140 × 81 mm with heterogeneous low density in the retroperitoneal. The lesion presence multiple punctate strip calcifications. (b, c) Contrast-enhanced CT scans depicted heterogeneous nonsignificant enhancement. The CT values of the noncontrast, arterial, and venous phases were 43, 67, and 65 HU. The postoperative CT diagnosis was paraganglioma and (d) liver multiple metastasis (arrow) occurred.

Figure 4

One case of a 67-year-old female with a retroperitoneal neoplasm. (a) Noncontrast CT scan showed an irregular, ill-defined tumour with heterogeneity attenuation and bulky calcification (arrow) was observed. (b, c) Contrast-enhanced scans displayed heterogeneous nonremarkable enhancement. The CT values of the noncontrast, arterial, and venous phases were 43, 79, and 88 HU. The neoplasm extends into the space of the adjacent organs and the left renal artery. (d) Liver multiple metastases occurred 5 years later.