Radiological Diagnosis

Abstract

Radiological diagnosis of jugular foramen tumors requires careful evaluation of contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) to differentiate the lesions and evaluate tumor extension. CT gives detailed information of cranial base bone structures, bone erosion, tumor calcification, and hyperostosis. The CT findings may be useful to differentiate schwannomas from paragangliomas and meningiomas. MRI with gadolinium is very useful to show the characteristics of tumor, its vascularization, extension, relationship with neighboring structures, and the presence of other tumors (multifocality and multicentricity). DSA is performed to evaluate tumor feeders, invasion of the internal carotid artery wall, involvement of the vertebral artery, and identify multicentric disease. The venous phase of DSA permits adequate visualization of the sinuses and veins as well as the position and patency of jugular bulb. Some radiological findings may be characteristic for tumors like paragangliomas with vascular flow voids patterns (“salt and pepper”) on MRI, meningiomas with “dural tail” on MRI, and hyperostosis and calcifications on CT, schwannomas may present jugular foramen erosion with well-defined corticate margins on CT.