Purpose: This study aimed to evaluate the clinical presentation and imaging characteristics of atypical retroperitoneal paragangliomas using contrast-enhanced computed tomography (CECT), and ultrasonography (US). Additionally, the study sought to identify imaging features that facilitate early and accurate preoperative diagnosis.
Materials and methods: A total of 69 patients (46 male; mean age, 52.0 years) with pathologically confirmed retroperitoneal paragangliomas, diagnosed between May 2015 and February 2025, were included. All patients underwent CECT, and 45 underwent US. Images were independently reviewed by two experienced radiologists, with clinical presentations and diagnostic characteristics systematically recorded. Based on the intraoperative hemodynamic status, patients were divided into two groups: the intraoperative hemodynamic instability group and the intraoperative hemodynamic stability group. This study analyzed the relationships between clinical characteristics as well as imaging features and the intraoperative hemodynamic status.
Results: CECT demonstrated that most retroperitoneal paragangliomas appeared as oval-shaped or lobulated masses. The majority of these tumors exhibited rapid washout and minimal washout patterns, along with avid enhancement and the presence of necrosis. They were typically located adjacent to the abdominal aorta and inferior vena cava. US revealed that these tumors presented as hypoechoic, oval-shaped or lobulated, heterogeneous masses, with central anechoic areas being commonly observed, and they were also situated in proximity to the abdominal aorta and inferior vena cava. RPPGs exhibiting a minimal washout or persistent enhancement pattern on CECT exhibited a significantly higher risk of intraoperative hemodynamic instability than those with rapid washout pattern (P = 0.021). There was no statistically significant difference between the clinical features and the remaining CECT imaging features between patients with intraoperative hemodynamic instability and stability.
Conclusion: Distinct diagnostic features identified through CECT and US may contribute to the accurate diagnosis of atypical retroperitoneal paragangliomas.
Keywords: CT; Contrast-enhanced CT; Diagnosis; Retroperitoneal paraganglioma; Ultrasonography.
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