Lumbosacral Intraspinal Paraganglioma: Clinicopathologic and Computed Tomography/Magnetic Resonance Imaging Features of 13 Cases.

OBJECTIVE: To retrospectively review the clinicopathologic features and computed tomography (CT) and magnetic resonance imaging (MRI) findings of lumbosacral intraspinal paragangliomas (PGLs).

METHODS: Thirteen patients with surgically and pathologically confirmed lumbosacral intraspinal PGLs were enrolled. Their clinicopathologic data and imaging findings were retrospectively reviewed.

RESULTS: Ten male and 3 female patients with a median age of 43 years (range, 36-74 years) were included. CT or MRI showed a well-defined (n = 13), oval (n = 10), or striated (n = 3) mass with heterogeneous (n = 6) or homogeneous density/signal intensity (n = 7). The lesions appeared isointense (n = 13) and mildly hyperintense (n = 13) on T1-weighted and T2-weighted MRI, respectively. On enhanced CT/MRI, markedly heterogeneous (n = 6) and homogeneous (n = 7) enhancement patterns were observed. The tadpole sign was observed in 9 cases. Systolic and diastolic blood pressure were higher before than after surgery (PSBP  = 0.002 and PDBP  = 0.001). Both systolic and diastolic blood pressure were reduced to normal after surgery. No recurrence or metastatic disease was found during the follow-up period.

CONCLUSIONS: Lumbosacral intraspinal PGLs should be considered when a mass appears as well defined or oval, and when a striated solitary homogeneous or heterogeneous mass is characterized by a tadpolelike appearance with a marked enhancement pattern. The fluctuation of blood pressure before and after surgery is an interesting clinical feature of lumbosacral intraspinal PGLs.