# Role of Pseudo-Continuous Arterial Spin Labeling and 4D MR Angiography in the Diagnosis of Neck Paragangliomas

## TL;DR

This study shows that combining pseudo-continuous arterial spin labeling (pcASL) and 4D MR angiography (TRICKS) improves the accuracy of diagnosing neck paragangliomas.

## Contribution

The study demonstrates that pcASL and TRICKS together provide the highest diagnostic confidence and reader agreement for identifying neck paragangliomas.

## Key findings

- pcASL and TRICKS showed the highest reader concordance (K = 1) for diagnosing paragangliomas.
- Schwannomas did not show increased signal on pcASL or arterial enhancement on TRICKS.
- Combined pcASL-TRICKS images are recommended for standardized NPGL characterization.

## Abstract

Background/Objectives: The purpose of this study was to identify the most effective MRI techniques for detecting and characterising neck paragangliomas (NPGLs), which are highly vascularised tumors. Methods: Five readers were asked which MRI sequence among T2-WI, contrast-enhanced fat-suppressed T1-WI, pcASL, and TRICKS made them most confident in diagnosing paraganglioma. To evaluate concordance among the readers, the Fleiss K value was calculated. Sensitivity, specificity, and negative predictive values were calculated for each observer separately, and from all values, a mean was calculated. Results: The final cohort consisted of 28 patients (11 diagnosed with head-and-neck paragangliomas (HNPGLs)) of whom 7 were histologically confirmed and 4 identified based on a positive family history; 11 patients were undergoing familial screening (8 with HNPGLs and 3 without), and 6 patients had surgically confirmed vagal schwannomas. None of the schwannomas showed any increase in signal on pcASL sequences or arterial enhancement on TRICKS acquisition. The best concordance among readers was reached for pcASL and combined pcASL-TRICKS images (K = 1). Conclusions: The combined use of pcASL and TRICKS should be considered essential in a standardised protocol for characterising NPGLs.