Salt and pepper sign (paraganglioma)
Last revised by Paul Beech
on 9 Jan 2025
Citation, DOI, disclosures and article data
Citation:
Bell D, Baba Y, Thibodeau R, et al. Salt and pepper sign (paraganglioma). Reference article, Radiopaedia.org (Accessed on 20 Mar 2025) https://doi.org/10.53347/rID-95433
rID:
95433
Article created:
Disclosures:
At the time the article was created Daniel J Bell had no recorded disclosures.
View Daniel J Bell's current disclosures
Last revised:
9 Jan 2025,
Paul Beech
Disclosures:
At the time the article was last revised Paul Beech had no financial relationships to ineligible companies to disclose.
View Paul Beech's current disclosures
Revisions:
7 times, by
5 contributors -
see full revision history and disclosures
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Synonyms:
- Salt and pepper sign (paragangliomas)
- Salt and pepper (paraganglioma)
- Salt and pepper signs (paraganglioma)
- Salt-and-pepper sign (paraganglioma)
The salt and pepper sign is used to describe a typical MRI appearance of some highly vascular tumors that contain foci of hemorrhage, typically a paraganglioma 1-3. The appearance is on T1-weighted sequences, and is made up of:
punctate regions of hyperintensity = salt
small flow voids = pepper
Typical tumors with this appearance include:
A similar appearance may be seen on T2 sequences or post-contrast T1 sequences in patients with juvenile nasopharyngeal angiofibroma 4.
This appearance can also be seen in other hypervascular tumors such as metastatic renal cell carcinoma or metastatic thyroid carcinoma 5.
References
- 1. Thelen J & Bhatt A. Multimodality Imaging of Paragangliomas of the Head and Neck. Insights Imaging. 2019;10(1):29. doi:10.1186/s13244-019-0701-2 - Pubmed
- 2. Chavhan G & Shroff M. Twenty Classic Signs in Neuroradiology: A Pictorial Essay. Indian J Radiol Imaging. 2009;19(2):135-45. doi:10.4103/0971-3026.50835 - Pubmed
- 3. Yang C, Li G, Fang J et al. Clinical Characteristics and Surgical Outcomes of Primary Spinal Paragangliomas. J Neurooncol. 2015;122(3):539-47. doi:10.1007/s11060-015-1742-0 - Pubmed
- 4. Seo C, Han M, Chang K, Yeon K. Angiofibroma Confined to the Pterygoid Muscle Region: CT and MR Demonstration. AJNR Am J Neuroradiol. 1996;17(2):374-6. PMC8338372 - Pubmed
- 5. Chavhan G & Shroff M. Twenty Classic Signs in Neuroradiology: A Pictorial Essay. Indian J Radiol Imaging. 2009;19(2):135-45. doi:10.4103/0971-3026.50835 - Pubmed
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