Salt and pepper sign (paraganglioma)

Last revised by Yahya Baba on 1 Sep 2023

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 hypernephroma or metastatic thyroid carcinoma 5.

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