Salt and pepper sign (paraganglioma)

Last revised by Daniel J Bell on 4 Dec 2021

The salt and pepper sign is used to describe a typical MRI appearance of some highly vascular tumors which 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:

Similar appearance may be seen on T2 sequences or post contrast T1 sequences in patients with juvenile nasopharyngeal angiofibromas 4.

This appearance can also be seen in other hypervascular tumors such as metastatic hypernephroma or metastatic thyroid carcinoma 5.

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Cases and figures

  • Case 1: glomus jugulare
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  • Case 2
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