Salt and pepper sign (paraganglioma)
Last revised by Daniel J Bell ◉ on 4 Dec 2021
Citation, DOI, disclosures and article data
Citation:
Bell D, Worsley C, Salt and pepper sign (paraganglioma). Reference article, Radiopaedia.org (Accessed on 27 Mar 2023) https://doi.org/10.53347/rID-95433
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rID:
95433
Article created:
3 Dec 2021, Daniel J Bell ◉
Disclosures:
At the time the article was created Daniel J Bell had no recorded disclosures.
View Daniel J Bell's current disclosuresLast revised:
4 Dec 2021, Daniel J Bell ◉
Disclosures:
At the time the article was last revised Daniel J Bell had no recorded disclosures.
View Daniel J Bell's current disclosuresRevisions:
2 times, by 2 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 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.
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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