Bone metastases from head and neck paragangliomas: Uncommon MR findings in an uncommon condition - Report of three cases

Malignancy (defined as metastatic disease) has been. reported in nearly 5% of head and neck paragangliomas: Metastases preferentially target the lymph nodes, lung, liver, or bone. We describe three patients with multiple silent bone metastases exhibiting a fatty halo at MRI that coexisted with expansive bone lesions. in all cases, 1231 metaiodobenzylguanidine ((123)MIBG) scintigraphy showed no abnormal tracer uptake, whereas In-111-pentetreotide scintigraphy visualized a few silent bone metastases. These findings indicate that MRI should be included in the staging of paraganglioma patients with risk factors for malignancy.