CT angiography of the carotid body: bridging the gap between normal and neoplastic lesions

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OBJECTIVE: Sympathetic nervous system hyperactivation in chronic conditions, such as hypertension and metabolic syndrome, can lead to carotid body (CB) hyperplasia, potentially mimicking small carotid body tumours (CBTs) in radiological evaluations. This study aimed to investigate CT angiography (CTA) findings to differentiate CBTs from non-neoplastic CBs. METHODS: Patients were categorized into CBT and non-neoplastic CB groups. Demographics (smoking status, hypertension, diabetes mellitus), shape, dimensions, volume, and density (including standard deviations) were assessed. Density ratios were calculated using CB/CBT and ipsilateral common carotid artery density. Diagnostic performance was evaluated via ROC analysis, and logistic regression identified factors associated with increased CBT risk. RESULTS: Significant differences between the CB and CBT groups were found in gender, smoking status, and shape (P < .01), while age, location, hypertension, and diabetes mellitus showed no association (P > .05). The CBT group had significantly higher density, standard deviation, and density ratios (P < .001). Multivariate analysis, adjusted for age, gender, and smoking, showed that saddle shape, standard deviation ≥21.5, and density ratio ≥0.5603 predicted CBT diagnosis with 92.6% sensitivity and 99.3% specificity. CONCLUSIONS: Saddle shape, along with increased density and standard deviation values, emerges as findings suggestive of a CBT diagnosis. The proposed imaging features may improve differentiation of small CBTs from non-neoplastic CBs, particularly in cases with enlarged CBs lacking typical tumour features. ADVANCES IN KNOWLEDGE: Specific CTA findings, including saddle shape, increased density, and standard deviation, can effectively differentiate small CBTs from non-neoplastic CBs, offering a novel approach to improving radiological diagnostics in cases with CB hyperplasia.