Neurogenic tumors of the abdomen and pelvis: imaging features, differential diagnosis, and diagnostic pitfalls.

Neurogenic tumors of the abdomen and pelvis are a diverse group of neoplasms arising from paraganglia, peripheral nerves, and autonomic ganglia. Their imaging appearances range from benign incidental lesions to aggressive neoplasms with metastatic potential, creating diagnostic challenges because of overlapping imaging features and broad differential diagnoses. Cross-sectional imaging, supplemented by functional imaging, plays a central role in lesion characterization, staging, and surgical planning. This review summarizes the imaging features of paraganglion cell-derived, nerve sheath-derived, and ganglion cell-derived tumors, emphasizing characteristic imaging findings, anatomic distribution, clinical presentation, and pathologic correlation. Representative cases illustrate both classic and atypical appearances while highlighting important diagnostic pitfalls, including life-threatening catecholamine crisis from biopsy of an unrecognized pheochromocytoma or paraganglioma. A practical, imaging-based diagnostic algorithm is presented to facilitate systematic evaluation of abdominal and pelvic neurogenic tumors and narrow the differential diagnosis. Recognition of characteristic imaging patterns and integration of clinical, laboratory, and pathologic findings are essential for accurate diagnosis, appropriate management, and avoidance of potentially serious diagnostic and therapeutic errors.