Multiple endocrine neoplasia type 2 CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [5]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [6]

Overview

Neck CT scan may be helpful in the diagnosis of multiple endocrine neoplasia type 2. Findings on CT scan suggestive of multiple endocrine neoplasia type 2 include irregular dense calcific foci within thyroid, ectopic mediastinal gland, and heterogeneous masses with areas of necrosis within adrenal gland.

Both primary and metastatic lesions usually have irregular dense calcific foci within.^[1]
In the chest, bullae formation and pulmonary fibrosis might happen as a result of a desmoplastic reaction.

Three-dimensional single-photon emission CT (SPECT) is used for preoperative adenoma localization.
In the past CT was more commonly used in the setting of a failed parathyroidectomy for the detection of suspected ectopic glands (often mediastinal).^[2]
However, in recent years, 4D-CT has emerged as valuable modality especially in the era of minimally invasive parathyroidectomy. This type of surgery requires precise localization with anatomical detail and a confident diagnosis of parathyroid adenoma. 4D-CT has been shown to be more sensitive than sonography and scintigraphy for preoperative localisation of parathyroid adenomas.^[3]

On 4D-CT parathyroid adenomas typically demonstrate intense enhancement on arterial phase, washout of contrast on delayed phase and low attenuation on non-contrast imaging.
Secondary signs include the following:

The polar vessel which represents an enlarged feeding artery or draining vein to the hypervascular parathyroid adenoma.
A larger lesion size increases the confidence of diagnosis.
Parathyroid adenomas can also have cystic change.

CT is the first imaging modality to be used, with an overall sensitivity of 89%. This is on account of 98% of tumors being located within the abdomen and 90% limited to the adrenal glands.^[4]^[3]
Pheochromocytoma is usually large, heterogeneous masses with areas of necrosis and cystic change.
Pheochromocytoma typically enhance avidly.^[5]
Pheochromocytoma tend to enhance more on the portal venous phase than the arterial phase.
110 HU of enhancement on the arterial phase is compatible with pheochromocytoma; hypervascular metastases could also be considered in an appropriate setting.
It should be noted, that in patients with suspected pheochromocytomas contrast may be contraindicated as it could precipitate a hypertensive crisis.

↑ McCook TA, Putman CE, Dale JK, Wells SA (1982). "Review: Medullary carcinoma of the thyroid: radiographic features of a unique tumor". AJR Am J Roentgenol. 139 (1): 149–55. doi:10.2214/ajr.139.1.149. PMID 7046403.
↑ Johnson NA, Tublin ME, Ogilvie JB (2007). "Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism". AJR Am J Roentgenol. 188 (6): 1706–15. doi:10.2214/AJR.06.0938. PMID 17515397.
↑ ^3.0 ^3.1 "Radiopedia 2015 Parathyroid adenoma [Dr Bruno Di Muzio and Dr Yuranga Weerakkody]".
↑ Blake, Michael (2009). Adrenal imaging. Totowa, NJ: Humana Press. ISBN 193411586X.
↑ Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR; et al. (2004). "Pheochromocytoma: an imaging chameleon". Radiographics. 24 Suppl 1: S87–99. doi:10.1148/rg.24si045506. PMID 15486252.
↑ Image courtesy of Dr Paresh K Desai. Radiopaedia (original file[1]).Creative Commons BY-SA-NC
↑ Image courtesy of Dr Frank Gaillard. Radiopaedia (original file[2]).Creative Commons BY-SA-NC
↑ Image courtesy of Dr Roberto Schubert. Radiopaedia (original file[3]).Creative Commons BY-SA-NC
↑ Image courtesy of Dr Nafisa Shakir Batta. Radiopaedia (original file[4]).Creative Commons BY-SA-NC

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