Multiple endocrine neoplasia type 2 CT: Difference between revisions
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===Parathyroid Carcinoma=== | ===Parathyroid Carcinoma=== | ||
* Three-dimensional single-photon emission CT (SPECT) is used for preoperative preadenoma localization. | * Three-dimensional single-photon emission CT (SPECT) is used for preoperative preadenoma 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) 6. | * In the past CT was more commonly used in the setting of a failed parathyroidectomy for the detection of suspected ectopic glands (often mediastinal).<ref name="pmid17515397">{{cite journal| author=Johnson NA, Tublin ME, Ogilvie JB| title=Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1706-15 | pmid=17515397 | doi=10.2214/AJR.06.0938 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515397 }} </ref> | ||
* 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. 4DCT has been shown to be more sensitive than sonography and scintigraphy for preoperative localisation of parathyroid adenomas<ref name=Radiopaedia 2015 Parathyroid adenoma>{{cite web | title = Radiopedia 2015 Parathyroid adenoma [Dr Bruno Di Muzio and Dr Yuranga Weerakkody]| url = http://radiopaedia.org/articles/parathyroid-adenoma }}</ref> | * 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. 4DCT has been shown to be more sensitive than sonography and scintigraphy for preoperative localisation of parathyroid adenomas<ref name=Radiopaedia 2015 Parathyroid adenoma>{{cite web | title = Radiopedia 2015 Parathyroid adenoma [Dr Bruno Di Muzio and Dr Yuranga Weerakkody]| url = http://radiopaedia.org/articles/parathyroid-adenoma }}</ref> | ||
====Enhancement on 4D-CT==== | |||
* 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 12. | |||
* Secondary signs include 14: | |||
:* 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 | |||
===Pheochromocytoma=== | ===Pheochromocytoma=== | ||
* 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<ref>{{cite book | last = Blake | first = Michael | title = Adrenal imaging | publisher = Humana Press | location = Totowa, NJ | year = 2009 | isbn = 193411586X }}</ref><ref name=Radiopaedia 2015 Pheochromocytoma>{{cite web | title = Radiopedia 2015 Pheochromocytoma [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pheochromocytoma-2 }}</ref> | * 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<ref>{{cite book | last = Blake | first = Michael | title = Adrenal imaging | publisher = Humana Press | location = Totowa, NJ | year = 2009 | isbn = 193411586X }}</ref><ref name=Radiopaedia 2015 Pheochromocytoma>{{cite web | title = Radiopedia 2015 Pheochromocytoma [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pheochromocytoma-2 }}</ref> |
Revision as of 18:27, 23 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
CT
Medullary Thyroid Carcinoma
- 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.
Parathyroid Carcinoma
- Three-dimensional single-photon emission CT (SPECT) is used for preoperative preadenoma 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. 4DCT has been shown to be more sensitive than sonography and scintigraphy for preoperative localisation of parathyroid adenomas
Enhancement on 4D-CT
- 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 12.
- Secondary signs include 14:
- 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
Pheochromocytoma
- 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[3]
- Usually large, heterogeneous masses with areas of necrosis and cystic change
- They typically enhance avidly[4]
- May wash out similar to an adrenal adenoma, but they tend to have greater enhancement in an arterial or portal venous contrast phase
- 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 be considered in an appropriate setting
- Up to 7% demonstrate areas of calcification[5]
- An adrenal pheochromocytoma
- It should be noted, that in patients with suspected pheochromocytomas contrast may be contraindicated as it could precipitate a hypertensive crisis.
-
PheochromocytomaCase courtesy of Dr Paresh K Desai , [6]
-
Pheochromocytoma Case courtesy of Dr Frank Gaillard, [7]
-
Case courtesy of Dr Roberto Schubert, [8]
-
Case courtesy of Dr Nafisa Shakir Batta, [9]
Reference
- ↑ 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.
- ↑ 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.
- ↑ Reiser, Maximilian (2008). Magnetic resonance tomography. Berlin: Springer. ISBN 354029354X.
- ↑ "http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/6819">rID: 6819
- ↑ "http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/6478">rID: 6478
- ↑ "http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/16148">rID: 16148
- ↑ "http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/29512">rID: 29512