Multiple endocrine neoplasia type 2 CT
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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) 6.
- 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
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[2]
- Usually large, heterogeneous masses with areas of necrosis and cystic change
- They typically enhance avidly[3]
- 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[4]
- An adrenal pheochromocytoma
- It should be noted, that in patients with suspected pheochromocytomas contrast may be contraindicated as it could precipitate a hypertensive crisis.
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PheochromocytomaCase courtesy of Dr Paresh K Desai , [5]
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Pheochromocytoma Case courtesy of Dr Frank Gaillard, [6]
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Case courtesy of Dr Roberto Schubert, [7]
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Case courtesy of Dr Nafisa Shakir Batta, [8]
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.
- ↑ 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