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{{Multiple endocrine neoplasia type 2}}
{{Multiple endocrine neoplasia type 2}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{Ammu}}
==Overview==
==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]].
[[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 tendinitis|calcific]] foci within [[thyroid]], [[ectopic]] [[Mediastinum|mediastinal]] [[gland]], and [[heterogeneous]] masses with areas of [[necrosis]] within [[adrenal gland]].
 
==CT==
==CT==
===Medullary Thyroid Carcinoma===
===Medullary Thyroid Carcinoma===
* Both primary and metastatic lesions usually have irregular dense calcific foci within.<ref name="pmid7046403">{{cite journal| author=McCook TA, Putman CE, Dale JK, Wells SA| title=Review: Medullary carcinoma of the thyroid: radiographic features of a unique tumor. | journal=AJR Am J Roentgenol | year= 1982 | volume= 139 | issue= 1 | pages= 149-55 | pmid=7046403 | doi=10.2214/ajr.139.1.149 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7046403  }} </ref>
* Both primary and [[metastatic]] lesions usually have irregular [[dense]] calcific foci within.<ref name="pmid7046403">{{cite journal| author=McCook TA, Putman CE, Dale JK, Wells SA| title=Review: Medullary carcinoma of the thyroid: radiographic features of a unique tumor. | journal=AJR Am J Roentgenol | year= 1982 | volume= 139 | issue= 1 | pages= 149-55 | pmid=7046403 | doi=10.2214/ajr.139.1.149 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7046403  }} </ref>
* In the [[chest]], [[bullae]] formation and pulmonary [[fibrosis]] might happen as a result of a desmoplastic reaction.
* In the [[chest]], bullae formation and [[pulmonary fibrosis]] might happen as a result of a [[desmoplastic]] reaction.


===Parathyroid Carcinoma===
===Parathyroid Carcinoma===
* Three-dimensional single-photon emission [[CT]] (SPECT) is used for preoperative pre[[adenoma]] localization.
* Three-dimensional [[Single photon emission tomography|single-photon emission CT]] ([[Single photon emission computed tomography|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 [[gland]]s (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>   
* In the past [[CT]] was more commonly used in the setting of a failed [[parathyroidectomy]] for the detection of suspected [[ectopic]] [[gland]]s (often [[Mediastinum|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]]. 4D[[CT]] has been shown to be more sensitive than [[sonography]] and [[scintigraphy]] for preoperative localisation of [[parathyroid adenoma]]s<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, [[Hyperparathyroidism CT|4D-CT]] has emerged as valuable modality especially in the era of [[Hyperparathyroidism surgery|minimally invasive parathyroidectomy]]. This type of [[surgery]] requires precise localization with [[anatomical]] detail and a confident [[diagnosis]] of [[parathyroid adenoma]]. [[Hyperparathyroidism CT|4D-CT]] has been shown to be more sensitive than [[sonography]] and [[scintigraphy]] for preoperative localisation of [[parathyroid adenoma]]s.<ref name="Radiopaedia">{{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====
====Enhancement on 4D-CT====
* On 4D-[[CT]] [[parathyroid adenoma]]s typically demonstrate intense enhancement on arterial phase, washout of contrast on delayed phase and low attenuation on non-contrast imaging 12.
* On 4D-[[CT]] [[parathyroid adenoma]]s typically demonstrate intense enhancement on [[arterial]] [[Phase (waves)|phase]], washout of [[contrast]] on delayed phase and low [[attenuation]] on non-contrast [[imaging]].
* Secondary signs include the following:
* Secondary [[signs]] include the following:
:* The polar vessel which represents an enlarged feeding [[artery]] or draining [[vein]] to the hypervascular [[parathyroid adenoma]]
:* 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]]
:* A larger [[lesion]] size increases the confidence of [[diagnosis]].
:* [[Parathyroid adenoma]]s can also have cystic change
:* [[Parathyroid adenoma]]s 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 [[tumor]]s being located within the [[abdomen]] and 90% limited to the [[adrenal gland]]s<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 (tests)|sensitivity]] of 89%. This is on account of 98% of [[tumor]]s being located within the [[abdomen]] and 90% limited to the [[adrenal gland]]s.<ref>{{cite book | last = Blake | first = Michael | title = Adrenal imaging | publisher = Humana Press | location = Totowa, NJ | year = 2009 | isbn = 193411586X }}</ref><ref name="Radiopaedia">{{cite web | title = Radiopedia 2015 Pheochromocytoma  [Dr Matt A. Morgan and Dr Frank Gaillard]| url = http://radiopaedia.org/articles/pheochromocytoma-2 }}</ref>
:* Usually large, heterogeneous masses with areas of necrosis and cystic change
* [[Pheochromocytoma]] is usually large, heterogeneous masses with areas of [[necrosis]] and [[cystic]] change.
:* They typically enhance avidly<ref name="pmid15486252">{{cite journal| author=Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR et al.| title=Pheochromocytoma: an imaging chameleon. | journal=Radiographics | year= 2004 | volume= 24 Suppl 1 | issue=  | pages= S87-99 | pmid=15486252 | doi=10.1148/rg.24si045506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486252  }} </ref>
* [[Pheochromocytoma]] typically enhance avidly.<ref name="pmid15486252">{{cite journal| author=Blake MA, Kalra MK, Maher MM, Sahani DV, Sweeney AT, Mueller PR et al.| title=Pheochromocytoma: an imaging chameleon. | journal=Radiographics | year= 2004 | volume= 24 Suppl 1 | issue=  | pages= S87-99 | pmid=15486252 | doi=10.1148/rg.24si045506 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15486252  }} </ref>
:* May wash out similar to an [[adrenal adenoma]], but they tend to have greater enhancement in an arterial or portal venous contrast phase
* [[Pheochromocytoma]] tend to enhance more on the [[Portal venous system|portal venous]] phase than the [[arterial]] 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 also be considered in an appropriate setting.
* 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<ref>{{cite book | last = Reiser | first = Maximilian | title = Magnetic resonance tomography | publisher = Springer | location = Berlin | year = 2008 | isbn = 354029354X }}</ref>
* An adrenal [[pheochromocytoma]]
* It should be noted, that in patients with suspected [[pheochromocytoma]]s contrast may be contraindicated as it could precipitate a [[hypertensive crisis]].
* It should be noted, that in patients with suspected [[pheochromocytoma]]s contrast may be contraindicated as it could precipitate a [[hypertensive crisis]].
<gallery>
<gallery>
Image:Pheochromocytoma CT.jpg|PheochromocytomaCase courtesy of Dr Paresh K Desai , <ref>"http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/6819">rID: 6819</ref>
Image:Pheochromocytoma CT.jpg|Pheochromocytoma Image courtesy of Dr Paresh K Desai<ref name=radio01>Image courtesy of Dr Paresh K Desai. [http://www.radiopaedia.org Radiopaedia] (original file[http://radiopaedia.org/cases/6819‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:Pheochromocytoma CT 2.jpg|Pheochromocytoma Case courtesy of Dr Frank Gaillard, <ref>"http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/6478">rID: 6478</ref>
[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:Pheochromocytoma CT 04.jpg|Case courtesy of Dr Roberto Schubert, <ref>"http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/16148">rID: 16148</ref>
Image:Pheochromocytoma CT 2.jpg|Pheochromocytoma Image courtesy of Dr Frank Gaillard<ref name=radio02>Image courtesy of Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] (original file[http://radiopaedia.org/cases/6478‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
Image:Pheochromocytoma CT 05.jpg|Case courtesy of Dr Nafisa Shakir Batta, <ref>"http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/29512">rID: 29512</ref>
Image:Pheochromocytoma CT 04.jpg|Image courtesy of Dr Roberto Schubert<ref name=radio04>Image courtesy of Dr Roberto Schubert. [http://www.radiopaedia.org Radiopaedia] (original file[http://radiopaedia.org/cases/16148‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
 
Image:Pheochromocytoma CT 05.jpg|Image courtesy of Dr Nafisa Shakir Batta.<ref name=radio03>Image courtesy of Dr Nafisa Shakir Batta. [http://www.radiopaedia.org Radiopaedia] (original file[http://radiopaedia.org/cases/29512‘’here’’]).[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>
</gallery>
</gallery>


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==References==
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Latest revision as of 20:39, 13 June 2019

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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.

CT

Medullary Thyroid Carcinoma

Parathyroid Carcinoma

Enhancement on 4D-CT

Pheochromocytoma

  • Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]

    Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]

  • Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]

    Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]

  • Image courtesy of Dr Roberto Schubert[8]

    Image courtesy of Dr Roberto Schubert[8]

  • Image courtesy of Dr Nafisa Shakir Batta.[9]

    Image courtesy of Dr Nafisa Shakir Batta.[9]

References

  1. ↑ 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.
  2. ↑ 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. ↑ 3.0 3.1 "Radiopedia 2015 Parathyroid adenoma [Dr Bruno Di Muzio and Dr Yuranga Weerakkody]".
  4. ↑ Blake, Michael (2009). Adrenal imaging. Totowa, NJ: Humana Press. ISBN 193411586X.
  5. ↑ 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.
  6. ↑ Image courtesy of Dr Paresh K Desai. Radiopaedia (original file[1]).Creative Commons BY-SA-NC
  7. ↑ Image courtesy of Dr Frank Gaillard. Radiopaedia (original file[2]).Creative Commons BY-SA-NC
  8. ↑ Image courtesy of Dr Roberto Schubert. Radiopaedia (original file[3]).Creative Commons BY-SA-NC
  9. ↑ Image courtesy of Dr Nafisa Shakir Batta. Radiopaedia (original file[4]).Creative Commons BY-SA-NC

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