Multiple endocrine neoplasia type 2 CT: Difference between revisions

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==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]], ectopic mediastinal gland, and heterogeneous masses with areas of necrosis within adrenal gland.
[[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.
* 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>
* Pheochromocytoma is usually large, heterogeneous masses with areas of necrosis and cystic change.
* [[Pheochromocytoma]] is usually large, heterogeneous masses with areas of [[necrosis]] and [[cystic]] change.
* 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>
* [[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>
* Pheochromocytoma tend to enhance more on the portal venous phase than the arterial phase.
* [[Pheochromocytoma]] tend to enhance more on the [[Portal venous system|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 also be considered in an appropriate setting.
* 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>
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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 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>
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>
Image:Metastasis in MEN 2.jpg|Spiral abdominopelvic CT scan (with contrast). The report was as follows. Multiple calcified and noncalcified lesions in liver are seen (metastasis should be considered). Some of the small bowel loops have thickened wall. Mild right side hydronephrosis is present. Anterior abdominal wall fistula is depicted. A few small paraaortic lymphnodes are seen. Mild left side pleural effusion and massive ascites were also noted.<ref name="ShahnazariAghamaleki2012">{{cite journal|last1=Shahnazari|first1=Banafshe|last2=Aghamaleki|first2=Aria|last3=Larijani|first3=Bagher|last4=Mohajeri Tehrani|first4=Mohammad Reza|last5=Rafati|first5=Hasan|last6=Babamahmoodi|first6=Abdolreza|title=A Case of Multiple Endocrine Neoplasia Type 2B and Gangliomatosis of Gastrointestinal Tract|journal=Case Reports in Medicine|volume=2012|year=2012|pages=1–4|issn=1687-9627|doi=10.1155/2012/491054}}</ref>
</gallery>
</gallery>


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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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