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]] [[Mediastinum|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. | ||
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* Three-dimensional [[Single photon emission tomography|single-photon emission CT]] ([[Single photon emission computed tomography|SPECT]]) is used for preoperative [[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 [[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> | * 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, [[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> | * 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]]. | ||
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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> | ||
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Latest revision as of 20:39, 13 June 2019
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Multiple endocrine neoplasia type 2 Microchapters |
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Differentiating Multiple endocrine neoplasia type 2 from other Diseases |
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Diagnosis |
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Treatment |
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Multiple endocrine neoplasia type 2 CT On the Web |
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American Roentgen Ray Society Images of Multiple endocrine neoplasia type 2 CT |
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Directions to Hospitals Treating Multiple endocrine neoplasia type 2 |
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Risk calculators and risk factors for Multiple endocrine neoplasia type 2 CT |
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
- 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 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]
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.
- 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.
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.[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.
-
![Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]](/images/7/7e/Pheochromocytoma_CT.jpg)
Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]
-
![Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]](/images/0/01/Pheochromocytoma_CT_2.jpg)
Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]
-
![Image courtesy of Dr Roberto Schubert[8]](/images/0/08/Pheochromocytoma_CT_04.jpg)
Image courtesy of Dr Roberto Schubert[8]
-
![Image courtesy of Dr Nafisa Shakir Batta.[9]](/images/c/c5/Pheochromocytoma_CT_05.jpg)
Image courtesy of Dr Nafisa Shakir Batta.[9]
![Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]](/index.php/File:Pheochromocytoma_CT.jpg)
![Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]](/index.php/File:Pheochromocytoma_CT_2.jpg)
![Image courtesy of Dr Roberto Schubert[8]](/index.php/File:Pheochromocytoma_CT_04.jpg)
![Image courtesy of Dr Nafisa Shakir Batta.[9]](/index.php/File:Pheochromocytoma_CT_05.jpg)
References
- ↑ 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
]