Multiple endocrine neoplasia type 2 CT: Difference between revisions
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{{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 foci within [[thyroid]]. | ||
==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 | * Three-dimensional single-photon emission [[CT]] (SPECT) is used for preoperative pre[[adenoma]] localization. | ||
* In the past CT was more commonly used in the setting of a failed parathyroidectomy for the detection of suspected ectopic | * 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> | ||
* 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. | * 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> | ||
====Enhancement on 4D-CT==== | ====Enhancement on 4D-CT==== | ||
* On 4D-CT parathyroid | * 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. | ||
* Secondary signs include | * 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 | :* [[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 | * [[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> | ||
:* Usually large, heterogeneous masses with areas of necrosis and cystic change | :* 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> | :* 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> | ||
:* May wash out similar to an adrenal adenoma, but they tend to have greater enhancement in an arterial or portal venous contrast phase | :* 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 | :* 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 | * 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> | :* 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 | * An adrenal [[pheochromocytoma]] | ||
* It should be noted, that in patients with suspected | * 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|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 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> | 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> |
Revision as of 16:50, 28 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
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.
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 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[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]
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.
- ↑ 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