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

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.
• 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).
• 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 14:

• 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

• Usually large, heterogeneous masses with areas of necrosis and cystic change
• They typically enhance avidly
• 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

• 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 ,

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  Pheochromocytoma Case courtesy of Dr Frank Gaillard,

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  Case courtesy of Dr Roberto Schubert,

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  Case courtesy of Dr Nafisa Shakir Batta,