Multiple endocrine neoplasia type 2 CT

Multiple endocrine neoplasia type 2 Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Multiple endocrine neoplasia type 2 from other Diseases
Epidemiology & Demographics
Risk Factors
Screening
Natural History, Complications & Prognosis
Diagnosis
Diagnostic Criteria
History & Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Multiple endocrine neoplasia type 2 CT On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Multiple endocrine neoplasia type 2 CT All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Multiple endocrine neoplasia type 2 CT
CDC on Multiple endocrine neoplasia type 2 CT
Multiple endocrine neoplasia type 2 CT in the news
Blogs on Multiple endocrine neoplasia type 2 CT
Directions to Hospitals Treating Multiple endocrine neoplasia type 2
Risk calculators and risk factors for Multiple endocrine neoplasia type 2 CT

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.
• 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

• 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.

• 

  PheochromocytomaCase courtesy of Dr Paresh K Desai ,

• 

  Pheochromocytoma Case courtesy of Dr Frank Gaillard,

• 

  Case courtesy of Dr Roberto Schubert,

• 

  Case courtesy of Dr Nafisa Shakir Batta,

• 

  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.