Multiple endocrine neoplasia type 2 CT
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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
- 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.
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![Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]](/images/7/7e/Pheochromocytoma_CT.jpg)
Pheochromocytoma Image courtesy of Dr Paresh K Desai[6]
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![Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]](/images/0/01/Pheochromocytoma_CT_2.jpg)
Pheochromocytoma Image courtesy of Dr Frank Gaillard[7]
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![Image courtesy of Dr Roberto Schubert[8]](/images/0/08/Pheochromocytoma_CT_04.jpg)
Image courtesy of Dr Roberto Schubert[8]
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![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
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