內(nèi)分泌代謝疾?。篋iagnostic imaging of endocrine system 20161220

DiagnosticimagingofendocrinesystemMajorendocrineglands.(Maleleft,

femaleontheright.)

1.Pinealgland

2.Pituitarygland

3.Thyroidgland

4.Thymus5.Adrenalgland

6.Pancreas

7.Ovary

8.TestesEndocrinediseases

Endocrinedisordersmaybesubdividedintothreegroups:Endocrineglandhyposecretion(leadingtohormonedeficiency)Endocrineglandhypersecretion(leadingtohormoneexcess)Tumours(benignormalignant)ofendocrineglands

Introduction

ImagingmodalityUltrasound：Thyroiddisease

X-rayCT：Adrenaldiseases

MRI：PituitarydiseaseNuclearmedicine

Radiology：Anatomy+Pathology+…影像診斷

=定位診斷

+定性診斷

ImageThyroiddisorders

GoiterHyperthyroidism Graves-Basedowdisease Toxicmultinodulargoitre

HypothyroidismThyroiditis Hashimoto'sthyroiditisThyroidneoplasm

Thyroidcancer

Thyroiddisorders

GoiterHyperthyroidism Graves-Basedowdisease Toxicmultinodulargoitre

HypothyroidismThyroiditis Hashimoto'sthyroiditisThyroidneoplasm

Thyroidcancer

ThyroidneoplasmThyroidnodulesarecommon,majorpresentationofthyroidneoplasm,asdeterminedusingultrasound.Thewidespreaduseofimagingexaminations(ultrasound,CT)hasledtoan"epidemic"ofthyroidnodules.Thyroidnodulesoccurinupto3%~8%ofadultpopulationwithoutanysymptom.However,5%~10%ofthyroidnodulesaremalignant.Thyroidnodulardisease:toxicornontoxic?malignantorbenign?

MultinodularGoiterMedullaryThyroidCancerThyroidneoplasmThyroidneoplasmisaneoplasmortumorofthethyroid.Itcanbeabenigntumorsuchasthyroidadenoma,oritcanbeamalignantneoplasm(thyroidcarcinoma),suchaspapillary,follicular,medullaryoranaplasticthyroidcarcinoma.ThyroidneoplasmClinicalmanifestationLaboratoryexaminationImagingexaminationUltrasonographyRadionuclidescanningCTMRI

Fineneedleaspirationcytology(FNAC)UltrasonographyUltrasoundisaneasilyavailableandrelativelyinexpensivemodalityandisusedasroutineexaminationfordetectionofthyroidnodule.

Ultrasoundcanaccuratelydetectnonpalpablenodules,estimatethesizeofthenoduleandthevolumeofthegoiter,anddifferentiatesimplecysts,whichhavealowriskofbeingmalignant,fromsolidnodulesorfrommixedcysticandsolidnodules,whichhavea5percentriskofbeingmalignant.thyroidadenomathyroidcarcinomaCT

CTisnotroutinelyusedasaprimarymodalityfordetectionofthyroidnodule.SomecasesofthyroidcarcinomacanbediagnosedcorrectlyaccordingtothecharacteristicmanifestationsonCT.CTscanningcanbeusedtoevaluatesoft-tissueextensionoflargeorsuspiciousthyroidmassesintotheneck,trachea,oresophagusandtoassessmetastasestothecervicallymphnodes.ThyroidcarcinomaThyroidcarcinomaThyroiddisorders

GoiterHyperthyroidism Graves-Basedowdisease Toxicmultinodulargoitre

HypothyroidismThyroiditis Hashimoto'sthyroiditisThyroidneoplasm

Thyroidcancer

甲狀腺腫：a.b.彌漫性甲狀腺腫；c.d.多結(jié)節(jié)性甲狀腺腫

MultinodularGoiterThyroiddisorders

GoiterHyperthyroidism Graves-Basedowdisease Toxicmultinodulargoitre

HypothyroidismThyroiditis Hashimoto'sthyroiditisThyroidneoplasm

Thyroidcancer

Hyperthyroidism

Hypercortisolism

Cushing’sSyndromeCushing’sSyndrome(Hypercortisolism),aconditioncausedbyprolongedexposuretohighlevelsofcortisolproducedbythebodyortakenasmedication.Symptomsincludeupperbodyobesity,roundedor"MOONFACE",easybruising,weakenedbones,fatigue,highbloodpressure,andhighbloodsugar.Cushing'ssyndrome

pituitary（70%）adrenal（20%）ectopic（10%）others

Cushing'ssyndrome

pituitary（70%）adrenal（20%）ectopic（10%）othersDiagnosingCushing'sdiseaseisamultidisciplinaryprocessinvolvingdoctors,endocrinologists,radiologists,surgeons,andchemicalpathologists.

Cushing's

disease

Cushing'sdiseaseisacauseof

Cushing'ssyndrome

characterisedbyincreasedsecretionof

ACTHfromthe

anteriorpituitary.Thisismostoftenasaresultofapituitaryadenomathatstimulatesthesynthesisofcortisolbytheadrenalglands.Pituitaryadenomasareresponsiblefor70%ofendogenousCushing'ssyndrome.

ACTHSource:pituitarygland.Stimulatesthegrowthandsecretionsoftheadrenalcortex.Stimulatestheadrenalcortextosecretecortisol.

Pituitary/Hypothalamic-basedHyperplasia(Cushing’sDisease)AnatomyNormalhypothalamic-pituitaryregion(coronaland

sagitalview)PituitaryGlandorHypophysis,isapea-sizedorganlocatedatthebaseofthebrain.ItisknownastheMASTERGLANDbecauseitregulatesmanybodyactivitiesandstimulatesotherglandstosecretetheirownspecifichormones.Consistsoftheanteriorandposteriorlobe.

MRIofthepituitaryglandHigh-resolutionThin-sectionCoronalandsagittalplanesGadolinium-enhanced(dynamic)ACTH-secretingpituitaryadenomas

microadenoma（≤l0mm）macroadenoma（＞l0mm）hugeadenoma

（invasive）macroadenoma

microadenoma

MRmanifestationsofmicroadenomaT1WI:slightlyhypointensetoisointenseT2WI:isointensetohyperintenseintratumoralhemorrhageorcysticchangesrelativelylowenhancement

Secondarymorphologicfeatures:

focalerosionofthesellarfloorfocalupwardconvexityofthediaphragmasellaedeviationofthestalktotheoppositeside

microadenoma

MRmanifestationsofmacroadenomaMass,WaistlineSignal:T1hypotoiso,T2isotohyperintenseNecrosis,Cystformation,HemorrhageHeterogeneousenhancementInvasionmacroadenoma

Pituitaryapoplexyor

pituitarytumorapoplexyisaclinicalsyndromeofheadache,visualdeficits,ophthalmoplegiaor

doublevision,andalterationinmentalstatusresultingfromthesuddenhemorrhageorinfarctionofapituitaryadenoma.CTandMRimaging,arehelpfulfordiagnosisinboththeacuteandsubacutesettings.PituitaryapoplexyPituitaryapoplexy

Cushing'ssyndrome

pituitary（70%）adrenal（20%）ectopic（10%）othersAdrenalImagingCTisthemostcommonlyuseddiagnosticimagingmodalityforthedetectionandforthecharacterizationofadrenalmasses.UltrasoundCT:size,homogeneity,densityMRIPET-CT

AnatomyoftheAdrenalglandsHyperplasticDisordersCorticalHyperplasiaMacronodularHyperplasiaMicroadenomatousHyperplasiaoftheAdrenalOtherTypesofAdrenalHyperplasiaAdrenalHyperplasiaAdrenalNeoplasmsCorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytomaAdrenalNeoplasmsCorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytomaTumorsassociatedwithCushing’ssyndromearetypicallyunilateralandpresentassharplycircumscribedorencapsulatedmassesthatweighlessthan50gandmeasure3–4cminaveragediameter.Thecortexadjacenttofunctionaladenomasandinthecontralateraladrenalistypicallyatrophic.AdrenalNeoplasmsCorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytomaPheochromocytomaisarare

tumor

ofadrenalglandtissue.Itresultsinthereleaseoftoomuchepinephrineandnorepinephrine,hormonesthatcontrol

heartrate