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What is the initial effect of inflammation on thyroid hormones in Hashitoxicosis?
Which imaging modality is superior to CT for assessing invasion of trachea/oesophagus in thyroid cancer?
What is the characteristic appearance of enlarged parathyroid glands on imaging?
What is the primary purpose of contrast-enhanced CT scans in thyroid cancer?
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What is the role of Ultrasonography Guided Fine Needle Aspiration (FNA) in thyroid nodules?
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Which of the following is NOT a type of thyroid nodule?
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What is the role of Scintigraphy in thyroid imaging?
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Which imaging modality is NOT commonly used in thyroid gland imaging?
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What is the recommended imaging modality for the thyroid gland?
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What is the characteristic of a Lipid-Poor Adenoma on CT?
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What is the role of fat in differentiating Adenoma from Carcinoma?
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What is the recommended imaging modality for the pituitary gland?
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What is the characteristic of a Parathyroid gland on imaging?
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What is the characteristic of Graves' disease on Ultrasound?
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What is the characteristic of a Pheochromocytoma on MRI?
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What is the role of Calcification in Adrenal Gland Pathology?
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What is the recommended imaging modality for the adrenal gland in neonates and children?
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What is the characteristic of an Adrenal gland on Ultrasound?
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What is the typical echogenicity of the thyroid gland in relation to the surrounding strap muscles on ultrasound?
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What is the normal range of length for the thyroid gland lobes on ultrasound?
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What type of Doppler image is typically used to evaluate thyroid vascularity?
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Which of the following imaging modalities uses ionizing radiation?
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What is the typical appearance of the thyroid gland on ultrasound in the sagittal plane?
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What is the relationship between the thyroid gland and the parathyroid glands in terms of anatomical location?
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Study Notes
Imaging Modalities for Endocrine System
- Imaging modalities for the endocrine system can be categorized into ionizing radiation (X-ray, CT, fluoroscopy, angiography, nuclear medicine) and non-ionizing radiation (US, MRI) methods.
Thyroid and Parathyroids
- The thyroid gland is located in the anterior neck and has a schematic relationship with important anatomical landmarks.
- The parathyroid glands are represented by green dots and are also located in the anterior neck.
Thyroid US Anatomy
- The thyroid gland appears homogenous and echogenic/hyperechoic on US, with a sagittal and axial plane.
- The gland has a normal vascularity on color Doppler image, with a spectral Doppler flow showing a low resistive wave.
- The transverse dimension (width-W) and anterior-posterior length (L) of the lobes are 4-5 cm.
Thyroid Pathology
- Thyroid pathology can be seen in adenoma, myelolipoma, trauma, and granulomatous infection.
- Graves' disease appears as an enlarged, heterogenous, and hypermetabolic gland on imaging.
- Hashimoto's disease cannot be differentiated from Graves' disease on imaging in its initial stage.
Adrenal Gland
- The adrenal gland can be imaged using CT, MRI, and PET-CT.
- A lipid-poor adenoma appears as an indeterminate lesion on non-contrast CT, with a signal drop on out-of-phase imaging compared to in-phase imaging.
- Pheochromocytoma appears as a heterogeneous enhancing right adrenal mass on CT, with intense tracer uptake on PET-CT and a high signal on T2W MRI.
- Adrenocortical carcinoma appears as a heterogeneous enhancing right adrenal mass on CT, with punctate, irregular calcifications.
Take Home Messages
- The first line of imaging modality for endocrine system components depends on the type of organ being imaged.
- Complimentary imaging modalities are used to further evaluate the organ.
- Thyroid gland appears homogenous and echogenic/hyperechoic on US, and hyperdense on CT.
- Parathyroid gland is not identifiable in all imaging modalities when normal, but appears as a hypoechoic nodule when enlarged.
- Pituitary gland is best evaluated using MRI, which can identify microadenoma and macroadenoma.
- Adrenal gland is best evaluated using US in neonates and children, and CT in adults.
Thyroid Nuclear Medicine Studies
- Scintigraphy and PET-CT are used to evaluate thyroid nodules and carcinoma.
- Malignant nodule carcinoma appears as a hot spot on isotope scan/scintigraphy and PET-CT.
Parathyroid Gland Pathologies
- Parathyroid gland pathologies can be seen in adenoma and hyperparathyroidism.
- Enlarged parathyroid glands appear as hypoechoic nodules on US and may compress the adjacent anterior thyroid parenchyma.
FNA and Ultrasound
- Ultrasonography-guided fine needle aspiration (FNA) is used to diagnose thyroid nodules.
- Contrast-enhanced CT scans and MRI are useful in evaluating the extension and invasion of tumor into the adjacent neck structures.
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Description
This quiz covers the different imaging modalities used to diagnose and visualize the endocrine system, including the thyroid and parathyroid glands.