内分泌系统教学资料diagnosticimagingofendocrinesystem

Diagnosticimagingofendocrinesystem FANGWenqiangDepartmentofRadiology RuijinHospitalShanghaiJiaotongUniversitySchoolofMedicine Majorendocrineglands Maleleft femaleontheright 1 Pinealgland2 Pituitarygland3 Thyroidgland4 Thymus5 Adrenalgland6 Pancreas7 Ovary8 Testes Endocrinediseases Endocrinedisordersmaybesubdividedintothreegroups Endocrineglandhyposecretion leadingtohormonedeficiency Endocrineglandhypersecretion leadingtohormoneexcess Tumours benignormalignant ofendocrineglands Introduction ImagingmodalityUltrasound ThyroiddiseaseX rayCT AdrenaldiseasesMRI PituitarydiseaseNuclearmedicine Radiology Anatomy Pathology 影像诊断 定位诊断 定性诊断 Image Thyroiddisorders GoiterHyperthyroidismGraves BasedowdiseaseToxicmultinodulargoitreHypothyroidismThyroiditisHashimoto sthyroiditisThyroidneoplasmThyroidcancer Thyroiddisorders GoiterHyperthyroidismGraves BasedowdiseaseToxicmultinodulargoitreHypothyroidismThyroiditisHashimoto sthyroiditisThyroidneoplasmThyroidcancer Thyroidneoplasm Thyroidnodulesarecommon majorpresentationofthyroidneoplasm asdeterminedusingultrasound Thewidespreaduseofimagingexaminations ultrasound CT hasledtoan epidemic ofthyroidnodules Thyroidnodulesoccurinupto3 8 ofadultpopulationwithoutanysymptom However 5 10 ofthyroidnodulesaremalignant Thyroidnodulardisease toxicornontoxic malignantorbenign MultinodularGoiter MedullaryThyroidCancer Thyroidneoplasm Thyroidneoplasmisaneoplasmortumorofthethyroid Itcanbeabenigntumorsuchasthyroidadenoma oritcanbeamalignantneoplasm thyroidcarcinoma suchaspapillary follicular medullaryoranaplasticthyroidcarcinoma Thyroidneoplasm ClinicalmanifestationLaboratoryexaminationImagingexaminationUltrasonographyRadionuclidescanningCTMRIFineneedleaspirationcytology FNAC Ultrasonography Ultrasoundisaneasilyavailableandrelativelyinexpensivemodalityandisusedasroutineexaminationfordetectionofthyroidnodule Ultrasoundcanaccuratelydetectnonpalpablenodules estimatethesizeofthenoduleandthevolumeofthegoiter anddifferentiatesimplecysts whichhavealowriskofbeingmalignant fromsolidnodulesorfrommixedcysticandsolidnodules whichhavea5percentriskofbeingmalignant thyroidadenoma thyroidcarcinoma CT CTisnotroutinelyusedasaprimarymodalityfordetectionofthyroidnodule SomecasesofthyroidcarcinomacanbediagnosedcorrectlyaccordingtothecharacteristicmanifestationsonCT CTscanningcanbeusedtoevaluatesoft tissueextensionoflargeorsuspiciousthyroidmassesintotheneck trachea oresophagusandtoassessmetastasestothecervicallymphnodes Thyroidcarcinoma Thyroidcarcinoma Thyroiddisorders GoiterHyperthyroidismGraves BasedowdiseaseToxicmultinodulargoitreHypothyroidismThyroiditisHashimoto sthyroiditisThyroidneoplasmThyroidcancer 甲状腺肿 a b 弥漫性甲状腺肿 c d 多结节性甲状腺肿 MultinodularGoiter Thyroiddisorders GoiterHyperthyroidismGraves BasedowdiseaseToxicmultinodulargoitreHypothyroidismThyroiditisHashimoto sthyroiditisThyroidneoplasmThyroidcancer Hyperthyroidism HypercortisolismCushing sSyndrome Cushing 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 others DiagnosingCushing sdiseaseisamultidisciplinaryprocessinvolvingdoctors endocrinologists radiologists surgeons andchemicalpathologists Cushing sdisease Cushing sdiseaseisacauseofCushing ssyndromecharacterisedbyincreasedsecretionofACTHfromtheanteriorpituitary Thisismostoftenasaresultofapituitaryadenomathatstimulatesthesynthesisofcortisolbytheadrenalglands Pituitaryadenomasareresponsiblefor70 ofendogenousCushing ssyndrome ACTHSource pituitarygland Stimulatesthegrowthandsecretionsoftheadrenalcortex Stimulatestheadrenalcortextosecretecortisol Pituitary Hypothalamic basedHyperplasia Cushing sDisease Anatomy Normalhypothalamic pituitaryregion coronalandsagitalview PituitaryGlandorHypophysis isapea sizedorganlocatedatthebaseofthebrain ItisknownastheMASTERGLANDbecauseitregulatesmanybodyactivitiesandstimulatesotherglandstosecretetheirownspecifichormones Consistsoftheanteriorandposteriorlobe MRIofthepituitarygland High resolutionThin sectionCoronalandsagittalplanesGadolinium enhanced dynamic ACTH secretingpituitaryadenomas microadenoma l0mm macroadenoma l0mm hugeadenoma invasive macroadenoma microadenoma MRmanifestationsofmicroadenoma T1WI slightlyhypointensetoisointenseT2WI isointensetohyperintenseintratumoralhemorrhageorcysticchangesrelativelylowenhancementSecondarymorphologicfeatures focalerosionofthesellarfloorfocalupwardconvexityofthediaphragmasellaedeviationofthestalktotheoppositeside microadenoma MRmanifestationsofmacroadenoma Mass WaistlineSignal T1hypotoiso T2isotohyperintenseNecrosis Cystformation HemorrhageHeterogeneousenhancementInvasion macroadenoma Pituitaryapoplexyorpituitarytumorapoplexyisaclinicalsyndromeofheadache visualdeficits ophthalmoplegiaordoublevision andalterationinmentalstatusresultingfromthesuddenhemorrhageorinfarctionofapituitaryadenoma CTandMRimaging arehelpfulfordiagnosisinboththeacuteandsubacutesettings Pituitaryapoplexy Pituitaryapoplexy Cushing ssyndrome pituitary 70 adrenal 20 ectopic 10 others AdrenalImaging CTisthemostcommonlyuseddiagnosticimagingmodalityforthedetectionandforthecharacterizationofadrenalmasses UltrasoundCT size homogeneity densityMRIPET CT AnatomyoftheAdrenalglands HyperplasticDisorders CorticalHyperplasiaMacronodularHyperplasiaMicroadenomatousHyperplasiaoftheAdrenalOtherTypesofAdrenalHyperplasia AdrenalHyperplasia AdrenalNeoplasms CorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytoma AdrenalNeoplasms CorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytoma TumorsassociatedwithCushing ssyndromearetypicallyunilateralandpresentassharplycircumscribedorencapsulatedmassesthatweighlessthan50gandmeasure3 4cminaveragediameter Thecortexadjacenttofunctionaladenomasandinthecontralateraladrenalistypicallyatrophic AdrenalNeoplasms CorticalAdenomasCorticalCarcinomaNeuroblasticTumorsPheochromocytoma Pheochromocytomaisararetumorofadrenalglandtissue Itresultsinthereleaseoftoomuchepinephrineandnorepinephri