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1、Diagnostic imaging of endocrine system,FANG Wenqiang Department of Radiology, Ruijin Hospital Shanghai Jiaotong University School of Medicine,Major endocrine glands. (Male left, female on the right.) 1.Pineal gland 2.Pituitary gland 3.Thyroid gland 4.Thymus 5.Adrenal gland 6.Pancreas 7.Ovary 8.Teste
2、s,Endocrine diseases,Endocrine disorders may be subdivided into three groups: Endocrine gland hyposecretion (leading to hormone deficiency) Endocrine gland hypersecretion (leading to hormone excess) Tumours (benign or malignant) of endocrine glands,Introduction,Imaging modality Ultrasound：Thyroid di
3、sease X-ray CT：Adrenal diseases MRI：Pituitary disease Nuclear medicine,Radiology ：Anatomy + Pathology + ,影像诊断 = 定位诊断 + 定性诊断,Image,Thyroid disorders,Goiter Hyperthyroidism Graves-Basedow disease Toxic multinodular goitre Hypothyroidism Thyroiditis Hashimotos thyroiditis Thyroid neoplasm Thyroid cance
4、r,Thyroid disorders,Goiter Hyperthyroidism Graves-Basedow disease Toxic multinodular goitre Hypothyroidism Thyroiditis Hashimotos thyroiditis Thyroid neoplasm Thyroid cancer,Thyroid neoplasm,Thyroid nodules are common, major presentation of thyroid neoplasm, as determined using ultrasound. The wides
5、pread use of imaging examinations (ultrasound, CT) has led to an “epidemic“ of thyroid nodules. Thyroid nodules occur in up to 3%8% of adult population without any symptom. However, 5%10% of thyroid nodules are malignant.,Thyroid nodular disease: toxic or nontoxic? malignant or benign?,Multinodular
6、Goiter,Medullary Thyroid Cancer,Thyroid neoplasm,Thyroid neoplasm is a neoplasm or tumor of the thyroid. It can be a benign tumor such as thyroid adenoma, or it can be a malignant neoplasm (thyroid carcinoma), such as papillary, follicular, medullary or anaplastic thyroid carcinoma.,Thyroid neoplasm
7、,Clinical manifestation Laboratory examination Imaging examination Ultrasonography Radionuclide scanning CT MRI Fine needle aspiration cytology (FNAC),Ultrasonography,Ultrasound is an easily available and relatively inexpensive modality and is used as routine examination for detection of thyroid nod
8、ule. Ultrasound can accurately detect nonpalpable nodules, estimate the size of the nodule and the volume of the goiter, and differentiate simple cysts, which have a low risk of being malignant, from solid nodules or from mixed cystic and solid nodules, which have a 5 percent risk of being malignant
9、.,thyroid adenoma,thyroid carcinoma,CT,CT is not routinely used as a primary modality for detection of thyroid nodule. Some cases of thyroid carcinoma can be diagnosed correctly according to the characteristic manifestations on CT. CT scanning can be used to evaluate soft-tissue extension of large o
10、r suspicious thyroid masses into the neck, trachea, or esophagus and to assess metastases to the cervical lymph nodes.,Thyroid carcinoma,Thyroid carcinoma,Thyroid disorders,Goiter Hyperthyroidism Graves-Basedow disease Toxic multinodular goitre Hypothyroidism Thyroiditis Hashimotos thyroiditis Thyro
11、id neoplasm Thyroid cancer,甲状腺肿：a.b.弥漫性甲状腺肿；c.d.多结节性甲状腺肿,Multinodular Goiter,Thyroid disorders,Goiter Hyperthyroidism Graves-Basedow disease Toxic multinodular goitre Hypothyroidism Thyroiditis Hashimotos thyroiditis Thyroid neoplasm Thyroid cancer,Hyperthyroidism,Hypercortisolism Cushings Syndrome,
12、Cushings Syndrome (Hypercortisolism), a condition caused by prolonged exposure to high levels of cortisol produced by the body or taken as medication. Symptoms include upper body obesity, rounded or “MOON FACE“, easy bruising, weakened bones, fatigue, high blood pressure, and high blood sugar.,Cushi
13、ngs syndrome,pituitary （70%） adrenal （20%） ectopic （10%） others,Cushings syndrome,pituitary （70%） adrenal （20%） ectopic （10%） others,Diagnosing Cushings disease is a multidisciplinary process involving doctors, endocrinologists, radiologists, surgeons, and chemical pathologists.,Cushings disease,Cus
14、hings disease is a cause of Cushings syndrome characterised by increased secretion of ACTH from the anterior pituitary. This is most often as a result of a pituitary adenoma that stimulates the synthesis of cortisol by the adrenal glands. Pituitary adenomas are responsible for 70% of endogenous Cush
15、ings syndrome.,ACTH Source: pituitary gland. Stimulates the growth and secretions of the adrenal cortex. Stimulates the adrenal cortex to secrete cortisol.,Pituitary/Hypothalamic-based Hyperplasia (Cushings Disease),Anatomy,Normal hypothalamic-pituitary region (coronal and sagital view),Pituitary Gl
16、and or Hypophysis, is a pea-sized organ located at the base of the brain. It is known as the MASTER GLAND because it regulates many body activities and stimulates other glands to secrete their own specific hormones. Consists of the anterior and posterior lobe.,MRI of the pituitary gland,High-resolut
17、ion Thin-section Coronal and sagittal planes Gadolinium-enhanced (dynamic),ACTH-secreting pituitary adenomas,microadenoma （ l0mm ） macroadenoma （l0mm ） huge adenoma （invasive）,macroadenoma,microadenoma,MR manifestations of microadenoma,T1WI: slightly hypointense to isointense T2WI: isointense to hyp
18、erintense intratumoral hemorrhage or cystic changes relatively low enhancement Secondary morphologic features: focal erosion of the sellar floor focal upward convexity of the diaphragma sellae deviation of the stalk to the opposite side,microadenoma,MR manifestations of macroadenoma,Mass, Waistline
19、Signal: T1 hypo to iso, T2 iso to hyperintense Necrosis, Cyst formation, Hemorrhage Heterogeneous enhancement Invasion,macroadenoma,Pituitary apoplexy or pituitary tumor apoplexy is a clinical syndrome of headache, visual deficits, ophthalmoplegia or double vision, and alteration in mental status re
20、sulting from the sudden hemorrhage or infarction of a pituitary adenoma. CT and MR imaging, are helpful for diagnosis in both the acute and subacute settings.,Pituitary apoplexy,Pituitary apoplexy,Cushings syndrome,pituitary （70%） adrenal （20%） ectopic （10%） others,Adrenal Imaging,CT is the most com
21、monly used diagnostic imaging modality for the detection and for the characterization of adrenal masses.,Ultrasound CT: size, homogeneity, density MRI PET-CT,Anatomy of the Adrenal glands,Hyperplastic Disorders,Cortical Hyperplasia Macronodular Hyperplasia Microadenomatous Hyperplasia of the Adrenal
22、 Other Types of Adrenal Hyperplasia,Adrenal Hyperplasia,Adrenal Neoplasms,Cortical Adenomas Cortical Carcinoma Neuroblastic Tumors Pheochromocytoma,Adrenal Neoplasms,Cortical Adenomas Cortical Carcinoma Neuroblastic Tumors Pheochromocytoma,Tumors associated with Cushings syndrome are typically unila
23、teral and present as sharply circumscribed or encapsulated masses that weigh less than 50 g and measure 34 cm in average diameter.,The cortex adjacent to functional adenomas and in the contralateral adrenal is typically atrophic.,Adrenal Neoplasms,Cortical Adenomas Cortical Carcinoma Neuroblastic Tu
24、mors Pheochromocytoma,Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure.,Pheochromocytoma with necrosis,Cushings syndrome,pituitary （70%） adrenal （20%） ectop
25、ic （10%） others,Ectopic Cushing syndrome, on the other hand, occurs when ACTH is produced somewhere other than the pituitary gland. Ectopic means occurring in an abnormal place.,Cushings syndrome,pituitary （70%） adrenal （20%） ectopic （10%） others,Ectopic Cushing syndrome is caused by tumors that rel
26、ease ACTH. Tumors that can, in rare cases, release ACTH include: Benign carcinoid tumors of the lung Islet cell tumors of the pancreas Medullary carcinoma of the thyroid Small cell tumors of the lung Tumors of the thymus gland,F 35Y,12853,Case 1,1d,Ectopic ACTH syndrome,Case 1,Ectopic ACTH syndrome,12853,Case 1,Ectopic ACTH syndrome,Thank You!,