內(nèi)分泌系統(tǒng)教學(xué)資料 diagnostic imaging of endocrine system 1220

1、fang wenqiangdepartment of radiology, ruijin hospitalshanghai jiaotong university school of medicinemajor 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.testesendocrine diseases endocrine disorders ma

2、y 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 introductionimaging modality ultrasound：thyroid disease x-ray ct：adrenal diseases mri：pituitar

3、y disease nuclear medicine radiology ：anatomy + pathology + 影像診斷影像診斷 = 定位診斷定位診斷 + 定性診斷定性診斷 imagethyroid disorders goiter hyperthyroidismgraves-basedow diseasetoxic multinodular goitre hypothyroidism thyroiditishashimotos thyroiditis thyroid neoplasmthyroid cancer thyroid disorders goiter hyperthyroi

4、dismgraves-basedow diseasetoxic multinodular goitre hypothyroidism thyroiditishashimotos thyroiditis thyroid neoplasmthyroid cancer thyroid neoplasm thyroid nodules are common, major presentation of thyroid neoplasm, as determined using ultrasound. the widespread use of imaging examinations (ultraso

5、und, 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 goitermedullary thyroid cancerthyroid neopla

6、sm 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 clinical manifestation laboratory examination

7、 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 nodule. ultrasound can accurately detect nonpalpa

8、ble 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. thyroid adenomathyroid carcinomact ct is not

9、 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 or suspicious thyroid masses into the neck, trach

10、ea, or esophagus and to assess metastases to the cervical lymph nodes. thyroid carcinomathyroid carcinomathyroid disorders goiter hyperthyroidismgraves-basedow diseasetoxic multinodular goitre hypothyroidism thyroiditishashimotos thyroiditis thyroid neoplasmthyroid cancer 甲狀腺腫：a.b.彌漫性甲狀腺腫；c.d.多結(jié)節(jié)性甲狀

11、腺腫 multinodular goiterthyroid disorders goiter hyperthyroidismgraves-basedow diseasetoxic multinodular goitre hypothyroidism thyroiditishashimotos thyroiditis thyroid neoplasmthyroid cancer hyperthyroidism cushings syndrome (hypercortisolism), a condition caused by prolonged exposure to high levels

12、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.cushings syndrome pituitary （70%） adrenal （20%） ectopic （10%） others cushings syndrome pituitary （70%）

13、 adrenal （20%） ectopic （10%） others diagnosing cushings disease is a multidisciplinary process involving doctors, endocrinologists, radiologists, surgeons, and chemical pathologists. cushings disease cushings disease is a cause of cushings syndrome characterised by increased secretion of acth from t

14、he 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 cushings syndrome. acthsource: pituitary gland. stimulates the growth and secretions of the adrenal c

15、ortex. stimulates the adrenal cortex to secrete cortisol. pituitary/hypothalamic-based hyperplasia(cushings disease)anatomynormal hypothalamic-pituitary region (coronal and sagital view)pituitary gland or hypophysis, is a pea-sized organ located at the base of the brain. it is known as the master gl

16、and 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-resolution thin-section coronal and sagittal planes gadolinium-enhanced (dynamic) acth-secreting pituitary ad

17、enomas microadenoma （ l0mm ） macroadenoma （l0mm ） huge adenoma（invasive）macroadenoma microadenoma mr manifestations of microadenoma t1wi: slightly hypointense to isointense t2wi: isointense to hyperintense intratumoral hemorrhage or cystic changes relatively low enhancement secondary morphologic fea

18、tures: focal erosion of the sellar floorfocal upward convexity of the diaphragma sellaedeviation of the stalk to the opposite side microadenoma mr manifestations of macroadenoma mass, waistline signal: t1 hypo to iso, t2 iso to hyperintense necrosis, cyst formation, hemorrhage heterogeneous enhancem

19、ent invasionmacroadenoma pituitary apoplexy or pituitary tumor apoplexy is a clinical syndrome of headache, visual deficits, ophthalmoplegia or double vision, and alteration in mental status resulting from the sudden hemorrhage or infarction of a pituitary adenoma. ct and mr imaging, are helpful for

20、 diagnosis in both the acute and subacute settings. pituitary apoplexypituitary apoplexy cushings syndrome pituitary （70%） adrenal （20%） ectopic （10%） others ct is the most commonly used diagnostic imaging modality for the detection and for the characterization of adrenal masses. ultrasound ct: size

21、, homogeneity, density mri pet-ct anatomy of the adrenal glandshyperplastic disorders cortical hyperplasia macronodular hyperplasia microadenomatous hyperplasia of the adrenal other types of adrenal hyperplasiaadrenal hyperplasiaadrenal neoplasms cortical adenomas cortical carcinoma neuroblastic tum

22、ors pheochromocytomaadrenal neoplasms cortical adenomas cortical carcinoma neuroblastic tumors pheochromocytomatumors associated with cushings syndrome aretypically unilateral and present as sharply circumscribedor encapsulated masses that weigh less than50 g and measure 34 cm in average diameter.th

23、e cortex adjacent to functional adenomas and in the contralateral adrenal is typically .adrenal neoplasms cortical adenomas cortical carcinoma neuroblastic tumors pheochromocytomapheochromocytoma is a rare tumor of adrenal gland tissue. it results in the release of too much epinephrine and norepinephrine, hormones that control