Protocol introduction to pheochromocytoma pediatric and reproductive endocrinology branch national institute of child health and human development national institutes of health we are inviting you to participate in this study because we believe that you may have pheochromocytoma, a tumor located in the adrenal gland or outside the adrenal gland. To study the magnetic resonance imaging characteristics of adrenal and extraadrenal pheochromocytomas in the abdomen and pelvis. About 10% of pheochromocytomas were thought to be hereditary, but neumann et al, 8 have shown that approximately 25% of patients with sporadic pheochromocytoma and no family history have germline mutations of one of four susceptibility genes for pheochromocytoma. You have to specify that you need the breast area studied.
Localization of pheochromocytoma by computed tomography. Coronal t1 and t2weighted images from the anterior margin of the frontal sinus to the hypothalamus were. Differentiating an adenoma from a pheochromocytoma is more difficult using ct scanning. Pheochromocytoma is an important, often clinically occult neoplasm with devastating consequences if overlooked. Our radiologists work closely with ohsu mri technologists in the art of creating. Choledocholithiasis and cholelithiasis with intrahepatic and extra hepatic biliary ductal dilatation but without sonographic evidence of acute cholecystitis. Pheochromocytoma with posthemorrhagic cystic degeneration. Magnetic resonance characterization of pheochromocytomas in. Choose one of the access methods below or take a look at our subscribe or free trial options. Usefulness of imibg scintigraphy in the evaluation of. Mri protocols are a combination of various mri sequences, designed to optimally assess a particular region of the body andor pathological process.
An mibg scan is commonly used for detection of neuroendocrine tumours, such as neuroblastoma and phaeochromocytoma. An overview of magnetic resonance imaging relating to diagnosis, extraction and followup of a pheochromocytoma article in the canadian journal of medical radiation technology camrt 353. You may leave the departmenthospital during this time. Mri may also be used as the initial imaging procedure when there is pregnancy involved. Pheochromocytoma allison becker medical student jayanth h. Magnetic resonance imaging findings in kallmann syndrome. Protocol for the examination of specimens from patients with. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. The book does a good job of describing the physical principles of mri in a clear and concise manner. Protocol for the examination of specimens from patients. Correspondence from the new england journal of medicine diagnosis of pheochromocytoma by computed axial tomographic scan and other methods. The book has a small pocket book format, and is therefore easy to bring along.
Eligibility criteria pheochromocytoma and paraganglioma. Building 10, room 140 10 center drive bethesda, md 20892. Diagnosis of pheochromocytoma by computed axial tomographic. A recipe book presenting protocols for most major studies in mr images. Head, neck, chest, and abdominal mri may be helpful in the diagnosis of pheochromocytoma. Ppt pheochromocytoma powerpoint presentation free to. Mri is the most sensitive modality for identification of pheochromocytomas and is particularly useful in cases of extraadrenal location. Medical intelligence from the new england journal of medicine localization of pheochromocytoma by computed tomography. Magnetic resonance imaging clinics of north america, vol. Pheochromocytomas are most common in the fourth through sixth decades of life. The adrenal medulla plays an instrumental role in synthesizing and secreting catecholamines hormones such as epinephrine adrenaline and norepinephrine. Mri handbook mr physics, patient positioning, and protocols.
The college of american pathologist breast cancer protocol 40 recommends that the size of hpf be measured by using a micrometer. Pheochromocytomas release chemicals called catecholamines, causing high. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Each layer of these glands makes different hormones. The mri of extraadrenal pheochromocytoma in the abdominal. A pheochromocytoma is a rare, catecholaminesecreting tumor derived from chromaffin cells. Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol. Paraganglioma pg of the urinary bladder is a rare neuroendocrine neoplasm, accounting for mri is increasingly used because of its multiplanar capability, high sensitivity for contrast enhancement, and lack of ionizing radiation.
These tumors, which usually arise from the adrenal glands, are often difficult to detect with current methods. Protocol for the examination of specimens from patients with pheochromocytomas and extraadrenal paragangliomas. The second part of the book chapters 611 uses extensive illustrations, images, and protocol tables to explain tips and tricks to achieve optimal mr image. Pheochromocytoma cook, linda kay, phd, rn, ccrn, ccns, acnpbc ajn the american journal of nursing. She also complains of diarrhea for the past 2 weeks. Pheochromocytoma imaging with an unremarkable biochemical. Hpi 67 year old female presents with ruq pain following large meals. Varying imaging protocols show a highly necrotic mass displacing the right kidney. T1weighted slightly hypointense to the remainder of the adrenal gland, if there is necrosis andor hemorrhage then the signal will be more heterogeneous. Pheochromocytoma is a rare neuroendocrine tumor, occurring in less than 0.
Alternatively, it has been suggested that that the high power field diameterarea can also be calculated by using the following formulas 40. T1 functional imaging for pheochromocytomaparaganglioma. Mri, scintigraphy bone, octreotide, 18ffdg pet, 1imibg, blood and urine catecholamine and metabolite measurements, and clinical followup. The relative usefulness of mri and i1metaiodobenzylguanidine mibg scintigraphy is controversial. Doctors give unbiased, trusted information on the use of ct scan for pheochromocytoma. The general concept of mri is that the body part of interest is put into a magnetic field. Purpose we sought to characterize the magnetic resonance imaging mri findings in patients with kallmann syndrome ks materials and methods fourteen patients with ks and a comparison group of 20 matched people with normal mri were analyzed with optimized voxelbased morphometry. There is also a possibility of a second set of images at 48 hours after the injection. T2 a step closer to understanding its place in clinical practice. The term pheochromocytoma in greek, phios means dusky, chroma means color, and cytoma means tumor refers to the color the tumor cells acquire when stained with chromium salts. This site provides clear and easily accessible guide to many of the practical aspects of mri including mri protocols, mri planning, mri anatomy, mri. The reason for this difference is unknown, but it likely results from the high water content in cellular homogeneous tumors or from the high water content in. To ascertain the magnetic resonance mr imaging characteristics of pheochromocytomas and paragangliomas and to compare mr with computed tomography ct and iodine1 metaiodobenzylguanidine i1 mibg, 19 patients 18 with pheochromocytomas, one with a paraganglioma were studied.
Mri showing bilateral macronodular hyperplasia causing cushings syndrome. Can a ct scan of the abodmen and pelvis with and without. The first five chapters of the book introduce the reader to the basics of mr imaging, including the relaxation concept, mr pulse sequences, and mr imaging. Superior to the right kidney in the area of the adrenal gland there is a wellcircumscribed, heterogenous mass which measures 4. In approximately 60 percent of patients, the tumor is discovered incidentally during computed tomography ct or magnetic resonance imaging mri of. Nuclear medicine adrenal gland scan providence health care. It also provides many details for protocols and imaging. Phcmn044 feb08 page 2 of 2 what happens during the test. The extraadrenal lesions are also referred to as paragangliomas.
It outlines all sequences and protocols currently applied in our mri section. Incidental right adrenal mass which is incompletely characterized by ultrasound. I had a followup ct that showed nothing, but the technician didnt have my positive mri, and they forgot to have me fast or swallow ct contrast until just. Advances in the diagnostic imaging of pheochromocytomas rmi. The various imaging appearances on ultrasound, ct, mri, and functional imaging can be complementary and have features that are useful for differentiating pheochromocytoma from other lesions of the adrenal. The cancer typically develops in the central part of the adrenal glands called the adrenal medulla, which is responsible for producing important hormones such epinephrine, adrenalin.
These tumors arise from neural crestderived cells, which also give rise to portions of the central nervous system and the sympathetic paraganglion system. These hormones help keep your heart rate and blood pressure. Abdominal ct scanning has accuracy of 8595% for detecting adrenal masses with a spatial resolution of 1 cm or greater. Functional imaging for pheochromocytomaparaganglioma. Aug 10, 2018 a pheochromocytoma is a rare, catecholaminesecreting tumor derived from chromaffin cells. A nuclear medicine mibg exam is used to detect and localize neuroendocrine tumors. Magnetic resonance characterization of pheochromocytomas. The middle part of the adrenal glands makes epinephrine and norepinephrine. Mri of the knee is a comprehensive guide for investigations of the knee joint. Pheochromocytoma is a rare tumor that usually develops from one of the bodys two adrenal glands, located above each kidney in the back of the upper abdomen. The goal of this study is to develop better methods of diagnosis, localization, and treatment for pheochromocytomas.
This book provides an overview of current knowledge on the clinical situation, diagnosis and therapy of the disease as well as an extensive discussion of novel aspects in the molecular basis of this disease such as the recognition of new tools in. Eleven consecutive patients with an extraadrenal pheochromocytoma in abdominal cavity who underwent preoperative 0. The patient is a 65yearold white man with a past medical history significant for severe coronary artery disease, arrhythmias, hypertension, hyperlipidemia, anxiety and type 2 diabetes. Because of their varied clinical, imaging, and pathologic appearances, accurate diagnosis can be challenging. Hammerstead on can a ct scan of the abodmen and pelvis with and without contract detect pheochromocytoma. The mri of extraadrenal pheochromocytoma in the abdominal cavity.
A subscription is required to access all the content in best practice. This will be determined after the images are taken at. Computed tomography ct, rather than magnetic resonance imaging mri, is recommended as the firstline imaging technique. May 11, 2011 advances in the diagnostic imaging of pheochromocytomas eva forssellaronsson1, emil schuler1, hakan ahlman21department of radiation physics, 2department of surgery, lundberg laboratory of cancer research, institute of clinical sciences, sahlgrenska academy at the university of gothenburg, sahlgrenska university hospital, gothenburg, swedenabstract. Pheochromocytomas are rare, mostly benign tumors of the adrenal medulla whose symptoms are caused by a tumorinduced secretion of catecholamines. These mutations may be seen in isolation 94% of cases or as part of a.
Mri protocols, mri planning, mri techniques and anatomy. Definition pheochromocytomas, sometimes simply referred to as pheos, are rare tumors that develop in the inner region medulla of the adrenal gland. Our literary philosophy is that mri books for clinicians should be written by clinicians. I had a followup ct that showed nothing, but the technician didnt have my positive mri, and they forgot to have me fast or swallow ct contrast until just before the scan. Hi, i thought i found my pheo when i had a questionable 1 cm mass on my adrenal gland, on mri. Mr imaging reveals a large well defined mass in the right adrenal gland. An overview of magnetic resonance imaging relating to. The purpose of this study was to summarize the mr appearances of extraadrenal pheochromocytoma in the abdominal cavity and evaluate the capabilities of mri in diagnosis of the tumor. Pheochromocytoma something about radiology just for. An mibg scan is a nuclear medicine scan that uses iodine123 metaiodobenzylguanidine mibg for short. A pheochromocytoma is an adrenal medullary tumor composed of chromaffin cells and capable of secreting biogenic amines and peptides, including epinephrine, norepinephrine, and dopamine.