Radiology 412

Question 1

Imaging tools for adrenal masses

Answer 1

appearance - diagnostic radiology (CT scans etc)
functional characteristics - nuclear medicine
percutaneous biopsy (rarely done) - interventional radiology

Question 2

Best imaging test for pituitary mass

Answer 2

CT scan is better because you get a 3D map - first line; If you’re specifically looking for something on adrenals, you can get both normal and contrast enhancement. Look for how quickly contrast washes out.

Can also use MRI (no radiation). Reserved for people who need to avoid radiation.

PET/CT scan - nuclear medicine test. Anatomical information combined with functional characteristics. Do this if there is a specific question about malignancy.

Question 3

What aspects of the CT scan of adrenal glands indicates that it is more or less likely malignant? (3)

Answer 3

1 .If the intensity is <10 we are reassured that it pribably isn’t malignant (probably fatty);

2. Risk of malignancy is much higher for tumor > 4cm;
3. If there is little contrast washout, we worry that the tumor is malignant.

Question 4

MRI for assessing adrenal glands

Answer 4

MRI is good at looking at soft tissue - more detail;

Can use gadolinium contrast;

Question 5

What is nuclear medicine?

Answer 5

Use radioactive substances to diagnosis or treat patients;

Question 6

Problems with PET/CT

Answer 6

Concerns with radiation;

Question 7

1231 MIBG

Answer 7

used in the workup of patients with suspected pheochromocytoma

Question 8

18F-FDG PET/CT

Answer 8

Whole body PET after IV infjection of 18F-FDG (taken up quickly by cancer cells). ALlows s to see cancer cells.
High sensitivity for detecting malignancy.

Question 9

Percutaneous needle biopsy

Answer 9

Done rarely.
Biopsy adrenal nodule under CT-guidance. But differentiating malignant/benign in adrenal gland, can’t be done with a biopsy!. It can however, detect metastatic tissue, so we do this if we suspect metastatic disease.