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Anatomical and functional imaging in endocrine hypertension.

Chaudhary V, Bano S - Indian J Endocrinol Metab (2012)

Bottom Line: In endocrine hypertension, hormonal excess results in clinically significant hypertension.The functional imaging (such as radionuclide imaging) complements anatomy-based imaging (such as ultrasound, computed tomography, and magnetic resonance imaging) to facilitate diagnostic localization of a lesion causing endocrine hypertension.The aim of this review article is to familiarize general radiologists, endocrinologists, and clinicians with various anatomical and functional imaging techniques used in patients with endocrine hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Employees' State Insurance Corporation (ESIC) Model Hospital, Gurgaon, Haryana, India.

ABSTRACT
In endocrine hypertension, hormonal excess results in clinically significant hypertension. The functional imaging (such as radionuclide imaging) complements anatomy-based imaging (such as ultrasound, computed tomography, and magnetic resonance imaging) to facilitate diagnostic localization of a lesion causing endocrine hypertension. The aim of this review article is to familiarize general radiologists, endocrinologists, and clinicians with various anatomical and functional imaging techniques used in patients with endocrine hypertension.

No MeSH data available.


Related in: MedlinePlus

Grave's disease. Tc-99m scintigraphy image of thyroid gland, of a 37-year-old male patient who presented with neck mass and proptosis, demonstrates bilateral enlarged thyroid lobes with diffusely increased uptake of the tracer (arrow)
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Figure 7: Grave's disease. Tc-99m scintigraphy image of thyroid gland, of a 37-year-old male patient who presented with neck mass and proptosis, demonstrates bilateral enlarged thyroid lobes with diffusely increased uptake of the tracer (arrow)

Mentions: Severe untreated hyperthyroidism (thyrotoxicosis) can be associated with elevated blood pressure; however, treatment of thyroid disorder usually lowers the blood pressure to normal. Most common forms of hyperthyroidism include diffuse toxic goiter (Graves’ disease), toxic multinodular goiter (Plummer's disease), toxic adenoma, and subacute thyroiditis. CT and MRI are not routinely used to determine the cause of hyperthyroidism, although can be used selectively when sonography is inadequate or to detect the involvement of adjacent structures by the lesion.[4142] Ultrasound is very sensitive, noninvasive imaging modality of choice for detecting thyroid lesions and distinguishing nodules from cysts. Combining high-resolution sonography with color Doppler and spectral analysis of the vasculature further improves the characterization of thyroid lesions [Figure 5].[43] In Graves’ disease, the thyroid usually appears normal or moderately enlarged with hypoechoic or heterogeneous echotexture. Doppler study demonstrates diffuse parenchymal hypervascularity (“thyroid inferno”) on color flow imaging and significantly high peak systolic velocities (PSV>70–100 cm/s) in inferior thyroid arteries on spectral Doppler analysis. With toxic adenoma or multinodular goiter, sonogram demonstrates one or more thyroid nodules. In subacute thyroiditis, the gland is edematous and hypoechoic. On Doppler evaluation, hot nodules can also be differentiated from cold nodules with more prominent vascular patterns and significantly higher PSV values (>50–70 cm/s) in ipsilateral inferior thyroid artery.[4445] Iodine-123 (123I) and technetium-99m (99mTc) are used for thyroid scanning, which provide anatomic information on the type of lesion. A toxic multinodular goiter demonstrates an enlarged thyroid with multiple nodules and areas of increased and decreased uptake [Figure 6]. Graves’ disease is associated with diffuse enlargement of both thyroid lobes, with an elevated uptake [Figure 7]. A toxic adenoma demonstrates a solitary hot nodule with suppression of function in the surrounding normal thyroid tissue. Subacute thyroiditis usually demonstrates very low 123I isotope uptake.[46] A high correlation between radioisotope scan and color Doppler study has been established, which demonstrates that a scintigraphically hot nodule appears hypervascularized on color Doppler sonography with high PSV in ipsilateral inferior thyroid artery. Being an inexpensive, fast, and noninvasive imaging procedure as compared to radioisotope scan, the Doppler sonography is gaining importance over scintigraphy for the functional evaluation of thyroid disorders. Like 123I isotope scan, Doppler sonography now also has a well-documented role in the management of patients with Graves’ disease, as it helps in monitoring the patients with Graves’ disease on anithyroid drug therapy. The important parameters evaluating the therapeutic efficacy in thyrotoxic patients are decrease in thyroid (Graves’ disease) or nodular (toxic nodule) volume; decreased PSV in the inferior thyroid arteries and decreased radioiodine uptake (Graves’ disease). Moreover, Doppler sonography is the investigation of choice in pregnancy and lactation where nuclear imaging is contraindicated.[4445]


Anatomical and functional imaging in endocrine hypertension.

Chaudhary V, Bano S - Indian J Endocrinol Metab (2012)

Grave's disease. Tc-99m scintigraphy image of thyroid gland, of a 37-year-old male patient who presented with neck mass and proptosis, demonstrates bilateral enlarged thyroid lobes with diffusely increased uptake of the tracer (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475894&req=5

Figure 7: Grave's disease. Tc-99m scintigraphy image of thyroid gland, of a 37-year-old male patient who presented with neck mass and proptosis, demonstrates bilateral enlarged thyroid lobes with diffusely increased uptake of the tracer (arrow)
Mentions: Severe untreated hyperthyroidism (thyrotoxicosis) can be associated with elevated blood pressure; however, treatment of thyroid disorder usually lowers the blood pressure to normal. Most common forms of hyperthyroidism include diffuse toxic goiter (Graves’ disease), toxic multinodular goiter (Plummer's disease), toxic adenoma, and subacute thyroiditis. CT and MRI are not routinely used to determine the cause of hyperthyroidism, although can be used selectively when sonography is inadequate or to detect the involvement of adjacent structures by the lesion.[4142] Ultrasound is very sensitive, noninvasive imaging modality of choice for detecting thyroid lesions and distinguishing nodules from cysts. Combining high-resolution sonography with color Doppler and spectral analysis of the vasculature further improves the characterization of thyroid lesions [Figure 5].[43] In Graves’ disease, the thyroid usually appears normal or moderately enlarged with hypoechoic or heterogeneous echotexture. Doppler study demonstrates diffuse parenchymal hypervascularity (“thyroid inferno”) on color flow imaging and significantly high peak systolic velocities (PSV>70–100 cm/s) in inferior thyroid arteries on spectral Doppler analysis. With toxic adenoma or multinodular goiter, sonogram demonstrates one or more thyroid nodules. In subacute thyroiditis, the gland is edematous and hypoechoic. On Doppler evaluation, hot nodules can also be differentiated from cold nodules with more prominent vascular patterns and significantly higher PSV values (>50–70 cm/s) in ipsilateral inferior thyroid artery.[4445] Iodine-123 (123I) and technetium-99m (99mTc) are used for thyroid scanning, which provide anatomic information on the type of lesion. A toxic multinodular goiter demonstrates an enlarged thyroid with multiple nodules and areas of increased and decreased uptake [Figure 6]. Graves’ disease is associated with diffuse enlargement of both thyroid lobes, with an elevated uptake [Figure 7]. A toxic adenoma demonstrates a solitary hot nodule with suppression of function in the surrounding normal thyroid tissue. Subacute thyroiditis usually demonstrates very low 123I isotope uptake.[46] A high correlation between radioisotope scan and color Doppler study has been established, which demonstrates that a scintigraphically hot nodule appears hypervascularized on color Doppler sonography with high PSV in ipsilateral inferior thyroid artery. Being an inexpensive, fast, and noninvasive imaging procedure as compared to radioisotope scan, the Doppler sonography is gaining importance over scintigraphy for the functional evaluation of thyroid disorders. Like 123I isotope scan, Doppler sonography now also has a well-documented role in the management of patients with Graves’ disease, as it helps in monitoring the patients with Graves’ disease on anithyroid drug therapy. The important parameters evaluating the therapeutic efficacy in thyrotoxic patients are decrease in thyroid (Graves’ disease) or nodular (toxic nodule) volume; decreased PSV in the inferior thyroid arteries and decreased radioiodine uptake (Graves’ disease). Moreover, Doppler sonography is the investigation of choice in pregnancy and lactation where nuclear imaging is contraindicated.[4445]

Bottom Line: In endocrine hypertension, hormonal excess results in clinically significant hypertension.The functional imaging (such as radionuclide imaging) complements anatomy-based imaging (such as ultrasound, computed tomography, and magnetic resonance imaging) to facilitate diagnostic localization of a lesion causing endocrine hypertension.The aim of this review article is to familiarize general radiologists, endocrinologists, and clinicians with various anatomical and functional imaging techniques used in patients with endocrine hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Employees' State Insurance Corporation (ESIC) Model Hospital, Gurgaon, Haryana, India.

ABSTRACT
In endocrine hypertension, hormonal excess results in clinically significant hypertension. The functional imaging (such as radionuclide imaging) complements anatomy-based imaging (such as ultrasound, computed tomography, and magnetic resonance imaging) to facilitate diagnostic localization of a lesion causing endocrine hypertension. The aim of this review article is to familiarize general radiologists, endocrinologists, and clinicians with various anatomical and functional imaging techniques used in patients with endocrine hypertension.

No MeSH data available.


Related in: MedlinePlus