Organs

X-ray
Hypothalamus
Pituitary
Pineal
3
Thyroid
Parathyroid
Adrenals
3
Pancreas
1 ERCP
Ovaries
Testicles
Note! Subjective data!

CT
2
2
2

2
1

MRI
1
1
1
3
1
1/2

U/S

Nuc Med

1/2
1/2
2
2
1
1

1
1
3

Angiography

3
3

Hypothalamus:
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Best viewed with MRI
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Magnetic Resonance Imaging (MRI) is a medical imaging technique based on the magnetic properties of protons.
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MRI is a tomographic modality, which means it images a set of slices throught the body.
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Variations of the numerous imaging parameters yield multiple contrasts (T1-weighted images, T2-weighted images, proton
density,...) which are complementary for the diagnosis of lesions.
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In addition, advanced MRI techniques (fMRI, DTI, perfusion imaging) make it possible to measure physiological parameters
during an MRI examination.
Pituitary
Magnetic Resonance Imaging (MRI) Scan
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MRI is the standard imaging test to identify pituitary tumors.
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MRI can easily identify a macroadenoma of the pituitary gland and is also good at identifying most microadenomas.
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But the MRI may not be able to detect many microadenomas smaller than three millimeters (about 1/8 inch).
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Sometimes the MRI scan finds a small abnormality in the pituitary unrelated to the patient's symptoms.
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Between 5 and 25 percent of healthy people have some minor abnormality of the pituitary gland that shows up on an MRI
scan.
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This scan uses magnetic fields and radio waves to generate images of the brain.
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MRI scans are particularly useful in diagnosing brain tumors because they outline soft tissues as well as bone.
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Sometimes a special dye is injected into the bloodstream to distinguish tumors from healthy tissue.
MRI (magnetic resonance imaging) with gadolinium:
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A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain
and spinal cord.
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A substance called gadolinium is injected into a vein.
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The gadolinium collects around the cancer cells so they show up brighter in the picture.
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This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan):
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A procedure that makes a series of detailed pictures of areas inside the brain, taken from different angles.
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The pictures are made by a computer linked to an x-ray machine.
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A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
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This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Pineal
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Request for magnetic resonance imaging (MRI) scan or a computed tomography (CT or CAT) scan be done, as well as chest
X-rays, to determine if the tumor has spread from another part of the body.
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An MRI usually finds low-grade astrocytomas earlier than CT.
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Cerebral angiography is rarely used to diagnose a brain tumor, but it may be done before surgery.
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X-rays of the Head and Skull
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An x-ray of the head may show alterations in skull bones that could indicate a tumor. It may show calcium deposits, which are
sometimes associated with brain tumors. However, a routine x-ray is a far less sensitive test than brain scans and so is used
less often.
Thyroid
MRI
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U/S
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These are high tech and high cost forms of x-rays that are rarely indicated in the evaluation of a thyroid mass.
Once in a very rare while, a complicated or difficult case may come along where this would be indicated. Rarely.
This test is a sort of "sonar" that may tell us if a thyroid tumor is solid or cystic, cystic meaning hollow and fluid filled.
This can be of some interest since thyroid cysts are rarely cancerous.
Still, in most cases skilled fingers can discern between the two types of masses without this test.
You, for example, could probably tell the difference between a golf ball and a ping pong ball if you were handed them while
blindfolded.

Also, many thyroid tumors can be partially solid and partially cystic, further confusing the matter because either might be
malignant or benign.
NUCLEAR MEDICINE
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This is a radioactive picture of the thyroid gland that can tell us if a tumor is "functioning" or "nonfunctioning".
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This can sometimes be helpful, but since some thyroid cancers function and some do not, it cannot diagnose thyroid cancer.
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A radioactive iodine uptake (RAI-U) test can help tell whether a person has Graves' disease, toxic multinodular goiter, or
thyroiditis.
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In this test, a small dose of radioactive iodine 123 is given in pill form.
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Several hours later, the amount of iodine in the bloodstream is measured, often accompanied by an x-ray that views how the
iodine concentrates in the thyroid.
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An overactive thyroid usually takes up higher amounts of iodine than normal, and that uptake is visible in the x-ray.
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A thyroid that takes up iodine is considered "hot," or overactive, as opposed to a "cold" or underactive thyroid.
In Graves' disease, RAI-U is elevated, and the entire gland becomes hot.
In Hashimoto's thyroiditis, the uptake is usually low, with patchy hot spots in the gland.
RAI-U can show when thyroid nodules are hot. If you are hyperthyroid due to a hot nodule, and not Graves' disease, the
nodule will show up as hot, and the rest of your thyroid will be cold. Hot nodules may overproduce thyroid hormone but they
are rarely cancerous.
RAI-U can also show which thyroid nodules are cold - not taking up iodine - and an estimated 10 to 20 percent of cold nodules
are cancerous.
Note: Radioactive iodine 131 (the type of iodine used for ablation of the thyroid and cancer treatment) is not used in this scan.
This scan uses radioactive I-123, which is considered better and safer for testing because it has a shorter half life, and gives
off a very low level of radiation.
In some cases, technetium 99M is used instead of iodine.
The half-life of technetium is six hours.
Technetium is sometimes preferred in women who are breastfeeding, because the radioactivity dissipates more quickly, and a
nursing mother could get back to nursing her infant more quickly.
Because this test involves radioactivity, it is not performed on pregnant women under any circumstances.
Parathyroid
Parathyroid hormone test:
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A procedure in which a blood sample is checked to measure the amount of parathyroid hormone released into the blood by the
parathyroid glands.
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A higher than normal amount of parathyroid hormone can be a sign of disease.
Sestamibi scan:
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A type of radionuclide scan used to find an overactive parathyroid gland.
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A small amount of a radioactive substance called technetium 99 is injected into a vein and travels through the bloodstream to
the parathyroid gland.
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The radioactive substance will collect in the overactive gland and show up brightly on a special camera that detects
radioactivity.
CT scan (CAT scan):
Ultrasound exam:
Angiogram:
A thyroid and parathyroid ultrasound is done to:
Check lumps (nodules) in the thyroid gland.
A thyroid ultrasound can usually show the difference between a solid thyroid gland nodule and a simple fluid-filled sac (cyst).
Find out whether the thyroid gland is enlarged.
A thyroid ultrasound may also be used to keep track of the size of the thyroid gland during treatment for a thyroid problem.
Look for enlarged parathyroid glands caused by disease.
Normal parathyroid glands are often difficult to see on ultrasound and cannot be felt during physical examination.
But abnormal parathyroid glands may be enlarged and easily seen by ultrasound.
Guide the placement of the needle during a thyroid biopsy.
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Adrenals
Adrenal imaging
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At this time, most of the adrenal incidentalomas are detected by ultrasound, which reflects the widespread use of this
technique.
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Additional imaging by CT is usually performed, as detailed characterization of an adrenal mass by ultrasound alone cannot be
obtained.
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An exception is the highly echogenic adrenal myelolipoma, which does not need further imaging investigation.
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On CT, adrenal adenomas typically appear homogeneous and exhibit a density lower than water (< 15 HU) and well defined
margins.
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A cut-off of < 2 HU was recommended to avoid overlooking a malignoma, but this low threshold leads to many indefinite
adrenal tumors .

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Therefore, a cut-off of 10 HU [23] and 24 HU with a 14 min delay on contrast enhanced CT scan seems to be practicable to
distinguish between adenomas and metastases.
Adrenal cortical carcinomas are generally larger, inhomogeneous and show soft tissue density.
Irregular margins and central necrosis or hemorrhage increase the probability of malignancy.
However, benign pheochromocytoma may also present as a large inhomogeneous tumor with hemorrhage.
Although chemical shift MRI is commonly performed, it probably does not provide additional information beyond that which is
already available on unenhanced CT.
In difficult cases, MRI may be helpful to further differentiate benign from malignant adrenal tumors, although again a clear
discrimination cannot be achieved.
Adenomas exhibit a decreased intensity on T2-weighted MRI compared to non-adenoma.
Gadolinium-enhanced dynamic studies have found strong enhancement and slow wash-out in malignant neoplasms, while
adenomas showed rapid wash-out.
However, there are contrary results in the differentiation of benign and malignant lesion.
The recently developed chemical shift MRI (CSI) is the recommended method of choice today.
Benign tumors like adrenal adenomas with high lipid content demonstrate a typical signal intensity loss on chemical shift
imaging relative to the liver . Recently a sensitivity of 91 % and specificity of 94 % was reported using CSI in comparison to
histopathology.
Additionally, 131I-methylnorcholesterol scan was recommended as a valuable screening tool for subclinical Cushings
syndrome, as evidence was provided that unilateral uptake is related to functioning adenomas.
Adrenocortical scintigraphy with NP-59 and 75Se-methylnorcholesterol has been advocated for analysis of adrenal
incidentalomas.
In malignant neoplasms the uptake of the radiotracer is decreased or missing at the tumor bearing side leading to a
discordant pattern.

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Pancreas
Computed Tomography (CT) Scan With Contrast Dye
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This imaging test can help assess the health of the pancreas.
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A CT scan can identify complications of pancreatic disease such as fluid around the pancreas, an enclosed infection
(abscess), or a collection of tissue, fluid, and pancreatic enzymes (pancreatic pseudocyst).
Abdominal Ultrasound
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An abdominal ultrasound can detect gallstones that might block the outflow of fluid from the pancreas.
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It also can show an abscess or a pancreatic pseudocyst.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
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In an ERCP, a health care professional places a tube down the throat, into the stomach, then into the small intestine.
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Dye is used to help the doctor see the structure of the common bile duct, other bile ducts, and the pancreatic duct on an X-ray.
Endoscopic Ultrasound
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In this test, a probe attached to a lighted scope is placed down the throat and into the stomach.
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Endoscopic ultrasound may reveal gallstones and can be helpful in diagnosing severe pancreatitis when an invasive test such
as ERCP might make the condition worse.
Magnetic Resonance Cholangiopancreatography
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This kind of magnetic resonance imaging (MRI) can be used to look at the bile ducts and the pancreatic duct.
Ovaries
Ultrasound/sonogram:
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Either an abdominal or transvaginal ultrasound exam may be performed to examine the ovaries.
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An abdominal ultrasound involves moving a hand-held transducer over the abdomen to create images of the ovaries.
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A transvaginal ultrasound involves inserting an ultrasound probe, slightly larger than a tampon, into the vagina to obtain
images of the ovaries.
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Researchers are investigating whether transvaginal ultrasound may be effective at screening women who are at high risk of
ovarian cancer but who do not have any symptoms of the disease.
Testicles
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Testicle ultrasound is an imaging test that examines the testicles and other parts inside the scrotum.
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The ultrasound is done to help determine why one or both testicles have become larger, or to find the reason for pain in the
testicles.
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The testicles and other areas in the scrotum should appear normal.
What Abnormal Results Mean
Possible causes of abnormal results include:
Infection with or without abscess
Noncancerous (benign) cyst
Testicular torsion
Testicular tumor
Risks
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There are no known risks. You will not be exposed to ionizing radiation with this test.
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Ionizing radiation procedures such as x-ray carry a small cancer risk and may damage sperm, but this test does not.

Considerations
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In certain cases, Doppler ultrasound may help identify blood flow inside the scrotum.
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For example, Doppler ultrasound is very helpful in cases of testicular torsion, because blood flow to the twisted testicle may be
reduced.

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