Multimodality Imaging Review of Multiple Endocrine Neoplasia.

OBJECTIVE. The purpose of this article is to review the clinical manifestations, endocrine tumors types, and multimodality diagnostic tools available to physicians involved in the management of patients with multiple endocrine neoplasia (MEN) syndrome, in addition to discussing relevant imaging findings and appropriate imaging follow-up. CONCLUSION. Thorough knowledge of the spectrum of tumors associated with MEN gene mutations aids in the screening, diagnostic workup, and posttreatment monitoring of patients with MEN-related gene mutations.

Imaging endocrinology in animal models of endocrine disease.

Endocrine organs secrete a variety of hormones involved in the regulation of a multitude of body functions. Although pancreatic islets were discovered at the turn of the 19th century, other endocrine glands remained commonly described as diffuse endocrine systems. Over the last two decades, development of new imaging techniques and genetically-modified animals with cell-specific fluorescent tags or specific hormone deficiencies have enabled in vivo imaging of endocrine organs and revealed intricate endocrine cell network structures and plasticity. Overall, these new tools have revolutionized our understanding of endocrine function. The overarching aim of this Review is to describe the current mechanistic understanding that has emerged from imaging studies of endocrine cell network structure/function relationships in animal models, with a particular emphasis on the pituitary gland and the endocrine pancreas.

A seeding-searching-ensemble method for gland segmentation in H&E-stained images.

BACKGROUND: Glands are vital structures found throughout the human body and their structure and function are affected by many diseases. The ability to segment and detect glands among other types of tissues is important for the study of normal and disease processes and helps their analysis and visualization by pathologists in microscopic detail. METHODS: In this paper, we develop a new approach for segmenting and detecting intestinal glands in H&E-stained histology images, which utilizes a set of advanced image processing techniques: graph search, ensemble, feature extraction, and classification. Our method is computationally fast, preserves gland boundaries robustly and detects glands accurately. RESULTS: We tested the performance of our gland detection and segmentation method by analyzing a dataset of over 1700 glands in digitized high resolution clinical histology images obtained from normal and diseased human intestines. The experimental results show that our method outperforms considerably the state-of-the-art methods for gland segmentation and detection. CONCLUSIONS: Our method can produce high-quality segmentation and detection of non-overlapped glands that obey the natural property of glands in histology tissue images. With accurately detected and segmented glands, quantitative measurement and analysis can be developed for further studies of glands and computer-aided diagnosis.

Hydatid disease involving some rare locations in the body: a pictorial essay.

Hydatid disease (HD) is an endemic illness in many countries, and it poses an important public health problem that's influenced by peoples' socioeconomic status and migration that spreads this disease. Although rare, it may occur in any organ or tissue. The most common site is the liver (59-75%), followed in frequency by lung (27%), kidney (3%), bone (1-4%) and brain (1-2%). Other sites such as the heart, spleen, pancreas and muscles are very rarely affected. Unusual sites for this disease can cause diagnostic problems. This pictorial essay illustrates various radiological findings of HD in the liver, spleen, kidney, pancreas, peritoneal cavity, omentum, adrenal, ovary, lung, mediastinum and retroperitoneum. Familiarity with the imaging findings of HD may be helpful in making an accurate diagnosis and preventing potential complications.

[Nuclear medicine for general radiologists: endocrinological examinations].

We reviewed nuclear endocrinological examinations of the thyroid, parathyroid, and adrenal glands that are clinically performed in Japan as well as somatostatin receptor imaging, which is widely used in Europe, the United States, and other countries. 123I thyroid scintigraphy is especially useful in detecting ectopic goiters and differentiating between Basedow's disease and subacute thyroiditis or Plummer's disease, all of which exhibit thyrotoxicosis. 201Tl is useful to detect foci metastasized from well differentiated thyroid cancer and to differentiate malignant from benign tumors. 67Ga-citrate is an agent used for patients suspected of having malignant lymphoma or undifferentiated carcinoma of the thyroid. Radioiodinated MIBG is a specific agent for medullary thyroid carcinoma. 99mTc-MIBI is a good agent for locating hyperfunctioning parathyroid tissues. 131I-adosterol is useful to locate the lesions of primary aldosteronism, Cushing's syndrome, adrenogenital syndrome, and select adenomas among incidental tumors. Radioiodinated MIBG scintigraphy has high diagnostic accuracy in locating pheochromocytomas and neuroblastomas. 111In-labeled octreotide is useful in locating, hormone-producing gastrointestinal and pancreatic tumors including carcinoids, gastrinomas, and insulinomas. Radiolabeled somatostatin receptor analogs are used not only to locate but also to treat malignant somatostatin receptor-positive tumors. We hope that Octreoscan will be available in Japan in the near future.

Cohen syndrome: evaluation of its cardiac, endocrine and radiological features.

Cohen syndrome (MIM no. 216550) is an autosomal recessive disorder with a typical clinical picture. Since the first report, most publications have represented single case reports. In this study, our aim was to describe cardiac, endocrine and radiological abnormalities in 22 Cohen patients of Finnish descent. Detailed investigations of the heart revealed the anatomy of the heart to be normal with no evidence for clinically significant mitral prolapse. However, a decreased left ventricular function with advancing age was identified. No significant endocrine abnormalities were found at the examination of pituitary, adrenal and thyroid function. The height was either normal or patients were moderately short (mean height standard deviation score (SDS) - 2) at all ages, associated, however, often with the marked kyphosis. Truncal obesity was seen in 4/22 patients. X-rays of the chest, lumbar and thoracic spine, long bones, ankles and metacarpophalangeal pattern profiles revealed kyphosis, scoliosis and calcaneo planovalgus as common features. Fingers of these patients were slender but short with a characteristic metacarpophalangeal pattern profile.

[Present status and progress of endocrine nuclear medicine].

The author reviewed present status and progress of endocrine nuclear medicine including thyroid, parathyroid, adrenocortical, adrenomedullary and somatostatin receptor imaging and also radionuclide therapy of Basedow's disease, metastatic foci of post-operative thyroid cancer and malignant neural crest tumor. Relatively new imaging agents include 99mTc-MIBI and 99mTc-tetrofosmin for parathyroid imaging and 111In-pentetreotide for somatostatin receptor imaging. It is hoped that therapy of malignant neural crest tumors such as metastatic pheochromocytoma and neuroblastoma with 131I-MIBG and somatostatin receptor imaging will be available in Japan as soon as possible.

Endocrine therapies of breast cancer.

Endocrine therapies for breast cancer have been used for more than a century. The concept that changing the hormonal balance of the patient with breast cancer could lead to changes in tumor growth and regression of metastatic disease was recognized even before hormones and endocrine agents were available. Ablation of ovaries, adrenals, or hypophysis was used in advanced disease to obtain tumor regression and control of symptoms. Ovarian ablation was also tested for operable breast cancer showing a significant beneficial treatment effect. Several endocrine agents have been developed in recent years: estrogens, androgens, progestins, antiestrogens, aromatase inhibitors, gonadotropin-releasing hormone analogs, antiprogestins, and antiandrogens. The use of some of these agents in advanced disease led to investigations in early breast cancer: tamoxifen was the drug which was most extensively tested, showing a significant long-term benefit for treated patients. Progestins (medroxyprogesterone acetate) and aromatase inhibitors (aminoglutethimide) were also tested in a few clinical trials, but no conclusive recommendations for their use in patients with operable disease may be formulated. The most important current challenges for the appropriate use of endocrine therapies in breast cancer include (1) understanding the effect of endocrine therapies and the mechanisms of resistance associated with their use; (2) developing new agents with novel endocrine antitumor effect; (3) defining the best way to combine endocrine agents with cytotoxics or with other endocrine manipulations; and (4) identifying long-term effects of endocrine agents in terms of disease control and prevention, as well as desirable and undesirable side effects.

Endocrinological applications in nuclear medicine.

Diagnosis and treatment of thyroid diseases have played a major role in Central European Nuclear Medicine. Since 1950, endocrinological nuclear medicine has been one of the strengths of this medical discipline. Not only diagnosis but also conservative treatment with thyroid depressants or hormones is performed by the nuclear medicine specialists. Nuclear medicine also takes part in the diagnosis of other endocrine diseases. The respective procedures include imaging of the adrenal gland (cortex and medulla) as well as of the parathyroid glands. Especially in the latter diseases, imaging was improved through Tc-99m sestamibi scintigraphy. Beyond that, the measurement of bone mineral content contributes to the full spectrum of endocrinological nuclear medicine. The development of In-111 octreotide now plays a limited role in the diagnosis of diseases of the pituitary gland.

Radionuclides in endocrine imaging.

Radiopharmaceuticals used in endocrine imaging encompass both standard and recently developed techniques used to diagnose diseases of the endocrine system. The initial part of this article deals with the characteristics of a suitable radionuclide/radiopharmaceutical required for successful scintigraphic endocrine imaging. The remainder of the article includes clinical applications and practical uses of developed scintigraphic agents in diagnosing disorders of the various endocrine glands. Finally, there is reference to the new and exciting neuropeptide imaging agent Octreoscan 111.

Computed tomographic, magnetic resonance, and monoclonal antibody imaging of endocrine tumors.

Recent advances in diagnostic imaging with computed tomography, magnetic resonance imaging, and monoclonal antibody imaging in endocrine tumor evaluation are reviewed. Computed tomography is a mature technology whose role has not changed recently. Magnetic resonance imaging is continuing to advance in scan techniques, scan time reduction, and use of intravenous contrast agents; its future role on a routine basis may allow it to supplant computed tomography in endocrine tumor identification. Monoclonal antibody imaging has not yet proven to be as reliably diagnostic for tumor identification as is computed tomography, but continuing technical advances predict an advancing role for diagnosing endocrine tumors with this modality.

Imaging the endocrine glands.

Nuclear medicine utilizes specific radiopharmaceuticals which have the ability to concentrate in and be handled by specific organ systems. Functional imaging is therefore added to the information available from methods which excel in the recording of anatomical information (such as ultrasound, computed tomography and magnetic resonance imaging). The specificity of the radioactive tracer methods is particularly apparent when related to investigation of the endocrine glands (Figs 1-8). This short and practical survey outlines the main areas of clinical application and utility.

[New techniques of scintigraphic imaging]. / Les nouvelles techniques d'imagerie scintigraphique.

The purpose of scintigraphic imaging is not to explore the morphology of an organ (or its abnormalities) but rather its functional and metabolic characteristics. It is thus important that a molecular structure (e.g., a hormonal receptor or an antigen) closely linked to the functional activity of an organ or tissue be targeted on its cell surface. Such diagnostic targeting requires the synthesis and labeling of a radiopharmaceutical substance specific for the receptor or antigen in question. It also requires a detection system adapted to count rates and signal-to-background ratios (generally moderate). The synthesis of new radiopharmaceutical agents, a critical stage for the future of nuclear medicine, is a long and often risky process in which success is difficult to foresee. Radiolabeling must be stable in vitro and in vivo, and the radiopharmaceutical must subsequently retain its capability of recognizing the targeted molecule. In endocrinology, the exemplary achievement in this direction has been the synthesis of 131I-6-iodomethylnorcholesterol and 131I-metaiodobenzylquanidine for functional scintigraphy of the adrenal cortex and medulla. Progress in detection equipment has been marked by the development of monophotonic tomoscintigraphy, using gamma cameras with a revolving head to obtain slices in different spatial planes showing the distribution in the organism of the injected radiopharmaceutical agent.

The scintigraphic imaging of endocrine organs.

The nuclear medicine approach to the portrayal of endocrine organs is unique; the scintigraphic images provide not only anatomic and localization information, but in many instances allow a quantitative assessment of organ function. The ability to image endocrine glands is based upon the design of radionuclides and radiopharmaceuticals with characteristics to take advantage of many unique and specific biochemical and advantage of many unique and specific biochemical and metabolic functions of these tissues. The recent introduction of new radiopharmaceutical and tracers has provided the consulting endocrinologist with imaging procedures that allow localization and functional characterization not available by other single, noninvasive diagnostic modalities. This review will serve as an update of the available techniques to image and quantitate the function of the endocrine glands using the nuclear medicine approach.