Radiation diagnosis of thyroid diseasesRadiation diagnosis of thyroid diseases

Radiation diagnosis of emergency conditions

Dr. Lenchuk Tatyana Phd

Radiation methods of thyroid gland Radiation methods of thyroid gland

To investigate the thyroid gland (thyroid) using methods such basic radiation To investigate the thyroid gland (thyroid) using methods such basic radiation methods: methods:

1. 1. Ultrasound: Ultrasound: - Sonography (B - mode); - Sonography (B - mode); - Color Doppler mapping; - Color Doppler mapping; - Fine needle aspiration biopsy under ultrasound.- Fine needle aspiration biopsy under ultrasound. 2. 2. Radionuclide: Radionuclide: - Determination of thyroid iodine accumulation capacity; - Determination of thyroid iodine accumulation capacity; - Dynamic scintigraphy; - Dynamic scintigraphy; - Static scintigraphy; - Static scintigraphy; - Radio immune analysis.- Radio immune analysis.

3. 3. CTCT; ; 4. 4. MRIMRI..

UltrasonicUltrasonic

Ultrasound necessarily assigned all patients to confirm or exclude Ultrasound necessarily assigned all patients to confirm or exclude thyroid pathology . thyroid pathology . Indications for ultrasound:Indications for ultrasound:1. determine the size , scope , structure cancer to differentiate 1. determine the size , scope , structure cancer to differentiate nodular mixed , diffuse goiter and autoimmune thyroiditis ;nodular mixed , diffuse goiter and autoimmune thyroiditis ;2. determine the size , position , shape, structure ( echogenicity ) 2. determine the size , position , shape, structure ( echogenicity ) nodes , the presence of capsule micro calcifications ;nodes , the presence of capsule micro calcifications ;3. determining topographic changes of the neck of their mutual 3. determining topographic changes of the neck of their mutual location of the thyroid , possible dislocation of the neck ;location of the thyroid , possible dislocation of the neck ;4. definition enlarged regional lymph nodes.4. definition enlarged regional lymph nodes.  Preparing the patient for ultrasound is required. Studies conducted Preparing the patient for ultrasound is required. Studies conducted in the supine position .in the supine position .Normally the structure of thyroid isoechogenic , homogeneous, fine-Normally the structure of thyroid isoechogenic , homogeneous, fine-grained grained . Volume not exceeding 25 cm3 men and 18 cm3 in women. Volume not exceeding 25 cm3 men and 18 cm3 in women

Nodular Goiter

Ultrasound

Fine needle aspiration biopsy Fine needle aspiration biopsy has gained widely has gained widely used in the diagnosis of thyroid disease. The used in the diagnosis of thyroid disease. The study of biopsy material to determine the nature study of biopsy material to determine the nature of the process (benign or malignant) and to of the process (benign or malignant) and to clarify the histological identity of the tumor. clarify the histological identity of the tumor.

Research MethodologyResearch Methodology. In ultrasound doctor . In ultrasound doctor spends puncture site of thyroid fine needle that spends puncture site of thyroid fine needle that is connected to an empty syringe. Once the tip is connected to an empty syringe. Once the tip of the needle enters the middle of node, the of the needle enters the middle of node, the doctor repeatedly held aspiration of its contents doctor repeatedly held aspiration of its contents with a syringe.with a syringe.

Fine needle Fine needle aspiration biopsyaspiration biopsy

Radionuclide diagnosis Radionuclide diagnosis of thyroid image more like a butterfly rarely of thyroid image more like a butterfly rarely horseshoe, the central part of each particle is more contrasting than horseshoe, the central part of each particle is more contrasting than peripheral. In the case of toxic adenomas are detected "hot" nodes (with peripheral. In the case of toxic adenomas are detected "hot" nodes (with high function)high function),, if cysts - "cold" areas where I131 will not accumulate if cysts - "cold" areas where I131 will not accumulate..

Indications for scintigraphy:Indications for scintigraphy:1. Anatomical changes: 1. Anatomical changes: - Formation of focal neck (nodes); - Formation of focal neck (nodes); - Ectopic thyroid tissue.- Ectopic thyroid tissue.2. Functional changes ; 2. Functional changes ; - Hypothyroidism; - Hypothyroidism; - Hyperthyroidism. - Hyperthyroidism. 3. Monitoring during treatment: 3. Monitoring during treatment: - Therapeutic - evaluation of effectiveness; - Therapeutic - evaluation of effectiveness; - Surgery (preoperative preparation - definition of surgical intervention, - Surgery (preoperative preparation - definition of surgical intervention, evaluation areas of the body that are subject to removal and control of evaluation areas of the body that are subject to removal and control of postoperative changes).postoperative changes).

Radionuclide diagnosis

Hyperthyroidism Of Colloid Multinodular GoiterMultiple foci of increased isotope uptake with suppressed concentration in other areas

Radionuclide diagnosis

Hyperthyroid: Thyroid Nodule•I-123 uptake•One hot nodule•Suppressed uptake of iodine in rest of the gland

Graves Disease•Bilateral diffuse•Increased I-131 uptake

Radionuclide diagnosis

Radionuclide diagnosis

Thyroid Nodule

Indications for PET thyroid: Indications for PET thyroid: 1. Head and neck tumors: 1. Head and neck tumors: - Differential diagnosis of malignant and benign process; - Differential diagnosis of malignant and benign process; - Definition of the regional lymph nodes metastases; - Definition of the regional lymph nodes metastases; - Identification of distant metastases; - Identification of distant metastases; - Determination of tumor recurrence.- Determination of tumor recurrence.

CT and MRI CT and MRI is used to identify tumors of small size in the case of is used to identify tumors of small size in the case of common processes to determine the true limits of defeat. common processes to determine the true limits of defeat. CT before the operation provides information about the CT before the operation provides information about the relationship of thyroid tumors with surrounding relationship of thyroid tumors with surrounding anatomical structures.anatomical structures.

Thyroid Cancer With MetastasisScans obtained 48 hours after I 131 therapy demonstrate increased isotope accumulation in the thoracic spine, lumbar spine,  left upper rib and left pelvis, consistent with metastasis.

CT normal thyroid gland

Thyroid Carcinoma

Thyroid CarcinomaLeft lobe seen displacing the trachea.

Thyroid CancerLarge mass with inhomogenous enhancement seen arising from the right lobe of thyroid.Arrow points to normal enhancement of the left lobe.

Thyroid CancerLarge mass is seen arising from the left lobe of the thyroid gland with inhomogenous enhancement.Arrow points to normal right lobe.

Thyroid CancerMultiple lung metastasis

Emergency Conditions

Foreign body airway . Most often this happens with children. Leads to disruption of bronchial obstruction . X-ray contrast bodies based on radiographs of the chest cavity in two perpendicular projections. Most often localized in the right main bronchi or lower share bronchi . As a result of mucosal edema developed three levels of violations of bronchial obstruction - hypoventilation , emphysema, atelectasis. On these grounds diagnosed low-contrast foreign bodies . It must exclude using larynhotraheobronсhoscopy .

atelectasisforeign body

Hydropericardium-accumulation of transudate in the pericardial cavity observed in inflammatory and neoplastic lesions and wounds of the heart, in the development of cardiac, renal failure, hypothyroidism and congestion in the lungs. When X-ray observed a gradual increase in heart size, weakening and disappearance waves along its contours . Ultrasound - an effective and affordable method for the detection of even a small amount of fluid in the pericardial cavity. CT and MRI - a highly inaccessible.

Emergency Conditions

Hypothyroid: Pericardial EffusionIncidental left subpulmonic pleural effusion

Hydrothorax, the presence of liquid contents into the pleural cavity. The resulting tumor, systemic, inflammatory diseases, kidney and heart failure. X-rays intense shade of oblique upper edge (line Alice - Damuazo) ultrasound - is also an effective method for detecting fluid determining its structure. CT and MRI - best practices to identify not only fluid but also in lung and mediastinal organs .Organs shifted in the opposite direction.

Pleural Effusion

•White arrows point to bilateral pleural effusions.

Pleural EffusionHomogenous density in dependent portion, right lung base.Loss of diaphragmatic and right cardiac silhouette.Meniscus high in axilla.

Massive Pleural EffusionLeft hemithorax completely opacified.Mediastinum shifted to right.Left hemithorax larger.

Pneumothorax-air accumulation in the pleural cavity occurs due to violation of the integrity of the pleura and lung collapse, trauma surgery, breakthrough pathological focus into the pleural cavity. On radiographs turns air into the pleural cavity and descending lungs varying degrees. The diaphragm on the affected side is lowered, the bodies of the mediastinum shifted to the healthy side. Highly informative method for the diagnosis of pneumothorax is CT.

Pneumothorax•No vascular markings on right.•No shift of mediastinum to left.•Deep sulcus.•Atelectatic right lung.•Increased haziness on left; diversion of entire cardiac output.Small fluid level near costophrenic angle; hydro pneumothorax

Pneumothorax•Air in the pleural cavity

No vascular markingsDark

•Atelectatic lung margin.•Shift of mediastinum to opposite side.•Left hemithorax larger, closer to total lung capacity position.•Increased vascular markings on right. Shift of cardiac output to right lung.

The X-ray picture of the acute The X-ray picture of the acute abdomenabdomen

1.1. Bowel obstructionBowel obstruction..- highhigh;;- lowlow..SymptomsSymptoms::- - Kloyberg cups Kloyberg cups((at the background of at the background of

swallen bowel there is the presence of swallen bowel there is the presence of horisontal level of fluidhorisontal level of fluid).).

Symptoms do not patency the small intestine:Kloyberh bowl located in the central parts of the image;-Height is greater than their width;-Not see haustres. Arrow: Dilated jejunum.Arrowheads: Surgical clips.

Small Bowel Obstruction•Multiple dilated fluid filled small bowel loops. [white arrow ]•C : colon with contrast.•Incidentally note evidence of laminectomy. [double arrows ]

Bowel Obstruction•Dilated loops of bowel •Air fluid levels.  

Symptoms do not patency in the large intestine:Kloyberh bowl located in peripheral parts of the image; Their width is greater than height;Haustres - see.

2. Perforate ulcer.

- Symptom of sickle (the presence of air under the right cupola of the diaphragm).

Pneumoperitoneum

Arrow points to free air central tendon

Bowel Perforation / PneumoperitoneumFindings:•White arrow points to diaphragm.•Black arrow points to subdiaphragmatic air.