Pemeriksaan Radiologi untuk

sistem endokrin

Dr. Triana Dyah Cahyawati, Sp. Rad,

M.Sc
Pemeriksaan radiologi untuk tiroid

Foto polos
USG
CT
MRI
Skintigraf
PET / PET CT
Foto polos

Peran relatif terbatas

Dapat memperlihatkan
Gambaran massa jaringan lunak
(kalsifkasi +/-)
Deviasi trakhea.
Perluasan retrosternal
Metastasis paru (pada foto thorax)
.
www.themegallery.c
om
Coned apical radiograph of the upper
thorax shows curvilinear calcifcation in a
thyroid adenoma, at the root of the neck,
on the right side.
Massa tiroid
Snowstorm Appearance-innumerable small pulmonary
nodules frequently associated with metastatic
carcinoma from thyroid
Ultrasonograf

Mudah tersedia
Non invasif , Non radiasi
Sensitif untuk mendiagnosis lesi tiroid.
Modalitas penting untuk evaluasi massa
tiroid
Evaluasi rutin nodul
Evaluasi limfonodi cervicales
FNAB guiding USG dari lnn yang dicurigai
guiding luasnya pembedahan.
USG color doppler
Ultrasonograf

www.themegallery.c
om
 USG

USG: Normal thyroid gland

Colloid nodule. Transverse US image shows a predominantly anechoic cystic
lesion (*)
with a thin wall, well-circumscribed margins, and mild posterior acoustic
enhancement.
Note the linear echogenic colloid crystals suspended within the fuid (arrow).
Chronic lymphocytic (Hashimoto) thyroiditis in a 53-year-old woman
with a swollen thyroid. (a) Longitudinal duplex US image shows
diffusely heterogeneous thyroid parenchyma with abnormal
diffusely increased vascular fow.
 Computed Tomography (CT) &
Magnetic resonance imaging [MRI]
Evaluasi
Perluasan tumor (ke leher, trakea,
esofagus dsb)
Metastasis ke Limfonodi cervical yang
terkait
A 51-year-old woman with follicular carcinoma with venous invasion.
She presented with an enlarging neck mass. (a) Axial enhanced CT
image demonstrates a heterogeneously enlarged thyroid gland
(arrows), displacing the trachea to the right. This was biopsied and
determined to be follicular carcinoma. There was no evidence of neck
adenopathy, and what resembles a node in the left neck
(arrowheads) represents intravenous extension of tumor in the left
internal jugular vein (IJV). (b) Coronal reformatted enhanced CT
A 65-year-old man with locally invasive and metastatic MTC with tracheal
invasion. He presented with a neck mass and had increased calcitonin
levels. (a) Axial enhanced CT image shows a large left thyroid lobe mass
that mildly narrows the trachea (asterisk), and abuts the esophagus (black
arrow) with loss of the fat plane. The mass contacts the vertebral body
(arrow), which was concerning for prevertebral space invasion. There is
also a large left level IV nodal metastasis that displaces and indents the
internal jugular vein (IJV) anteriorly and the common carotid artery (CCA)
medially. (b) Coronal reformatted enhanced CT image shows tenting on
the inner margin of the left trachea (arrow) suggesting intraluminal tumor
 Kedokteran nuklir
Kedokteran nuklir : bidang kedokteran yang
memanfaatkan materi radioaktif untuk
menegakkan diagnosis dan mengobati
penderita serta mempelajari penyakit manusi
Radiofarmaka : suatu senyawa aktif yang
dimasukkan ke dalam tubuh penderita
(ditelan atau disuntik) untuk menegakkan
diagnosis atau pengobatan dan tidak tertutup
kedap ( ikut metabolisme tubuh).
 Skintigraf tiroid
Untuk menentukan status fungsional nodul
Jumlah dan aktivitas nodul tiroid
Kasus tirotoksikosis
Menentukan hubungan dengan tiroid pada kasus
massa coli
Mendeteksi tiroid ektopik, lingual atau mediastinal
Monitor tiroiditis
Deteksi metastasis tiroid fungsional
Pada pasien dengan kecurigaan keganasan tiroid
Radiofarmaka
1. Tc-99m Pertechnetate
2. I-123
Follicular neoplasm in a 67-year-old man with a history of remote
hemithyroidectomy for a contralateral follicular neoplasm. Axial PET/CT
image shows a 5-cm mass that is markedly FDG avid (SUV = 7). At FNAB, this
nodule was reported as a follicular neoplasm. Histologic
analysis of the surgically resected specimen would be required to determine
whether this fnding represents follicular adenoma or follicular carcinoma.
Magnetic resonance imaging
(MRI)
Terbatas pada rumah sakit besar
Unggul untuk penilaian jaringan
lunak
Pasien harus kooperatif
Evaluasi
Perluasan tumor (ke leher, trakea,
esofagus dsb)
Metastasis ke Limfonodi cervical yang
terkait
MRI
Magnet
RF coils
Komputer
MRI - kontraindikasi
Absolut:
Patien dengan cardiac pacemakers
Cerebral aneurysm clips
Simulator Electronic
Benda asing logam di orbita
Relatif
Claustrophobia.
Pasien dengan prostesis katup jantung
IUD
A 68-year-old woman with papillary thyroid carcinoma with nodal metastatic
disease invading the trachea. (a) Axial T2-weighted image shows a T2
hyperintense mass in the right paratracheal region (arrow) with soft tissue
signal in the right tracheal cartilage and an intraluminal mass (arrowhead).
(b) Coronal T2-weighted image shows the mass encasing the right
brachiocephalic artery (BCA) with loss of the fat plane. There is also a right
level IV nodal metastasis (curved arrow).
 Pemeriksaan radiologi untuk
payudara
USG
Mammograf
CT
MRI
Foto polos
Mammograf
Mammograf
Mammogram merupakan pencitraan X-Ray
dosis rendah payudara dengan mesin yang
didesain khusus
Dilakukan kompresi pada payudara supaya
semua jaringan tervisualisasi
2 posisi standard, CC dan MLO kanan dan
kiri
 Mammograf
Dua kategori mammogram:
Skrining :
Rutin
Wanita asimtomatik
View standar: CC dan MLO.
Diagnostik:
Evaluasi gejala spesifk, temuan klinis
Follow up temuan saat skrining.
Dapat disertai view tambahan dan atau
modalitas lain
In a craniocaudal image, the x-ray In a mediolateral image, the x-ray
beam is passed through the breast beam is directed from the medial
from a superior to an inferior position side of the breast to the lateral
(head to toe). side.
Mammography before surgery, craniocaudal view and
magnifcation left breast tumor with malignant
characteristic.
Mammography, magnifcation and orthogonal view showing
cicatriceal type
calcifcations after intervention for an invasive ductal carcinoma
3-D Mammography (Tomosynthesis)

Combines multiple mammo images to

reduce tissue overlap (like CT)
Does not replace conventional
mammogram
Beneft: Improves call back rate and
detection
Requires more radiation
More expensive
Trendy but not currently a standard
recommendationTime will tell where it
fts in
3-D Mammography (Tomosynthesis)

Kombinasi
mammograf
multipel untuk
mengurangi
superposisi
jaringan.
Radiasi >>
 Ultrasonograf (USG)
Paling efektif sebagai alat diagnostik
Modalitas yg disarankan untuk wanita hamil,
menyusui, dan wanita dibawah usia 30 tahun.
Alternatif alat deteksi dini
Radiasi ionisasi (-)
Memperlihatkan anatomi dan pathologi yang berbeda
dengan mammograf
Dapat melengkapi mammograf untuk deteksi dini pada
wanita dengan dense breasts dan peningkatan risiko
yang tidak dapat dilakukan MRI
Modalitas terbaik untuk kepentingan biopsi
Operator dependent.
 Kista
(Fibroadeno
ma)
Karsinoma
 MRI payudara
Sensitivitas dan spesifsitas tinggi
Tanpa radiasi
Tidak dapat menggantikan mammograf
Direkomendasikan sebagai alat skrining dengan
mammograf pada pasien dengan risiko tinggi
Perlu bahan kontras (gadolinium intravena) untuk
evaluasi kanker
Dihindari pada kehamilan (Gadolinium kat C)
Breast MRI Indications
Magnetic resonance imaging in a 55 years old patient
showing multifocal invasive lobular carcinoma.
Kanker dengan metastasis
ke axilla
 Computed tomography (CT)

Pleural metastasis
Foto polos
 Pemeriksaan radiologi untuk pankreas

Foto polos
USG
CT
MRI
MRCP (Magnetic resonance cholangiopancreatography).
ERCP (endoscopic retrograde
cholangiopancreatography)
Px dengan kontras barium
Angiograf
Percutaneous transhepatic venous sampling
Percutaneous pancreatography
 Foto polos abdomen
Kalsifkasi pada pankreas (pasien pankreatitis alkoholik
kronis)
Soft tissue mass
Ascites
Pemeriksaan dengan bahan kontras
barium (OMD)
CT scan
CT

Teknik yg handal
untuk menilai
pankreas, jaringan
peripankreatik,
termasuk vaskular.
Dengan bahan kontras
 MRI
Pemeriksaan
penting untuk
pankreas
Deteksi dan
staging tumor
Anatomi
preoperatif
MRCP
Modalitas non
invasif
Menggantikan ERCP.
MRI dan
MRCP
 ERP
Investigasi
pankreas lebih
lanjut
Detaail anatomi
ductus untuk
perencanaan
operasi

Tindakan intervensi
Kasus batu
Dilatasi balon
 Pemeriksaan radiologi
adrenal
Foto polos
IVP
Arteriograf
Phlebograf
USG
CT scan
MRI
Radionuclide imaging
 X-ray examination

Osteolysis of sella turcica as a

late manifestation of the lagre
pituitary tumor.
Notice: The standard method
for this diagnosis is MRI !
 X-ray examination

Acromegaly
Arachnodactylia
X-ray examination

Hyper-PTH

Increased parathyroid
activity leading to
characteristic
subperiosteal resorption

Salt and peper

scull
 X-ray examination
Hyper-PTH

The bone changes of the

same finger after 6 months
therapy of primary hyper-
PTH.
 Ultrasonography
Indications:
1. Thyroid gland, parathyroid glands
- most important imaging method
2. Abdominal endocrinopathy (adrenal gland, endocrine
pancreas)
- gives only rough picture, replaced now with CT / MRI

Technics:
2D USG: Cystic changes and solid conditions as small as 3 to 5
mm can be detected.
Doppler USG: Blood-flow is present.
USG + Biopsy: USG guided removal of tissue samples
 CT / MRI
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
The better degree of contrast in the imaging than in USG.

The comparison of CT and MRI

CT advantages MRI advantages

Lower cost High resolution of vascular abnorm.

Better availability (e.g. differentiation of pituit. tumors
Beter resolution of bone structures and hemangiomas)
(e.g. osteolysis) No radiation load
MRI
CT
 MRI

Nodular goiter
 Biopsy
1. Thyroid gland - unclear solitary nodule, tumors
2. Adrenal glands - rarely

Thyroid gland - Fine needle

aspiration biopsy (FNAB)