Hypoglycemia CT: Difference between revisions
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* [[Ultrasound]], [[Computed tomography|Computed tomography,]] and [[Magnetic resonance imaging|MRI]] can differentiate between both.<ref name="pmid15763695">{{cite journal| author=Noone TC, Hosey J, Firat Z, Semelka RC| title=Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. | journal=Best Pract Res Clin Endocrinol Metab | year= 2005 | volume= 19 | issue= 2 | pages= 195-211 | pmid=15763695 | doi=10.1016/j.beem.2004.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763695 }}</ref> | * [[Ultrasound]], [[Computed tomography|Computed tomography,]] and [[Magnetic resonance imaging|MRI]] can differentiate between both.<ref name="pmid15763695">{{cite journal| author=Noone TC, Hosey J, Firat Z, Semelka RC| title=Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. | journal=Best Pract Res Clin Endocrinol Metab | year= 2005 | volume= 19 | issue= 2 | pages= 195-211 | pmid=15763695 | doi=10.1016/j.beem.2004.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763695 }}</ref> | ||
* The [[Sensitivity (tests)|sensitivity]] of [[Computed tomography|CT scan]] for diagnosing [[insulinoma]] has increased to 80%.<sup>[[Insulinoma CT#cite note-pmid23430217-1|[1]]]</sup> | * The [[Sensitivity (tests)|sensitivity]] of [[Computed tomography|CT scan]] for diagnosing [[insulinoma]] has increased to 80%.<sup>[[Insulinoma CT#cite note-pmid23430217-1|[1]]]</sup> | ||
* A negative imaging study does not exclude [[insulinoma]] and patient need more tests. | * A negative imaging study does not exclude [[insulinoma]] and patient need more tests.<ref name="pmid157636952">{{cite journal| author=Noone TC, Hosey J, Firat Z, Semelka RC| title=Imaging and localization of islet-cell tumours of the pancreas on CT and MRI. | journal=Best Pract Res Clin Endocrinol Metab | year= 2005 | volume= 19 | issue= 2 | pages= 195-211 | pmid=15763695 | doi=10.1016/j.beem.2004.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15763695 }}</ref> | ||
* Findings on [[Computed tomography|CT]] scan suggestive of insulinoma include:<sup>[[Insulinoma CT#cite note-pmid23430217-1|[1]]]</sup> | * Findings on [[Computed tomography|CT]] scan suggestive of insulinoma include:<sup>[[Insulinoma CT#cite note-pmid23430217-1|[1]]]</sup> | ||
**[[Computed tomography|CT]] shows hyperattenuating on arterial phase so arterial or [[pancreatic]] phase imaging may aid in better detection. Some may show [[calcification]].<ref name="pmid9534694">{{cite journal| author=King AD, Ko GT, Yeung VT, Chow CC, Griffith J, Cockram CS| title=Dual phase spiral CT in the detection of small insulinomas of the pancreas. | journal=Br J Radiol | year= 1998 | volume= 71 | issue= 841 | pages= 20-3 | pmid=9534694 | doi=10.1259/bjr.71.841.9534694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9534694 }}</ref> | **[[Computed tomography|CT]] shows hyperattenuating on arterial phase so arterial or [[pancreatic]] phase imaging may aid in better detection. Some may show [[calcification]].<ref name="pmid9534694">{{cite journal| author=King AD, Ko GT, Yeung VT, Chow CC, Griffith J, Cockram CS| title=Dual phase spiral CT in the detection of small insulinomas of the pancreas. | journal=Br J Radiol | year= 1998 | volume= 71 | issue= 841 | pages= 20-3 | pmid=9534694 | doi=10.1259/bjr.71.841.9534694 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9534694 }}</ref> | ||
**Greater degree of enhancement than [[parenchyma]] of the rest of [[pancreas]] (as its hypervascular) during the vascular phases of the contrast | **Greater degree of enhancement than [[parenchyma]] of the rest of [[pancreas]] (as its hypervascular) during the vascular phases of the contrast<ref name="pmid16498592">{{cite journal| author=Tucker ON, Crotty PL, Conlon KC| title=The management of insulinoma. | journal=Br J Surg | year= 2006 | volume= 93 | issue= 3 | pages= 264-75 | pmid=16498592 | doi=10.1002/bjs.5280 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16498592 }}</ref> | ||
**Most insulinomas are smaller, <1.3 cm (50%) and many of these are non-contour forming. Therefore, CT scan is less effective in diagnosing them than MRI.<sup>[[Insulinoma CT#cite note-pmid16179163-2|[2]]][[Insulinoma CT#cite note-pmid15763695-3|[3]]]</sup> | **Most insulinomas are smaller, <1.3 cm (50%) and many of these are non-contour forming. Therefore, CT scan is less effective in diagnosing them than MRI.<sup>[[Insulinoma CT#cite note-pmid16179163-2|[2]]][[Insulinoma CT#cite note-pmid15763695-3|[3]]]</sup> | ||
**It can appear hypovascular and hypodense lesions after the administration of contrast.< | **It can appear hypovascular and hypodense lesions after the administration of contrast.<ref name="pmid16179163">{{cite journal| author=McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P et al.| title=Multimodality preoperative imaging of pancreatic insulinomas. | journal=Clin Radiol | year= 2005 | volume= 60 | issue= 10 | pages= 1039-50 | pmid=16179163 | doi=10.1016/j.crad.2005.06.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16179163 }}</ref> | ||
[[File:Insulinoma CT gif.gif|center|500px|thumb|CT showing insulinoma, source: Case courtesy of Dr J. Ray Ballinger, Radiopaedia.org, rID: 23627]] | [[File:Insulinoma CT gif.gif|center|500px|thumb|CT showing insulinoma, source: Case courtesy of Dr J. Ray Ballinger, Radiopaedia.org, rID: 23627]] | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 14:44, 22 September 2017
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American Roentgen Ray Society Images of Hypoglycemia CT |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
CT scan can be used for diagnosing insulinoma and islet-cell hypertrophy. Currently, with the advances in technology. The sensitivity has risen to 80% and 94.4% for helical CT scan with dual-phase multidetector CT scan. Insulinoma is hypervascular and CT shows greater enhancement than rest of the pancreatic parenchyma. It can appear, atypically, hypovascular and hypodense lesions after the administration of contrast.
CT
- Hypoglycemia caused by endogenous insulin the differential diagnosis includes insulinoma and islet-cell hypertrophy.
- Ultrasound, Computed tomography, and MRI can differentiate between both.[1]
- The sensitivity of CT scan for diagnosing insulinoma has increased to 80%.[1]
- A negative imaging study does not exclude insulinoma and patient need more tests.[2]
- Findings on CT scan suggestive of insulinoma include:[1]
- CT shows hyperattenuating on arterial phase so arterial or pancreatic phase imaging may aid in better detection. Some may show calcification.[3]
- Greater degree of enhancement than parenchyma of the rest of pancreas (as its hypervascular) during the vascular phases of the contrast[4]
- Most insulinomas are smaller, <1.3 cm (50%) and many of these are non-contour forming. Therefore, CT scan is less effective in diagnosing them than MRI.[2][3]
- It can appear hypovascular and hypodense lesions after the administration of contrast.[5]
References
- ↑ Noone TC, Hosey J, Firat Z, Semelka RC (2005). "Imaging and localization of islet-cell tumours of the pancreas on CT and MRI". Best Pract Res Clin Endocrinol Metab. 19 (2): 195–211. doi:10.1016/j.beem.2004.11.013. PMID 15763695.
- ↑ Noone TC, Hosey J, Firat Z, Semelka RC (2005). "Imaging and localization of islet-cell tumours of the pancreas on CT and MRI". Best Pract Res Clin Endocrinol Metab. 19 (2): 195–211. doi:10.1016/j.beem.2004.11.013. PMID 15763695.
- ↑ King AD, Ko GT, Yeung VT, Chow CC, Griffith J, Cockram CS (1998). "Dual phase spiral CT in the detection of small insulinomas of the pancreas". Br J Radiol. 71 (841): 20–3. doi:10.1259/bjr.71.841.9534694. PMID 9534694.
- ↑ Tucker ON, Crotty PL, Conlon KC (2006). "The management of insulinoma". Br J Surg. 93 (3): 264–75. doi:10.1002/bjs.5280. PMID 16498592.
- ↑ McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P; et al. (2005). "Multimodality preoperative imaging of pancreatic insulinomas". Clin Radiol. 60 (10): 1039–50. doi:10.1016/j.crad.2005.06.005. PMID 16179163.