Recent Advances in Neuroendocrine Imaging Lead to Improved Diagnosis

Imaging is critical in the diagnosis and care of neuroendocrine disorders. The exponential growth of technology has improved techniques and engineering with medical imaging. In turn, this has affected the effectiveness of these tools.

Neuroendocrine tumors and lesions are found on multiple endocrine organs. Imaging of the pituitary, adrenal, thyroid and parathyroid glands are discussed in this article with perfusion metrics as a basis for evaluation. The MRI is touted as the most recent advance in imaging due to the comparison of sequences (pulse versus standard).

Pituitary imaging using 3 T-based MRI with three-dimensional anisotropy contrast is a relatively new approach to determining cavernous sinus invasion with a pituitary tumor. Dynamic MRI imaging is valuable when imaging microadenomas of the pituitary. 3T imaging with MRI increased the localization of small lesions/tumors, and both approaches are more accurate for patients with mild/episodic hypercortisolism. The value of CSS and IPSS are also discussed.

The addition of perfusion MRI aids in the evaluation of prolactinomas and the effectiveness of the treatment with dopamine antagonists. This, in turn, allows more informed decisions with respect to surgical intervention.

A similar protocol is used for patients with acromegaly caused by growth hormone-secreting tumors and who are treated with octreotide.

The newest addition to the evaluation of the adrenal glands is the the use of "MIBG, Octreotide or PET". This is key to avoidance of a bilateral adrenalectomy due to the lack of localization of an ectopic source of ACTH.

Chemical shift imaging is also being used to determine adrenal hyperplasia and tumors. This technique is based upon the "slightly differing resonant frequencies of protons in water and fat in an external magnet field." Hyperaldosteronism, a cause of hypertension, is one diagnosis that has been improved by this. Perfusion metrics are used with these techniques to improve accuracy in diagnosis.

In addition to the normal use of MRI, CT and ultrasound in the evaluation of the thyroid and parathyroid glands, the author talks about the increased use of PET-CT in the treatment of differentiated thyroid carcinomas with patients where conventional whole body scanning did not work. Perfusion imaging of the thyroid using (FAIR)-true fast imaging with steady precession (FISP) sequence is noted as a possible alternative for evaluating thyroid nodules. The same techniques are suggested for parathyroidism.

The author suggests the use of MRI with neuroendocrine disorders is still young, and there will be improvements over time.


Keogh, B.P. (2008). Recent advances in neuroendocrine imaging. Current Opinion in Endocrinology, Diabetes & Obesity, 15(4), 371-375.