Christopher M. Knaus MD, Abstract Co-Author: Nothing to Disclose

Nicholas John Patronas MD, Abstract Co-Author: Nothing to Disclose

James G. Smirniotopoulos MD, Presenter: Nothing to Disclose

The major presentations, clinical findings, and terminology associated with multiple endocrine neoplasia type 1 (MEN1) are discussed. These specific clinical questions in MEN1 are related to specific imaging strategies: 1. Elevated prolactin: Is it a macroadenoma (>10mm) or microadenoma (<10mm). Adenoma indings include a convex gland margin, stalk deviation, and sella floor erosion. Imaging with a small field of view (<14cm) and a rapid MRI sequence, such as FLASH, are best for identifying an adenoma. Therapy for macroadenoma  is surgery versus medical management for  microadenoma. 2. Hypercalcemia with elevated PTH: This indicates abnormal parathormone.  90% of parathyroid glands are found medial to the carotid sheath. Nuclear imaging imaging subtracts the Tc99m image from a MIBI showing adenomas.  3. GI Neuroendocrine tumors: Concern for a pancreatic islet cell tumor leads to an arterial phase CT. Pancreatico-duodeno-gastric carcinoids are found in the gastrinoma triangle, defined by junction of the common and cystic duct, junction of the neck and body of the pancreas, and junction of the second and third portions of the duodenum.

MEN 1 Background Clinical questions Pituitary imaging Parathyroid imaging Pancreatic islet cell / carcinoid imaging Adrenal cortical adenoma imaging Miscellaneous

http://abstract.rsna.org/uploads/2014/14000764/14000764_8uo3.pdf

Knaus, C, Patronas, N, Smirniotopoulos, J, Multiple Endocrine Neoplasia Type 1: Imaging Solutions to Clinical Conundrums.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000764.html