Molecular imaging well suited to the investigation of endocrine disease offering insights into physiology, pathophysiology and receptor expression. Here we explore how molecular imaging has evolved the diagnosis and management of different endocrine disease, illustrated by four clinical cases.
In thyroid disease, molecular imaging has a long history due to the exploitation of the sodium iodine symporter for both diagnosis and therapy. Given the heterogeneity of differentiated thyroid cancer, the radiotracer required is dependent on the individual pathology. This may include: 18F-Fluorodeoxyglucose (FDG), radiotracers targeting somatostatin receptors or various iodine isotopes.
From a pituitary perspective, there have been significant improvement in spatial resolution of molecular imaging, allowing for increased visualisation of small structures including the pituitary gland. The future horizons for pituitary tumour assessment with positron emission tomography will be discussed.
Tumour pathophysiology and genetics is key to understanding the role of PET imaging in phaeochromocytoma and paraganglioma. Molecular imaging is vital to the assessment of tumour burden in metastatic disease and pre-therapy assessment for PPGL which will be shown.
18F-Flurocholine PET/CT has high sensitivity in detection of parathyroid adenoma and hyperplasia in primary hyperparathyroidism despite negative conventional localisation studies. This will be highlighted through a clinical case and discussion of recent Australian experience with the radiotracer.