case_images: PMC11669864_01
case_images: Imaging of adrenal and liver nodules. (A-D) Adrenal mass. (E-H) Liver nodule in the right lobe (S7, S8). (I-L) Liver nodules in the left segment (S2, S3). (A, E, I) Contrast CT. (B, F, J) MRI. (C, G, K) 123I-MIBG scintigraphy. (D, H, L) FDG-PET.. Abbreviations: CT, computed tomography; FDG-PET, fluorodeoxyglucose positron emission tomography scan; MRI, magnetic resonance imaging; MIBG, metaiodobenzylguanidine.
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case_images: Computed tomography revealed a massive right adrenal mass (150 mm) with partial necrosis, accompanied by multiple liver nodules (Fig. 2). T2-weighted magnetic resonance imaging (Fig. 2). The urinary excretion of Ad, NA, DA, metanephrine, and normetanephrine was 355 microg/day (1937 nmol/day) (normal range: 3.4-26.9 microg/day; 18-146 nmol/day), 1690 microg/day (9989 nmol/day) (normal range: 48.6-168.4 microg/day; 287-995 nmol/day), 53 000 microg/day (258 322 nmol/day) (normal range: 365-961.5 microg/day; 1779-4686 nmol/day), 2.9 mg/day (14 703 nmol/day) (normal range: 0.0-0.19 mg/day; 0-963 nmol/day), and 8.6 mg/day (46 942 nmol/day) (normal range: 0.09-0.33 mg/day; 491-1801nmol/day), respectively (Table 2). 123I-metaiodobenzylguanidine (MIBG) and fluorodeoxyglucose (FDG) were strongly absorbed by the adrenal mass and slightly absorbed by the small liver nodules in S2 and S3 (Fig. 2). The liver nodules in S7 and S8 absorbed 123I-MIBG strongly and FDG partially (Fig. 2).
case_images: The hierarchical clustering analysis based on the catecholamine profiles. The data of 18 patients reported as DA-producing PPGL in the literature and 34 patients followed-up in Kanazawa University were included. Each patient and catecholamines were aligned horizontally and vertically, respectively. Dashed lines separate each cluster according to hierarchical clustering analysis. The colors in the heatmap represent relative levels of urinary Ad, NA, or DA excretion.. Abbreviations: Ad, adrenaline; DA, dopamine; NA, noradrenaline; PPGL, pheochromocytoma/paraganglioma.
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case_images: Patients were categorized into 4 clusters based on the catecholamine profiling (Fig. 3): patients in cluster 1 had high Ad levels and normal DA levels, patients in cluster 2 showed high DA levels and normal Ad levels, and patients in clusters 3 and 4 showed no catecholamine elevation and high NA levels, respectively.