How do I install the Ata Ppgl Imaging Modality Selection skill?

Run npx skillmds@latest add dromlakhani/ata-ppgl-imaging-modality-selection in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Ata Ppgl Imaging Modality Selection safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: CAUTION, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Ata Ppgl Imaging Modality Selection?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ata Ppgl Imaging Modality Selection free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Ata Ppgl Imaging Modality Selection?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Ata Ppgl Imaging Modality Selection by dromlakhani

Name: Ata Ppgl Imaging Modality Selection
Rating: 4.5 (4 reviews)
Author: dromlakhani

Ata Ppgl Imaging Modality Selection

Selects the initial imaging modality (CT, MRI, 123I-MIBG scintigraphy, or 18F-FDG PET) for suspected pheochromocytoma and paraganglioma based on clinical question (tumor localization vs metastasis detection) and patient factors. Triggered by biochemical confirmation of PPGL or strong clinical suspicion when clinicians ask 'What imaging test should I order for suspected pheochromocytoma?'

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Select initial imaging modality for suspected pheochromocytoma and paraganglioma

STEP 1 — Gather Information

Collect biochemical confirmation (fractionated metanephrines or plasma-free metanephrines >3× upper limit of normal), assess clinical suspicion, patient factors (age, pregnancy, renal function, need for radiation avoidance), clinical question (localize primary tumor vs detect metastasis), and known genetic status (especially SDHx variants).

STEP 2 — Rule In / Rule Out

Is the primary clinical question tumor localization (identifying the primary lesion and its anatomic relationships) or metastasis detection? If localization → proceed to Step 3 for localization; if metastasis detection → proceed to Step 3 for metastasis.

STEP 3 — Classify or Stratify

For localization: Choose MRI if patient is a child, pregnant, requires frequent follow‑up imaging, or to avoid radiation; otherwise choose contrast‑enhanced CT for superior spatial resolution, especially when lung or liver involvement is suspected.
For metastasis detection: If SDHx pathogenic variant is known or suspected, order 18F‑FDG PET; otherwise order 123I‑MIBG scintigraphy with thyroid blockade (potassium iodide 50–150 mg/day or Lugol’s solution 5–10 drops/day starting 3 days prior).

STEP 4 — Decide

Order the selected imaging modality and schedule thyroid blockade if 123I‑MIBG scintigraphy is chosen.

Clinical Guardrails / Mimics / Pitfalls

Avoid CT in children or pregnant patients when MRI suffices; do not rely on 123I‑MIBG alone in SDHx‑related PPGL due to false negatives; remember thyroid blockade to prevent thyroid uptake and medullary thyroid cancer interference; 18F‑FDG PET is less specific for primary tumor characterization; ensure biochemical confirmation precedes imaging to reduce false‑positive work‑ups.

Concrete Clinical Example

A 45‑year‑old woman with paroxysmal hypertension and headaches has plasma‑free metanephrines 4× ULN. She is non‑pregnant and requires anatomic detail of a right adrenal mass. Clinical question is localization. She opts for contrast‑enhanced CT of the abdomen/pelvis after confirming biochemical PPGL.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

---name: ata-ppgl-imaging-modality-selectiondescription: Selects the initial imaging modality (CT, MRI, 123I-MIBG scintigraphy, or 18F-FDG PET) for suspected pheochromocytoma and paraganglioma based on clinical question (tumor localization vs metastasis detection) and patient factors. Triggered by biochemical confirmation of PPGL or strong clinical suspicion when clinicians ask 'What imaging test should I order for suspected pheochromocytoma?'---# Select initial imaging modality for suspected pheochromocytoma and paraganglioma## STEP 1 — Gather InformationCollect biochemical confirmation (fractionated metanephrines or plasma-free metanephrines >3× upper limit of normal), assess clinical suspicion, patient factors (age, pregnancy, renal function, need for radiation avoidance), clinical question (localize primary tumor vs detect metastasis), and known genetic status (especially SDHx variants).## STEP 2 — Rule In / Rule OutIs the primary clinical question tumor localization (identifying the primary lesion and its anatomic relationships) or metastasis detection? If localization → proceed to Step 3 for localization; if metastasis detection → proceed to Step 3 for metastasis.## STEP 3 — Classify or Stratify**For localization:** Choose MRI if patient is a child, pregnant, requires frequent follow‑up imaging, or to avoid radiation; otherwise choose contrast‑enhanced CT for superior spatial resolution, especially when lung or liver involvement is suspected. **For metastasis detection:** If SDHx pathogenic variant is known or suspected, order 18F‑FDG PET; otherwise order 123I‑MIBG scintigraphy with thyroid blockade (potassium iodide 50–150 mg/day or Lugol’s solution 5–10 drops/day starting 3 days prior).## STEP 4 — DecideOrder the selected imaging modality and schedule thyroid blockade if 123I‑MIBG scintigraphy is chosen.## Clinical Guardrails / Mimics / PitfallsAvoid CT in children or pregnant patients when MRI suffices; do not rely on 123I‑MIBG alone in SDHx‑related PPGL due to false negatives; remember thyroid blockade to prevent thyroid uptake and medullary thyroid cancer interference; 18F‑FDG PET is less specific for primary tumor characterization; ensure biochemical confirmation precedes imaging to reduce false‑positive work‑ups.## Concrete Clinical ExampleA 45‑year‑old woman with paroxysmal hypertension and headaches has plasma‑free metanephrines 4× ULN. She is non‑pregnant and requires anatomic detail of a right adrenal mass. Clinical question is localization. She opts for contrast‑enhanced CT of the abdomen/pelvis after confirming biochemical PPGL.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, doi:10.1507/endocrj.EJ25-0165

Frequently asked questions