Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors

Figure 3 Ampullary neuroendocrine tumor. A 49-year-old female with 1.2 cm neuroendocrine neoplasm of the ampulla, metastatic to the liver. The tumor was incidentally found due to dilated biliary and pancreatic ducts on a renal protocol computed tomography (CT). The patient underwent classic pancreaticoduodenectomy and liver wedge resection, confirming a low grade (G1) 1.2 cm neuroendocrine neoplasm of the ampulla with invasion of the pancreas and peripancreatic tissues. 1 of 19 lymph nodes was involved and lymphovascular invasion was present. This case demonstrates the typical imaging appearance of a hypervascular intramural primary carcinoid, with additional specific imaging features of a periampullary mass. The case also illustrates important aspects of 3D postprocessing. Axial arterial phase (A) and venous phase (B) CT angiography (CTA) images of the 2^nd portion of the duodenum show a hypervascular mass in the ampulla (arrowheads). C: Coronal arterial phase image shows the hypervascular mass extending outside the duodenal wall, with adjacent hypervascular peripancreatic lymph nodes (arrowhead). Intrahepatic biliary ductal dilation is noted (arrow); D: Pancreatic ductal dilation results from the obstructing ampullary mass (arrowhead); E, F: Thick slab MPR (E) and VRT (F) images better depict the spatial relationships: The ampullary mass (blue arrowheads) causes moderate extrahepatic and intrahepatic biliary ductal dilation (arrowheads). Peripancreatic hypervascular lymph node metastases (arrows) are present. Note the advantage of MPR and VRT over axial slices in making the mass much more apparent. VRT: Volume rendered technique; MPR: Multiplanar reconstructions; 3D: Three-dimensional.