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

Figure 4 Duodenal Carcinoid. A 61-year-old male with duodenal carcinoid, status-post exploratory laparotomy for a mesenteric mass at an outside institution. Subsequent Whipple procedure demonstrated a 1.8 cm unifocal duodenal carcinoid (pT3, invading pancreas), with 6 of 15 regional lymph node metastases (pN1). This case illustrates the distinction of the primary mass from adjacent nodal metastatic disease and poses an example for nodal metastatic disease having a much larger volume than the primary tumor. A: Venous phase axial computed tomography image shows a 1.8 cm mass in the medial wall of the duodenum, extending into the moderately fatty replaced pancreas, compatible with the primary tumor (arrowheads); B: Arterial phase axial image (magnified, similar slice position) demonstrates heterogenous hypervascularity in the primary tumor (arrowheads). Multiple metastatic hypervascular peripancreatic lymph nodes are present (blue arrowheads); C: Arterial phase axial image shows a large hypervascular nodal metastasis in the inferior pancreatic groove (blue arrowhead); D: Axial venous phase image shows an enlarged portocaval lymph node (arrowhead); E: Note that in the same node on arterial phase axial image a left-sided hypervascular metastasis can be identified, which was not discernible on the venous phase (D) (arrow).