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

Figure 5 Duodenal carcinoid. Duodenal carcinoid tumor illustrated at two distinct time points. 46-year-old female status-post surgery for removal of an omental carcinoid metastasis, at the first time point presenting with a peripancreatic hypervascular nodal metastasis, which was subsequently surgically removed. A: Axial arterial phase computed tomography (CT) image shows a hypervascular peripancreatic nodal carcinoid metastasis (arrowheads); B: Coronal arterial phase VRT image well demonstrates the location of the hypervascular nodal mass (arrowhead) in the pancreatic groove, abutting the second portion of the duodenum; C: Coronal thick slab MIP image delineates the hypervascular nodal metastasis (arrowhead) in relationship to the SMV (arrow). One year later, at the second time point, a follow-up CT showed appearance of the primary tumor in the duodenal bulb, which was subsequently treated with pancreaticoduodenectomy (Whipple procedure); D, E: Axial (D) and coronal (E) arterial phase CT images show a hyperenhancing mural mass (arrowheads) in the duodenal bulb, just distal to the pylorus, compatible with the patient’s primary carcinoid tumor; F: Sagittal arterial phase CT image shows the hyperenhancing mural mass (arrowheads) in the duodenal bulb; G: Coronal arterial phase VRT image demonstrates the intramural hyperenhancing mass (arrowheads). This case illustrates that while the primary tumor may not be initially apparent, it may demarcate itself in the course of the disease, and it also shows the typical imaging appearance of the primary tumor in the form of a hypervascular intramural mass. SMV: Superior mesenteric vein; VRT: Volume rendered technique; MIP: Maximum intensity projections.