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

Figure 7 Small bowel carcinoid. A 74-year-old male with small bowel carcinoid (Stage IV), incidentally detected during computed tomography (CT) for presumed kidney stones. He subsequently described a history of flushing and diarrhea, and his urine 5-HIAA level was found elevated. In this case the primary tumor could not be detected on CT. Surgery and pathology demonstrated a polypoid 2 cm mass in the small bowel, likely not detected on CT due to bowel ischemia of the bowel segment involving the tumor. Local nodal metastatic and liver metastatic disease were present. A, B: Axial arterial phase (A) and venous phase (B) images show a hyperenhancing mesenteric mass surrounded by spiculations (arrows) with a small focal calcification (arrowheads), compatible with local nodal metastatic disease with desmoplastic reaction. Multiple dilated small bowel loops with hypoenhancing walls surround the mesenteric mass compatible with the surgical finding of bowel ischemia; C, D: Axial (C) and coronal (D) thick slab MPR images allow the depiction of the relationship of the mesenteric mass (arrows) to the SMA (arrowhead) and the adjacent bowel. The SMA appears irregular and is partially encased by the mass; E: Coronal VRT image allows good visualization of spatial relationships of mesenteric mass (arrow) with calcification, ischemic dilated small bowel loops (arrowhead) and a necrotic liver metastasis in the liver dome (blue arrowhead). VRT: Volume rendered technique; MPR: Multiplanar reconstructions; SMA: Superior mesenteric artery.