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

Figure 11 Carcinoid of unknown primary. Functional carcinoid tumor of unknown primary, metastatic to liver and mesenteric root. A 43-year-old female with history of postprandial nausea. Ultrasound exam detected bilobar liver metastases. Subsequent computed tomography (CT) demonstrated hypervascularity of the liver metastases. Liver biopsy confirmed carcinoid metastases. She underwent systemic chemotherapy with VP-16 and carboplatin and locoregional therapy to the liver metastases (Yttrium-90 microsphere embolization). This case illustrates the evaluation of and appearance of locoregional nodal metastatic and liver metastatic disease. A: Axial arterial phase CT shows multiple hypervascular liver metastases with treatment changes after chemoembolization (arrowheads) and diffuse perfusion change in the left liver lobe related to prior locoregional therapy; B: Axial arterial phase CT image shows a hypervascular mesenteric mass (arrowhead) compatible with metastatic nodal disease; C: Coronal thick slab MIP image demonstrates the hypervascular mesenteric mass (arrow) and its relationship to the SMA and portal vein (arrowhead); D: Coronal VRT image demonstrates hypervascular liver metastasis (arrowhead) and mesenteric mass (arrow). The extensive desmoplastic reaction surrounding the mesenteric mass is well shown. VRT: Volume rendered technique; MIP: Maximum intensity projections; SMA: Superior mesenteric artery.