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

Figure 12 Recurrent metastatic small bowel carcinoid. A 72-year-old female with metastatic small bowel carcinoid. She underwent right hemicolectomy and partial small bowel resection 10 years ago, and is currently on long-acting octreotide. This case illustrates the imaging appearance and evaluation of mesenteric locoregional nodal metastatic disease recurrence with 3D imaging. A: Axial arterial phase imaging shows a calcified mass in the mesentery (arrowhead) compatible with recurrent metastatic carcinoid tumor; B: Coronal CTA image shows encasement of branches of superior mesenteric artery (blue arrowhead), with associated luminal irregularities and narrowing of the artery; C: Coronal VRT image depicts the calcified mass (arrowhead) and allows analysis of the morphology of the SMA branches within and distal to the tumor. Encased SMA branches demonstrate luminal narrowing and irregularity (blue arrowhead); D: Thick slab coronal MIP is of high diagnostic value in this case, as it benefits from the excellent contrast between vascular lumen and tumor tissue, probably providing the best assessment of the morphology of the encased SMA branches (blue arrowhead). VRT: Volume rendered technique; MIP: Maximum intensity projections; SMA: Superior mesenteric artery.