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Carcinoid Tumors of the Small Bowel: A Multitechnique Imaging Approach

¹ All authors: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, 601 N Caroline St., JHOC 3253, Baltimore, MD 21287.

View larger version (96K): [in a new window]   Fig. 1. —Small-bowel carcinoid tumor. Photograph of surgical specimen shows small submucosal mass (arrow) causing kinking of bowel surface. (Courtesy of Askin F, Baltimore, MD)

View larger version (158K): [in a new window]   Fig. 2. —Patient with abdominal pain. Radiograph from small-bowel series shows thickening (arrows) of segments in right abdomen. Thickening was caused by ischemia resulting from desmoplastic reaction caused by carcinoid tumor.

View larger version (133K): [in a new window]   Fig. 3A. —Patient who presented with abdominal pain. Coronal contrast-enhanced CT scan shows small enhancing lesion (arrow) in small bowel near ligament of Treitz. Water as oral contrast agent helps reveal these small lesions.

View larger version (154K): [in a new window]   Fig. 3B. —Patient who presented with abdominal pain. Axial contrast-enhanced CT scan reveals mesenteric nodal mass (arrowhead).

View larger version (132K): [in a new window]   Fig. 4. —Patient with abdominal pain. Contrast-enhanced CT scan shows small mesenteric mass with calcification (arrow). At surgery, mass was found to be carcinoid tumor.

View larger version (148K): [in a new window]   Fig. 5. —Carcinoid tumor. Coronal contrast-enhanced CT scan shows large mesenteric mass and desmoplastic reaction. Adjacent small-bowel loops are thickened (arrows) as result of ischemia.

View larger version (179K): [in a new window]   Fig. 6. —Coronal contrast-enhanced CT scan shows large mesenteric mass encasing superior mesenteric artery and its branches. Mass was carcinoid tumor.

View larger version (129K): [in a new window]   Fig. 7. —Metastatic carcinoid tumor. Contrast-enhanced CT scan of abdomen shows small mesenteric mass (arrow). In addition, note multiple enhancing liver lesions, which are compatible with carcinoid metastasis. Incidental note is made of gallstones. Scan was obtained during arterial phase, which improves visualization of vascular liver metastasis.

View larger version (135K): [in a new window]   Fig. 8A. —Metastatic carcinoid tumor. Axial fast spin-echo T2-weighted image (TR/TE, 3,500/100) shows mildly hyperintense lesion (arrow) in right lobe of liver. Note markedly hyperintense cyst (arrowhead) in left lobe.

View larger version (141K): [in a new window]   Fig. 8B. —Metastatic carcinoid tumor. Axial T1-weighted fast multiplanar spoiled gradient-recalled acquisition in steady-state image (110/4.4; flip angle, 70°) in arterial phase (B) 20 sec after gadolinium injection shows homogenous enhancement of lesion (arrows) that persists in portal venous phase image (C). Arrowheads indicate cyst seen in A. These findings may be mistaken for atypical hemangioma.

View larger version (146K): [in a new window]   Fig. 8C. —Metastatic carcinoid tumor. Axial T1-weighted fast multiplanar spoiled gradient-recalled acquisition in steady-state image (110/4.4; flip angle, 70°) in arterial phase (B) 20 sec after gadolinium injection shows homogenous enhancement of lesion (arrows) that persists in portal venous phase image (C). Arrowheads indicate cyst seen in A. These findings may be mistaken for atypical hemangioma.

View larger version (175K): [in a new window]   Fig. 9A. —Carcinoid tumor. Coronal unenhanced T1-weighted image shows multiple liver metastases.

View larger version (104K): [in a new window]   Fig. 9B. —Carcinoid tumor. Axial contrast-enhanced T1-weighted images show enhancing lesions in arterial (B) and venous (C) phases.

View larger version (132K): [in a new window]   Fig. 9C. —Carcinoid tumor. Axial contrast-enhanced T1-weighted images show enhancing lesions in arterial (B) and venous (C) phases.

View larger version (70K): [in a new window]   Fig. 10. —Octreotide scan in patient with known carcinoid tumor shows liver metastasis (arrowhead) and nodal mass (arrow) in mid abdomen.

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