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

作     者：David Bonekamp Siva P Raman Karen M Horton Elliot K Fishman 

作者机构：the Russell H. Morgan Department of Radiology and Radiological Science the Johns Hopkins Medical Institutions 

出 版 物：《World Journal of Radiology》 (世界放射学杂志（英文版）（电子版）)

年 卷 期：2015年第7卷第9期

页      面：220-235页

学科分类：1001[医学-基础医学(可授医学、理学学位)] 100106[医学-放射医学] 10[医学] 

主　　题：Small bowel carcinoid Multidetector computed tomog 

摘      要：Small-bowel carcinoid tumors are the most common form(42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare(3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common(20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated.