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Anatomic and Functional Imaging of Metastatic Carcinoid Tumors¹

¹ From the Departments of Radiology (A.F.S., A.G., P.B., F.V.G., R.R.P.), Nuclear Medicine (A.F.S., J.S., K.M.B., F.V.G.), and Clinical Oncology (A.W.), Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Headington, Oxford, England; Academic Endocrine Unit, Nuffield Department of Clinical Medicine, Oxford, England (R.V.T.); and Cancer Research UK, University of Oxford, Oxford, England (D.T.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received April 6, 2006; revision requested June 29 and received August 21; accepted August 22. All authors have no financial relationships to disclose. Address correspondence to A.F.S., Department of Clinical Radiology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF, England (e-mail: andrew.scarsbrook{at}leedsth.nhs.uk).

Carcinoid tumors are a fascinating group of neuroendocrine neoplasms that develop either sporadically or as part of an inheritable syndrome. Many tumors arise in the bronchopulmonary or gastrointestinal tract, but a neuroendocrine tumor can arise in almost any organ. The tumors have varied malignant potential depending on the site of their origin, and the clinical manifestations often are nonspecific. Metastases may be present at the time of diagnosis, which often occurs at a late stage of the disease. Imaging plays a pivotal role in the localization and staging of neuroendocrine tumors and in monitoring the treatment response. Imaging is often challenging, and a combination of anatomic and functional techniques is usually required, depending on the tumor type and location. Techniques include ultrasonography, barium studies, endoscopy, computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, iobenguane scintigraphy, and, in select cases, positron emission tomography. Coregistration of structural and functional images is often of incremental value for accurate localization of the primary tumor and any meta-static disease. Radiologists must understand the contribution of each imaging modality in the assessment of different neuroendocrine tumors. In addition, knowledge of the optimal technique for each radiologic and radionuclide imaging examination is essential. Familiarity with the protean imaging appearances of both primary and metastatic disease is essential for accurate staging, treatment monitoring, and surveillance. Finally, an understanding of the wide variety of treatment options for patients with carcinoid tumors is vital for optimal management.

© RSNA, 2007

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