DOI: 10.1148/rg.272065058
Anatomic and Functional Imaging of Metastatic Carcinoid Tumors1
Andrew F. Scarsbrook, FRCR,
Arul Ganeshan, MRCP,
Jane Statham, DCR,
Rajesh V. Thakker, FRCP,
Andrew Weaver, FRCR,
Denis Talbot, FRCP,
Philip Boardman, FRCR,
Kevin M. Bradley, FRCR,
Fergus V. Gleeson, FRCR and
Rachel R. Phillips, FRCR
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.
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Figure 1a. Thymic carcinoid tumor. (a) CT pulmonary angiogram shows a large, partially enhancing anterior mediastinal mass (arrow) that subsequently was diagnosed as a thymic carcinoid tumor on the basis of biopsy results. (b) Axial contrast-enhanced CT image, obtained in a patient with a preexisting diagnosis of thymic carcinoid tumor, depicts metastatic mediastinal, pericardiac, and pleural deposits (arrows).
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Figure 1b. Thymic carcinoid tumor. (a) CT pulmonary angiogram shows a large, partially enhancing anterior mediastinal mass (arrow) that subsequently was diagnosed as a thymic carcinoid tumor on the basis of biopsy results. (b) Axial contrast-enhanced CT image, obtained in a patient with a preexisting diagnosis of thymic carcinoid tumor, depicts metastatic mediastinal, pericardiac, and pleural deposits (arrows).
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Figure 2a. Bronchial carcinoid tumor in four patients. (a) CT pulmonary angiogram obtained for evaluation of suspected pulmonary embolic disease shows a small intrabronchial carcinoid tumor in the right main bronchus (arrow) and a thrombus in the left inferior pulmonary artery (arrowhead). (b) Contrast-enhanced chest CT image obtained in another patient shows a partial collapse of the lower lobe of the right lung, caused by a calcified atypical carcinoid tumor (arrow). (c) Axial thoracic CT image demonstrates a typical bronchial carcinoid tumor in the periphery of the right lung. (d) Planar scintigram obtained with indium 111 (111In)-octreotide shows a focal area of radiotracer uptake (arrow) in the right hemithorax. (e) CT image obtained in the same patient as d shows a small right pulmonary nodule (arrow) that corresponds to the focal area of uptake in d. The patient had ectopic ACTH-induced Cushing syndrome due to a functional bronchial carcinoid tumor, which resolved after resection of the nodule. (Figs 2d and 2e courtesy of John Rees, MD, University Hospital of Wales, Cardiff, Wales.)
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Figure 2b. Bronchial carcinoid tumor in four patients. (a) CT pulmonary angiogram obtained for evaluation of suspected pulmonary embolic disease shows a small intrabronchial carcinoid tumor in the right main bronchus (arrow) and a thrombus in the left inferior pulmonary artery (arrowhead). (b) Contrast-enhanced chest CT image obtained in another patient shows a partial collapse of the lower lobe of the right lung, caused by a calcified atypical carcinoid tumor (arrow). (c) Axial thoracic CT image demonstrates a typical bronchial carcinoid tumor in the periphery of the right lung. (d) Planar scintigram obtained with indium 111 (111In)-octreotide shows a focal area of radiotracer uptake (arrow) in the right hemithorax. (e) CT image obtained in the same patient as d shows a small right pulmonary nodule (arrow) that corresponds to the focal area of uptake in d. The patient had ectopic ACTH-induced Cushing syndrome due to a functional bronchial carcinoid tumor, which resolved after resection of the nodule. (Figs 2d and 2e courtesy of John Rees, MD, University Hospital of Wales, Cardiff, Wales.)
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Figure 2c. Bronchial carcinoid tumor in four patients. (a) CT pulmonary angiogram obtained for evaluation of suspected pulmonary embolic disease shows a small intrabronchial carcinoid tumor in the right main bronchus (arrow) and a thrombus in the left inferior pulmonary artery (arrowhead). (b) Contrast-enhanced chest CT image obtained in another patient shows a partial collapse of the lower lobe of the right lung, caused by a calcified atypical carcinoid tumor (arrow). (c) Axial thoracic CT image demonstrates a typical bronchial carcinoid tumor in the periphery of the right lung. (d) Planar scintigram obtained with indium 111 (111In)-octreotide shows a focal area of radiotracer uptake (arrow) in the right hemithorax. (e) CT image obtained in the same patient as d shows a small right pulmonary nodule (arrow) that corresponds to the focal area of uptake in d. The patient had ectopic ACTH-induced Cushing syndrome due to a functional bronchial carcinoid tumor, which resolved after resection of the nodule. (Figs 2d and 2e courtesy of John Rees, MD, University Hospital of Wales, Cardiff, Wales.)
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Figure 2d. Bronchial carcinoid tumor in four patients. (a) CT pulmonary angiogram obtained for evaluation of suspected pulmonary embolic disease shows a small intrabronchial carcinoid tumor in the right main bronchus (arrow) and a thrombus in the left inferior pulmonary artery (arrowhead). (b) Contrast-enhanced chest CT image obtained in another patient shows a partial collapse of the lower lobe of the right lung, caused by a calcified atypical carcinoid tumor (arrow). (c) Axial thoracic CT image demonstrates a typical bronchial carcinoid tumor in the periphery of the right lung. (d) Planar scintigram obtained with indium 111 (111In)-octreotide shows a focal area of radiotracer uptake (arrow) in the right hemithorax. (e) CT image obtained in the same patient as d shows a small right pulmonary nodule (arrow) that corresponds to the focal area of uptake in d. The patient had ectopic ACTH-induced Cushing syndrome due to a functional bronchial carcinoid tumor, which resolved after resection of the nodule. (Figs 2d and 2e courtesy of John Rees, MD, University Hospital of Wales, Cardiff, Wales.)
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Figure 2e. Bronchial carcinoid tumor in four patients. (a) CT pulmonary angiogram obtained for evaluation of suspected pulmonary embolic disease shows a small intrabronchial carcinoid tumor in the right main bronchus (arrow) and a thrombus in the left inferior pulmonary artery (arrowhead). (b) Contrast-enhanced chest CT image obtained in another patient shows a partial collapse of the lower lobe of the right lung, caused by a calcified atypical carcinoid tumor (arrow). (c) Axial thoracic CT image demonstrates a typical bronchial carcinoid tumor in the periphery of the right lung. (d) Planar scintigram obtained with indium 111 (111In)-octreotide shows a focal area of radiotracer uptake (arrow) in the right hemithorax. (e) CT image obtained in the same patient as d shows a small right pulmonary nodule (arrow) that corresponds to the focal area of uptake in d. The patient had ectopic ACTH-induced Cushing syndrome due to a functional bronchial carcinoid tumor, which resolved after resection of the nodule. (Figs 2d and 2e courtesy of John Rees, MD, University Hospital of Wales, Cardiff, Wales.)
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Figure 3a. Gastric carcinoid tumors. (a) Contrast-enhanced arterial phase CT image shows a small avidly enhancing gastric nodule at the lesser curvature of the stomach (arrow). The nodule was histologically proved to be a type I tumor. (b) Contrast-enhanced CT image in another patient shows a large heterogeneous locally invasive mass that originated from the gastric cardia and surrounds the adjacent celiac artery (arrow). The tumor was resected and was proved at histologic analysis to be a type III gastric carcinoid tumor.
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Figure 3b. Gastric carcinoid tumors. (a) Contrast-enhanced arterial phase CT image shows a small avidly enhancing gastric nodule at the lesser curvature of the stomach (arrow). The nodule was histologically proved to be a type I tumor. (b) Contrast-enhanced CT image in another patient shows a large heterogeneous locally invasive mass that originated from the gastric cardia and surrounds the adjacent celiac artery (arrow). The tumor was resected and was proved at histologic analysis to be a type III gastric carcinoid tumor.
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Figure 4. Esophageal carcinoid tumor. Contrast-enhanced CT image shows asymmetric circumferential thickening of the wall of the distal esophagus (arrow), an extremely rare site of carcinoid disease. At endoscopic biopsy, the lesion was found to be a carcinoid tumor.
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Figure 5. Duodenal carcinoid tumor. Endoscopic US image depicts a 16-mm submucosal polyp in the proximal part of the duodenum (arrow). The polyp was resected endoscopically and diagnosed histologically as a carcinoid tumor. (Courtesy of Jane Phillips-Hughes, MD, Oxford Radcliffe Hospitals NHS Trust.)
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Figure 6a. Primary hepatic carcinoid tumor. (a) Coronal T2-weighted MR image shows a large solid mass in the right lobe of the liver. The mass contains a small area of high signal intensity (arrow) that is indicative of necrosis. At histologic analysis of a biopsy specimen, the mass was proved to be a poorly differentiated carcinoid tumor. After careful evaluation, it was determined that the liver was the primary site of disease. (b) Coronal, axial, and sagittal images from FDG PET in the same patient show the large solitary hepatic mass. (c) Axial gadolinium-enhanced T1-weighted MR image from another patient demonstrates a tumor with peripheral and septal enhancement.
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Figure 6b. Primary hepatic carcinoid tumor. (a) Coronal T2-weighted MR image shows a large solid mass in the right lobe of the liver. The mass contains a small area of high signal intensity (arrow) that is indicative of necrosis. At histologic analysis of a biopsy specimen, the mass was proved to be a poorly differentiated carcinoid tumor. After careful evaluation, it was determined that the liver was the primary site of disease. (b) Coronal, axial, and sagittal images from FDG PET in the same patient show the large solitary hepatic mass. (c) Axial gadolinium-enhanced T1-weighted MR image from another patient demonstrates a tumor with peripheral and septal enhancement.
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Figure 6c. Primary hepatic carcinoid tumor. (a) Coronal T2-weighted MR image shows a large solid mass in the right lobe of the liver. The mass contains a small area of high signal intensity (arrow) that is indicative of necrosis. At histologic analysis of a biopsy specimen, the mass was proved to be a poorly differentiated carcinoid tumor. After careful evaluation, it was determined that the liver was the primary site of disease. (b) Coronal, axial, and sagittal images from FDG PET in the same patient show the large solitary hepatic mass. (c) Axial gadolinium-enhanced T1-weighted MR image from another patient demonstrates a tumor with peripheral and septal enhancement.
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Figure 7. Pancreatic carcinoid tumor. Gadolinium-enhanced T1-weighted MR image shows an intermediate-signal-intensity mass in the head of the pancreas (arrow), a finding that is indistinguishable from pancreatic adenocarcinoma. The results of histologic analysis allowed a diagnosis of pancreatic carcinoid tumor.
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Figure 8a. Small-bowel carcinoid tumor. (a) Image from an enteroclysis study performed in a patient with a midgut carcinoid tumor demonstrates mucosal thickening (arrow), angulation, and fixation of a segment of the distal part of the ileum because of the tumor and associated mesenteric fibrosis. (b) Axial CT image in another patient with a distal ileal carcinoid tumor shows an area of desmoplastic reaction in the small-bowel mesentery (arrow). (c) Coronal T2-weighted MR image shows a large mesenteric mass with characteristic surrounding mesenteric fibrosis and with thickening of the ileal wall because of ischemia (arrows).
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Figure 8b. Small-bowel carcinoid tumor. (a) Image from an enteroclysis study performed in a patient with a midgut carcinoid tumor demonstrates mucosal thickening (arrow), angulation, and fixation of a segment of the distal part of the ileum because of the tumor and associated mesenteric fibrosis. (b) Axial CT image in another patient with a distal ileal carcinoid tumor shows an area of desmoplastic reaction in the small-bowel mesentery (arrow). (c) Coronal T2-weighted MR image shows a large mesenteric mass with characteristic surrounding mesenteric fibrosis and with thickening of the ileal wall because of ischemia (arrows).
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Figure 8c. Small-bowel carcinoid tumor. (a) Image from an enteroclysis study performed in a patient with a midgut carcinoid tumor demonstrates mucosal thickening (arrow), angulation, and fixation of a segment of the distal part of the ileum because of the tumor and associated mesenteric fibrosis. (b) Axial CT image in another patient with a distal ileal carcinoid tumor shows an area of desmoplastic reaction in the small-bowel mesentery (arrow). (c) Coronal T2-weighted MR image shows a large mesenteric mass with characteristic surrounding mesenteric fibrosis and with thickening of the ileal wall because of ischemia (arrows).
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Figure 9a. Cecal carcinoid tumor. (a) Image from a double contrast barium study demonstrates a polypoid cecal mass that was biopsied colonoscopically and proved to be a carcinoid tumor. (b) Axial CT image shows circumferential thickening of the cecum (arrow).
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Figure 9b. Cecal carcinoid tumor. (a) Image from a double contrast barium study demonstrates a polypoid cecal mass that was biopsied colonoscopically and proved to be a carcinoid tumor. (b) Axial CT image shows circumferential thickening of the cecum (arrow).
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Figure 10. Rectal carcinoid tumor. Axial T2-weighted high-resolution MR image demonstrates a tumor in the posterior rectal wall, with bilateral adjacent mesorectal nodal metastases (arrows). The rectal mass was a histologically proved carcinoid tumor.
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Figure 11. Cervical carcinoid tumor. Sagittal T2-weighted MR image shows a large mass that involves the uterus and cervix and extends into the endometrial cavity (arrows). Histologic analysis of a biopsy specimen revealed a poorly differentiated carcinoid tumor. A metastatic deposit in the sacrum (not shown) also was found at the time of diagnosis.
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Figure 12a. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 12b. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 12c. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 12d. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 12e. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 12f. Mesenteric metastases of carcinoid disease. (a) Coronal reformatted image from CT angiography of the mesenteric vessels shows a partly calcified mesenteric carcinoid deposit (arrow) that encases the distal superior mesenteric artery and ileal artery branch vessels. (b) Anterior planar image from whole-body scintigraphy performed with 111In-oct-reotide in another patient demonstrates radiotracer uptake in a mesenteric carcinoid metastasis (arrow). (c, d) Axial SPECT images obtained with 111In-octreotide in another patient demonstrate a solitary abnormal focus of radiotracer uptake in the midline (crosshairs). (e, f) Low-dose CT image (e) and SPECT/CT image (f) show a metastatic lymph node (crosshairs) just anterior to the body of the pancreas. The patient had undergone resection of an ileal carcinoid tumor 18 months previously, and levels of biochemical markers had since increased.
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Figure 13a. Metastases to other intraabdominal organs. (a) Axial gadolinium-enhanced T1-weighted abdominal MR image shows a subtle focal lesion in the body of the pancreas (arrow). (b) Corresponding SPECT image from scintigraphy performed with 111In-oct-reotide shows abnormal radiotracer uptake within the upper abdomen (arrow). (c) Fusion MR-SPECT image from a patient with a previous resection of primary ovarian carcinoid tumor and with increasing levels of biochemical markers shows the alignment of the two abnormalities (arrow), a finding indicative of an octreotide-avid metastatic deposit in the pancreatic body. (d) Axial contrast-enhanced CT image in a patient with an ileal carcinoid tumor demonstrates a left ovarian mass (arrow). After oophorectomy, the mass was histologically diagnosed as a carcinoid metastasis.
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Figure 13b. Metastases to other intraabdominal organs. (a) Axial gadolinium-enhanced T1-weighted abdominal MR image shows a subtle focal lesion in the body of the pancreas (arrow). (b) Corresponding SPECT image from scintigraphy performed with 111In-oct-reotide shows abnormal radiotracer uptake within the upper abdomen (arrow). (c) Fusion MR-SPECT image from a patient with a previous resection of primary ovarian carcinoid tumor and with increasing levels of biochemical markers shows the alignment of the two abnormalities (arrow), a finding indicative of an octreotide-avid metastatic deposit in the pancreatic body. (d) Axial contrast-enhanced CT image in a patient with an ileal carcinoid tumor demonstrates a left ovarian mass (arrow). After oophorectomy, the mass was histologically diagnosed as a carcinoid metastasis.
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Figure 13c. Metastases to other intraabdominal organs. (a) Axial gadolinium-enhanced T1-weighted abdominal MR image shows a subtle focal lesion in the body of the pancreas (arrow). (b) Corresponding SPECT image from scintigraphy performed with 111In-oct-reotide shows abnormal radiotracer uptake within the upper abdomen (arrow). (c) Fusion MR-SPECT image from a patient with a previous resection of primary ovarian carcinoid tumor and with increasing levels of biochemical markers shows the alignment of the two abnormalities (arrow), a finding indicative of an octreotide-avid metastatic deposit in the pancreatic body. (d) Axial contrast-enhanced CT image in a patient with an ileal carcinoid tumor demonstrates a left ovarian mass (arrow). After oophorectomy, the mass was histologically diagnosed as a carcinoid metastasis.
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Figure 13d. Metastases to other intraabdominal organs. (a) Axial gadolinium-enhanced T1-weighted abdominal MR image shows a subtle focal lesion in the body of the pancreas (arrow). (b) Corresponding SPECT image from scintigraphy performed with 111In-oct-reotide shows abnormal radiotracer uptake within the upper abdomen (arrow). (c) Fusion MR-SPECT image from a patient with a previous resection of primary ovarian carcinoid tumor and with increasing levels of biochemical markers shows the alignment of the two abnormalities (arrow), a finding indicative of an octreotide-avid metastatic deposit in the pancreatic body. (d) Axial contrast-enhanced CT image in a patient with an ileal carcinoid tumor demonstrates a left ovarian mass (arrow). After oophorectomy, the mass was histologically diagnosed as a carcinoid metastasis.
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Figure 14a. Hepatic metastases of carcinoid disease. (a) Contrast-enhanced arterial phase CT image shows avidly enhancing foci in the liver (arrows), features indicative of hepatic metastases in a patient with a gastric carcinoid tumor. (b) Contrast-enhanced portal phase CT image at the same level as a shows no foci of enhancement. (c, d) Axial T1-weighted MR image (c) and T2-weighted MR image (d) show regions of low T1-weighted signal intensity and high T2-weighted signal intensity, respectively, findings typical of carcinoid liver metastases.
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Figure 14b. Hepatic metastases of carcinoid disease. (a) Contrast-enhanced arterial phase CT image shows avidly enhancing foci in the liver (arrows), features indicative of hepatic metastases in a patient with a gastric carcinoid tumor. (b) Contrast-enhanced portal phase CT image at the same level as a shows no foci of enhancement. (c, d) Axial T1-weighted MR image (c) and T2-weighted MR image (d) show regions of low T1-weighted signal intensity and high T2-weighted signal intensity, respectively, findings typical of carcinoid liver metastases.
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Figure 14c. Hepatic metastases of carcinoid disease. (a) Contrast-enhanced arterial phase CT image shows avidly enhancing foci in the liver (arrows), features indicative of hepatic metastases in a patient with a gastric carcinoid tumor. (b) Contrast-enhanced portal phase CT image at the same level as a shows no foci of enhancement. (c, d) Axial T1-weighted MR image (c) and T2-weighted MR image (d) show regions of low T1-weighted signal intensity and high T2-weighted signal intensity, respectively, findings typical of carcinoid liver metastases.
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Figure 14d. Hepatic metastases of carcinoid disease. (a) Contrast-enhanced arterial phase CT image shows avidly enhancing foci in the liver (arrows), features indicative of hepatic metastases in a patient with a gastric carcinoid tumor. (b) Contrast-enhanced portal phase CT image at the same level as a shows no foci of enhancement. (c, d) Axial T1-weighted MR image (c) and T2-weighted MR image (d) show regions of low T1-weighted signal intensity and high T2-weighted signal intensity, respectively, findings typical of carcinoid liver metastases.
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Figure 15a. Metastases to bone. (a) Axial CT image obtained with bone window settings in a patient with metastatic bronchial carcinoid tumor demonstrates a sclerotic bone metastasis in the right iliac bone (arrow). (b) Planar images from bone scintigraphy (left), iobenguane I 123 scintigraphy (middle), and 111In-octreotide scintigraphy (right) obtained in the same patient over a 3-month period demonstrate multiple metastases to bone. The iobenguane scintigram is floridly abnormal, showing multiple foci of radiotracer uptake in the liver and throughout the marrow-containing bones. These features are less conspicuous on the other two images. (c) Sagittal MR images, obtained in another patient with a T1-weighted sequence (left) and a short inversion time inversion recovery sequence (right), depict multiple intravertebral foci of high T1-weighted and low T2-weighted signal intensity, respectively. These findings are indicative of metastases from an ileal carcinoid tumor.
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Figure 15b. Metastases to bone. (a) Axial CT image obtained with bone window settings in a patient with metastatic bronchial carcinoid tumor demonstrates a sclerotic bone metastasis in the right iliac bone (arrow). (b) Planar images from bone scintigraphy (left), iobenguane I 123 scintigraphy (middle), and 111In-octreotide scintigraphy (right) obtained in the same patient over a 3-month period demonstrate multiple metastases to bone. The iobenguane scintigram is floridly abnormal, showing multiple foci of radiotracer uptake in the liver and throughout the marrow-containing bones. These features are less conspicuous on the other two images. (c) Sagittal MR images, obtained in another patient with a T1-weighted sequence (left) and a short inversion time inversion recovery sequence (right), depict multiple intravertebral foci of high T1-weighted and low T2-weighted signal intensity, respectively. These findings are indicative of metastases from an ileal carcinoid tumor.
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Figure 15c. Metastases to bone. (a) Axial CT image obtained with bone window settings in a patient with metastatic bronchial carcinoid tumor demonstrates a sclerotic bone metastasis in the right iliac bone (arrow). (b) Planar images from bone scintigraphy (left), iobenguane I 123 scintigraphy (middle), and 111In-octreotide scintigraphy (right) obtained in the same patient over a 3-month period demonstrate multiple metastases to bone. The iobenguane scintigram is floridly abnormal, showing multiple foci of radiotracer uptake in the liver and throughout the marrow-containing bones. These features are less conspicuous on the other two images. (c) Sagittal MR images, obtained in another patient with a T1-weighted sequence (left) and a short inversion time inversion recovery sequence (right), depict multiple intravertebral foci of high T1-weighted and low T2-weighted signal intensity, respectively. These findings are indicative of metastases from an ileal carcinoid tumor.
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Figure 16a. Unusual sites of metastatic disease. (a) Contrast-enhanced CT image in a patient with advanced metastatic carcinoid disease demonstrates an enhancing nodule in the right anterior abdominal soft tissues, a finding consistent with a metastatic deposit (arrow). Marked hepatomegaly due to multiple liver metastases and ascites also is visible. (b) Axial T2-weighted MR image shows right parietal and occipital soft-tissue masses that traverse the calvaria in a patient with an end-stage thymic carcinoid tumor. The masses were histologically proved carcinoid metastases. (c) Gadolinium-enhanced T1-weighted MR image depicts an intraconal, retro-orbital metastasis (arrow) within the superomedial aspect of the left orbit.
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Figure 16b. Unusual sites of metastatic disease. (a) Contrast-enhanced CT image in a patient with advanced metastatic carcinoid disease demonstrates an enhancing nodule in the right anterior abdominal soft tissues, a finding consistent with a metastatic deposit (arrow). Marked hepatomegaly due to multiple liver metastases and ascites also is visible. (b) Axial T2-weighted MR image shows right parietal and occipital soft-tissue masses that traverse the calvaria in a patient with an end-stage thymic carcinoid tumor. The masses were histologically proved carcinoid metastases. (c) Gadolinium-enhanced T1-weighted MR image depicts an intraconal, retro-orbital metastasis (arrow) within the superomedial aspect of the left orbit.
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Figure 16c. Unusual sites of metastatic disease. (a) Contrast-enhanced CT image in a patient with advanced metastatic carcinoid disease demonstrates an enhancing nodule in the right anterior abdominal soft tissues, a finding consistent with a metastatic deposit (arrow). Marked hepatomegaly due to multiple liver metastases and ascites also is visible. (b) Axial T2-weighted MR image shows right parietal and occipital soft-tissue masses that traverse the calvaria in a patient with an end-stage thymic carcinoid tumor. The masses were histologically proved carcinoid metastases. (c) Gadolinium-enhanced T1-weighted MR image depicts an intraconal, retro-orbital metastasis (arrow) within the superomedial aspect of the left orbit.
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Figure 17. Carcinoid heart disease. Left: Cardiac US image in a patient with carcinoid syndrome due to a metastatic ileal carcinoid tumor shows the tricuspid valve (arrows) during diastole, and the electrocardiographic tracing shows that image acquisition occurred on the R wave, immediately before right ventricular contraction. Right: Cardiac US image shows the tricuspid valve (arrows) during systole, and the electrocardiographic tracing shows that image acquisition occurred during systole. The tricuspid valve appears fixed; the right ventricle has contracted, but the immobile valve remains wide open. The consequence is severe tricuspid regurgitation. (Courtesy of Robin Choudhury, MD, Department of Cardiovascular Medicine, University of Oxford.)
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Figure 18a. Ablation of hepatic metastases. (a) Axial contrast-enhanced CT image, obtained before ablation, shows a large and poorly defined carcinoid metastasis in the right lobe of the liver (arrow). (b) Postprocedural CT image shows an extensive low-attenuation region within the tumor, a feature that signifies technically successful ablation. The patient experienced a marked improvement in symptoms after ablation therapy.
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Figure 18b. Ablation of hepatic metastases. (a) Axial contrast-enhanced CT image, obtained before ablation, shows a large and poorly defined carcinoid metastasis in the right lobe of the liver (arrow). (b) Postprocedural CT image shows an extensive low-attenuation region within the tumor, a feature that signifies technically successful ablation. The patient experienced a marked improvement in symptoms after ablation therapy.
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Figure 19. Flow chart shows the suggested imaging protocol for evaluating patients in whom the presence of a carcinoid tumor is suspected. 11C–5-HTP = carbon 11–5-hydroxytryptophan, 5-HIAA = 5-hydroxyindolacetic acid.
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Figure 20. Flow chart shows the recommended procedures for disease monitoring, assessment of treatment response, and detection of new or recurrent lesions after an initial diagnosis of carcinoid tumor.
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Copyright © 2007 by the Radiological Society of North America.
