Bonekamp David, Raman Siva P, Horton Karen M, Fishman Elliot K
David Bonekamp, Siva P Raman, Karen M Horton, Elliot K Fishman, the Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States.
World J Radiol. 2015 Sep 28;7(9):220-35. doi: 10.4329/wjr.v7.i9.220.
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.
小肠类癌肿瘤是胃肠道类癌中最常见的形式（占42%），而胃肠道类癌本身占神经内分泌肿瘤的70%。尽管原发性小肠肿瘤总体上较为罕见（占所有胃肠道肿瘤的3%-6%），但类癌仍是继小肠腺癌之后第二常见的（占20%-30%）原发性小肠恶性肿瘤。对其进行影像学评估往往具有挑战性。先进的高分辨率多期计算机断层扫描以及先进的后处理方法为其显示提供了极佳的工具。然而，众多的交互式参数选择需要了解何时使用哪种技术。在此，我们讨论十二指肠、空肠和回肠类癌肿瘤的影像学表现及评估，包括原发性肿瘤、局部肠系膜淋巴结转移和远处转移疾病的影像学特征。本文提出了一个用于最佳病变检测的方案，包括使用计算机断层扫描小肠造影、容积采集、计算机断层扫描血管造影和三维映射。通过一系列具有挑战性的病例展示影像学表现，这些病例说明了小肠和肠系膜中可能出现的疾病谱、多期数据上肠本身可能出现的表现范围以及肠系膜的促纤维增生反应和高血供肝转移等腔外表现。文中还展示了典型的影像学陷阱和要点。
