Congratulations to Timothy L. Frankel, MD, and Paul G. Gauger, MD, of the University of Michigan, Ann Arbor; they coauthored the winning Image of the Year for 2009. Their Image of the Month article on Wermer syndrome and Zollinger-Ellison syndrome appeared in the April 2009 issue (Arch Surg. 2009;144:377-378). This article addressed the difficult problem of preoperative localization of multifocal gastrinomas in patients with multiple endocrine neoplasia type I. The preoperative computed tomography (CT) scan illustrated a novel technique that used a low-density, barium-based, oral contrast agent during the arterial phase of intravenous contrast-enhanced spiral CT of the abdomen. The oral agent distended the duodenum enough to silhouette the small arterially enhancing mucosal tumors. The CT scan was coupled with a photograph of the opened, resected duodenum showing the same tumors located on the mucosal surface. This photograph is a valuable teaching image for resident physicians, many of whom will have little or no opportunity to see these duodenal tumors during their general surgical training.
Please revisit our April 2009 issue to “Make the Diagnosis.”
Image of the Year for 2009. Arch Surg. 2009;144(12):1166. doi:10.1001/archsurg.2009.212