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December 21, 2009

Image of the Year for 2009

Arch Surg. 2009;144(12):1166. doi:10.1001/archsurg.2009.212

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[4]: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.