Diagnostic Approaches to Neuroendocrine Neoplasms of Unknown Primary Site

Abstract

Neuroendocrine tumors (NETs) are relatively uncommon heterogeneous neoplasms arising from endocrine and neuronal origin cells showing highly variable clinical behavior. By the time these tumors are discovered, up to 14% of patients with histologically proven NETs have metastasis, with the liver as the most frequently affected organ. Sometimes, no known primary site can be identified via routine imaging. Neuroendocrine tumors of unknown origin carry a poorer prognosis (compared with metastatic NETs with a known primary site) because of a lack of tailored surgical intervention and appropriate medical therapy (eg, chemotherapy or targeted therapy). A multimethod approach is frequently used in the trial to accurately determine the primary site for NETs of unknown primary sites and may include clinical, laboratory, radiological, histopathological, and surgical data. New molecular techniques using the genomic approach to identify the molecular signature have shown promising results. Various imaging modalities include ultrasound, computed tomography (CT), dual-energy CT, magnetic resonance imaging, and functional and hybrid imaging (positron emission tomography/CT, positron emission tomography/magnetic resonance imaging); somatostatin receptor imaging with new tracers is frequently used in an attempt for localization of the primary site.

Dual-Energy CT in Oncologic Imaging

“…Notably, recent advancements have highlighted its significant advantages in the evaluation of oncology patients [ 20 , 21 , 22 ]. Key among these applications are virtual non-contrast (VNC) and iodine maps, which effectively highlight tissue vascularity [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] in both primary tumors and metastases [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Furthermore, enhanced visualization of vascular structures enables the optimized assessment of vascular involvement [ 44 ].…”