European journal of radiology · 2026
Extended multiphasic computed tomography protocol improves detection of the primary tumor in neuroendocrine neoplasms of unknown primary: A single-center retrospective study.
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Niewiadomska Agnieszka, Szulc Urszula, Rosiek Violetta, Grażyńska Anna, Chrabański Olgierd, Kuźbińska Aleksandra, Barczyk-Gutkowska Anna, Krupa Kamil, Szczudło-Chraścina Joanna, Pilch-Kowalczyk Joanna, Kos-Kudła Beata, Steinhof-Radwańska Katarzyna
Аннотация
PURPOSE: To evaluate whether an extended multiphasic computed tomography (CT) protocol including an additional intermediate phase improves detection of the primary tumor in patients with neuroendocrine neoplasms of unknown primary site (CUP-NEN).
METHODS: This retrospective single-center study included 194 patients with histologically confirmed NEN of unknown origin who underwent contrast-enhanced CT between 2010 and 2023. All examinations were performed using an extended protocol comprising unenhanced, arterial, intermediate, and portal venous phases. The primary endpoint was detection of the primary tumor, confirmed by histopathology. Secondary analyses included metastatic patterns and association with tumor grade.
RESULTS: The primary tumor was identified in 79 of 194 patients (40.7%). The gastrointestinal tract was the most frequent location (18.0%), particularly the small intestine (13.4%), followed by the pancreas (15.0%). The mean tumor size was 14 mm (range 6-38 mm). Most patients presented with distant metastases, predominantly in the liver (76.3%), and lymph node metastases were observed in 50.5% of cases. No significant association between tumor grade and detection rate was found (p = 0.51). In a phase-based analysis, the intermediate phase provided exclusive or optimal visualization of primary tumors in 84.8% of detected cases.
CONCLUSIONS: An extended multiphasic CT protocol including an intermediate phase may improve detection of small hypervascular primary tumors in patients with CUP-NEN. Optimization of CT acquisition protocols represents a practical and widely accessible strategy to enhance diagnostic performance in this patient population.
METHODS: This retrospective single-center study included 194 patients with histologically confirmed NEN of unknown origin who underwent contrast-enhanced CT between 2010 and 2023. All examinations were performed using an extended protocol comprising unenhanced, arterial, intermediate, and portal venous phases. The primary endpoint was detection of the primary tumor, confirmed by histopathology. Secondary analyses included metastatic patterns and association with tumor grade.
RESULTS: The primary tumor was identified in 79 of 194 patients (40.7%). The gastrointestinal tract was the most frequent location (18.0%), particularly the small intestine (13.4%), followed by the pancreas (15.0%). The mean tumor size was 14 mm (range 6-38 mm). Most patients presented with distant metastases, predominantly in the liver (76.3%), and lymph node metastases were observed in 50.5% of cases. No significant association between tumor grade and detection rate was found (p = 0.51). In a phase-based analysis, the intermediate phase provided exclusive or optimal visualization of primary tumors in 84.8% of detected cases.
CONCLUSIONS: An extended multiphasic CT protocol including an intermediate phase may improve detection of small hypervascular primary tumors in patients with CUP-NEN. Optimization of CT acquisition protocols represents a practical and widely accessible strategy to enhance diagnostic performance in this patient population.