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Unknown Primary Tumors: Detection with Dual-Modality PET/CT—Initial Experience¹

¹ From the Departments of Diagnostic and Interventional Radiology (A.G., G.A., H.K., T.E., E.H., S.G., J.D.), Oto-Rhino-Laryngology (M.F.), and Nuclear Medicine (A.B., L.F.), University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. Received September 25, 2003; revision requested December 5; revision received March 11, 2004; accepted April 8. Address correspondence to A.G. (e-mail: Andreas.Gutzeit@ksa.ch).

PURPOSE: To retrospectively evaluate fused positron emission tomography (PET)/computed tomography (CT) in depicting the primary lesion in cancer of an unknown primary tumor, compared with PET, CT, and PET and CT side-by-side evaluation.

MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Forty-five patients (26 men and 19 women) with metastatic cervical adenopathy (n = 18) or extracervical metastases (n = 27) of unknown primary tumor were included. The mean age of the patients was 57 years (range, 29–95 years). PET/CT imaging was performed in all patients 1 hour after administration of 350 MBq of fluorodeoxyglucose with a whole-body field of view. Contrast agents were administered orally and intravenously in all patients to ensure diagnostic CT data. PET/CT data sets were evaluated for the primary tumor, and imaging results were compared with those of CT, PET, and PET and CT side-by-side evaluation. Differences in diagnostic performance were assessed by using the McNemar test with Bonferroni correction, which accounts for multiple comparisons.

RESULTS: PET/CT depicted the primary tumor in 15 (33%) of 45 patients. In 30 (67%) patients, the primary tumor site remained occult (P > .05). PET and CT side-by-side evaluation depicted 13 (29%) of 45 tumors (P > .05). PET alone revealed the primary tumor in 11 (24%) of 45 patients (P > .05), while CT alone helped in the correct diagnosis in eight (18%) of 45 patients (P > .05). There were no significant differences between the diagnostic accuracies of PET/CT and the other imaging modalities.

CONCLUSION: PET/CT was able to depict more primary tumors, though not significantly, than either of the other imaging modalities, but larger patient cohorts are required to finally judge its value for revealing the primary tumor site.

© RSNA, 2004

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