68Ga-DOTATOC PET/MR imaging and radiomic parameters in predicting histopathological prognostic factors in patients with pancreatic neuroendocrine well-differentiated tumours

Purpose To explore the role of fully hybrid 68Ga-DOTATOC PET/MR imaging and radiomic parameters in predicting histopathological prognostic factors in patients with pancreatic neuroendocrine tumours (PanNETs) undergoing surgery. Methods One hundred eighty-seven consecutive 68Ga-DOTATOC PET/MRI scans (March 2018–June 2020) performed for gastroenteropancreatic neuroendocrine tumour were retrospectively evaluated; 16/187 patients met the eligibility criteria ( 68Ga-DOTATOC PET/MRI for preoperative staging of PanNET and availability of histological data). PET/MR scans were qualitatively and quantitatively interpreted, and the following imaging parameters were derived: PET-derived SUVmax, SUVmean, somatostatin receptor density (SRD), total lesion somatostatin receptor density (TLSRD), and MRI-derived apparent difusion coefcient (ADC), arterial and late enhancement, necrosis, cystic degeneration, and maximum diameter. Additionally, frst-, second-, and higher-order radiomic parameters were extracted from both PET and MRI scans. Correla tions with several PanNETs’ histopathological prognostic factors were evaluated using Spearman’s coefcient, while the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate parameters’ predictive performance. Results Primary tumour was detected in all 16 patients (15/16 by 68Ga-DOTATOC PET and 16/16 by MRI). SUVmax and SUVmean resulted good predictors of lymphnodal (LN) involvement (AUC of 0.850 and 0.783, respectively). Second-order radiomic parameters GrayLevelVariance and HighGrayLevelZoneEmphasis extracted from T2 MRI demonstrated signifcant correlations with LN involvement (adjusted p=0.009), also showing good predictive performance (AUC=0.992). Conclusion This study demonstrates the role of the fully hybrid PET/MRI tool for the synergic function of imaging param eters extracted by the two modalities and highlights the potentiality of imaging and radiomic parameters in assessing histo pathological features of PanNET aggressiveness.