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

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Abstract

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 diffusion coefficient (ADC), arterial and late enhancement, necrosis, cystic degeneration, and maximum diameter. Additionally, first-, second-, and higher-order radiomic parameters were extracted from both PET and MRI scans. Correlations with several PanNETs’ histopathological prognostic factors were evaluated using Spearman’s coefficient, 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 significant 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 parameters extracted by the two modalities and highlights the potentiality of imaging and radiomic parameters in assessing histopathological features of PanNET aggressiveness.

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Acknowledgements

The SIGNA PET/MRI system (General Electric Healthcare, Waukesha, WI, USA) used in the present work has been purchased with funding from the Italian Ministry of Health.

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Author notes

  1. P. Mapelli and C. Bezzi contributed equally.

Authors and Affiliations

  1. Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy

    P. Mapelli, C. Bezzi, D. Palumbo, S. Ghezzo, A. Messina, A. Guarnaccia, V. Andreasi, S. Partelli, M. Falconi, F. De Cobelli & M. Picchio

  2. Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    P. Mapelli, C. Bezzi, C. Canevari, S. Ghezzo, A. M. Samanes Gajate, L. Presotto, V. Bettinardi, L. Gianolli, P. Scifo & M. Picchio

  3. Department of Radiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    D. Palumbo, A. Messina & F. De Cobelli

  4. Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Piazza Pugliatti 1, 98125, Messina, Italy

    B. Catalfamo

  5. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    F. Muffatti, V. Andreasi, S. Partelli & M. Falconi

  6. Pathology Department, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    M. Schiavo Lena

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Correspondence to M. Picchio.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All patients gave their informed consent to participate to the study.

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Prof. Massimo Falconi is Advisory Board Member of Advanced Accelerator Application (AAA). All the other authors have no conflicts of interest related to the present paper to disclose.

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Mapelli, P., Bezzi, C., Palumbo, D. et al. 68Ga-DOTATOC PET/MR imaging and radiomic parameters in predicting histopathological prognostic factors in patients with pancreatic neuroendocrine well-differentiated tumours. Eur J Nucl Med Mol Imaging 49, 2352–2363 (2022). https://doi.org/10.1007/s00259-022-05677-0

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