Can histogram analysis of MR images predict aggressiveness in pancreatic neuroendocrine tumors?

To evaluate MRI derived whole-tumour histogram analysis parameters in predicting pancreatic neuroendocrine neoplasm (panNEN) grade and aggressiveness. Pre-operative MR of 42 consecutive patients with panNEN > 1 cm were retrospectively analysed. T1-/T2-weighted images and ADC maps were analysed. Histogram-derived parameters were compared to histopathological features using the Mann-Whitney U test. Diagnostic accuracy was assessed by ROC-AUC analysis; sensitivity and specificity were assessed for each histogram parameter. ADC(entropy) was significantly higher in G2-3 tumours with ROC-AUC 0.757; sensitivity and specificity were 83.3 % (95 % CI: 61.2-94.5) and 61.1 % (95 % CI: 36.1-81.7). ADC(kurtosis) was higher in panNENs with vascular involvement, nodal and hepatic metastases (p= .008, .021 and .008; ROC-AUC= 0.820, 0.709 and 0.820); sensitivity and specificity were: 85.7/74.3 % (95 % CI: 42-99.2 /56.4-86.9), 36.8/96.5 % (95 % CI: 17.2-61.4 /76-99.8) and 100/62.8 % (95 % CI: 56.1-100/44.9-78.1). No significant differences between groups were found for other histogram-derived parameters (p >.05). Whole-tumour histogram analysis of ADC maps may be helpful in predicting tumour grade, vascular involvement, nodal and liver metastases in panNENs. ADC(entropy) and ADC(kurtosis) are the most accurate parameters for identification of panNENs with malignant behaviour. aEuro cent Whole-tumour ADC histogram analysis can predict aggressiveness in pancreatic neuroendocrine neoplasms. aEuro cent ADC entropy and kurtosis are higher in aggressive tumours. aEuro cent ADC histogram analysis can quantify tumour diffusion heterogeneity. aEuro cent Non-invasive quantification of tumour heterogeneity can provide adjunctive information for prognostication.