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Radiomic features on the pre-PRRT somatostatin receptor PET\/CT were evaluated using a custom MIM Software\u00ae LesionID workflow. Conventional PET\/CT metrics of tumor burden, such as somatostatin receptor expression and tumor volume, were calculated in addition to the indices of tumor heterogeneity for each lesion (intra-lesional) and then summarized across all lesions throughout the body (inter-lesional). Endpoints included post-PRRT 24-month time to progression (TTP) and overall survival (OS). Cox regression models were used to assess the predictive ability of the imaging factors on post-PRRT 24-month TTP and OS. LASSO-penalized Cox regression was used to build a multivariable model for each outcome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Eighty patients with a mean age of 65.1\u00a0years were included, with most (71.3%) completing 4 cycles of PRRT. Median TTP was 19.1\u00a0months, and OS at 60\u00a0months was 50%. A large degree of variability between patients was evidenced for imaging features related to somatostatin receptor expression. On multivariable analysis, total receptor expression and mean liver-corrected SUVmean were selected for 24-month TTP. The model was not able to significantly predict progression (C-statistic\u2009=\u20090.58, 95% CI 0.50\u20130.62). Total receptor expression and mean skewness were selected for OS. The resulting model was able to significantly predict death (C-statistic\u2009=\u20090.62, 95% CI 0.53\u20130.67), but the predictive ability was limited, as evidenced by the low C-statistic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our exploratory analysis provides preliminary results showing that imaging indices of inter- and intra-tumor heterogeneity from pretreatment PET\/CT images may potentially predict treatment efficacy in NET patients undergoing [<jats:sup>177<\/jats:sup>Lu]Lu-DOTA-TATE therapy. However, prospective evaluation in a larger cohort is needed to further assess whether a comprehensive characterization of tumor heterogeneity within a patient can help guide treatment decisions.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s41824-024-00227-3","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T23:01:36Z","timestamp":1732921296000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Inter- and intra-tumoral heterogeneity on [68Ga]Ga-DOTA-TATE\/[68Ga]Ga-DOTA-TOC PET\/CT predicts response to [177Lu]Lu-DOTA-TATE PRRT in neuroendocrine tumor patients"],"prefix":"10.1186","volume":"8","author":[{"given":"Camila","family":"Gadens Zamboni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayca","family":"Dundar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanchay","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Kruzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley T.","family":"Loeffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Graves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet H.","family":"Pollard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Mott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Dillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Menda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2397-6914","authenticated-orcid":false,"given":"Ahmad","family":"Shariftabrizi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,11,30]]},"reference":[{"issue":"6","key":"227_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/jne.13138","volume":"34","author":"H Almeamar","year":"2022","unstructured":"Almeamar H, Cullen L, Murphy DJ, Crowley RK, Toumpanakis C, Welin S et al (2022) Real-world efficacy of lutetium peptide receptor radionuclide therapy in patients with neuroendocrine tumours. 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This study was approved by the University of Iowa Institutional Review Board (IRB#200903778). The study was granted a full waiver of HIPAA Authorization (informed consent) based on the DHHS Federal wide Assurance#FWA00003007 for this project involving retrospective secondary analysis of existing data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Waived by the University of Iowa Institutional Review Board for this retrospective secondary analysis of existing data-please see the above for details.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare that they have no competing interests or relevant financial or non-financial interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"39"}}