Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (-0.37, p = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterial_entropy was significantly correlated to G (-0.368, p = 0.038) and to Ki67 percentage (-0.421, p = 0.018). The ROC curve for the Arterial_entropy reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545-0.928, p = 0.035) in the identification of G1-2 tumors. Arterial_uniformity values were correlated to G (0.346, p = 0.005) and Ki67 levels (0.383, p = 0.033). Arterial_entropy values were directly correlated with the SUV (0.449, p = 0.047) which was inversely correlated with Arterial_uniformity (-0.499, p = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases.

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