Radiomic Analysis for Ki-67 Classification in Small Bowel Neuroendocrine Tumors

<b>Objective</b>: To analyze radiomic features extracted from CT images of small bowel neuroendocrine tumors and evaluate their association with Ki-67 expression. <b>Methods</b>: 128 small bowel NET primary and secondary lesions from 34 patients were analyzed. Manual segmentation of the lesions was conducted on portal-phase CT images using ITK-SNAP v. 4.0^®, and 107 radiomic features were extracted using the PyRadiomics library. The lesions were categorized into two groups based on their Ki-67 index expression (≤1% and >1%). Correlation filtering reduced the set of 107 to 41 radiomic features. Inferential statistical analyses (<i>t</i>-test and Mann-Whitney U, following Shapiro-Wilk and Levene's tests) identified 19 significant features (<i>p</i> < 0.05) that were predominantly texture related. A ranking procedure further reduced these to eight top-performing variables across multiple selection methods (Information Gain, Gini, ANOVA, χ²). Five supervised Machine Learning models (Logistic Regression, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), XGBoost, and Random Forest) were trained and validated using 5-fold cross-validation. The evaluation metrics employed included AUC, accuracy, precision, recall, F1 score, and a confusion matrix. <b>Results</b>: Random Forest exhibited the best overall performance (AUC = 0.80; F1 score = 0.813; Recall = 0.847). The model's low false negative rate (15.3%) suggests potential clinical utility in minimizing the risk of underestimating more aggressive lesions. <b>Conclusions</b>: Radiomics represents a promising frontier to identify patterns associated with histopathological markers. This study highlights its potential for non-invasive assessment of proliferative rate in small bowel neuroendocrine tumors, confirming the performance in the literature, and posing an interesting prospect for future research.