Abstract: Objective To compare the diagnostic efficacy of visual interpretation versus T/L_ratio-ROC method based on ⁶⁸Ga-DOTATATE PET/CT imaging for neuroendocrine tumors （NETs）. Methods A total of 32 patients （18 males and 14 females with age of 15-84 yeas） underwent ⁶⁸Ga-DOTATATE PET/CT in our center from July 2018 to January 2019 and confirmed by pathology were included in the retrospective analysis.Their clinical data and pathological results were collected.The area of interest （ROI） was delineated in the liver and the lesion site.The mean SUV value (SUV_mean) of the liver and the maximum SUV value (SUV_max) of the lesion were measured.The ratio of tumor to liver (T/L_ratio) was defined as T_SUVmax/L_SUVmean.Visual interpretation and T/L_ratio-ROC methods were used to analyze the diagnostic accuracy.By visual interpretation,uptake in the lesion higher than that in the liver was regarded as positive to diagnosis of NETs.ROC analysis was used to analyze the performance of T/L_ratio to diagnose NETs.The pathological result was the golden standard. Results Pathological results showed that 26 cases had NETs,including 10 cases of pheochromocytoma,2 cases of pheochromocytoma combined with paraganglioma,3 cases of paraganglioma,5 cases of pancreatic neuroendocrine tumors,2 cases of rectal neuroendocrine tumors,1 case of pheochromocytoma combined with medullary thyroid carcinoma,1 case of hilar neuroendocrine carcinoma,1 case of hepatic and 1 case of duodeneal NET.Six cases had non-NETs,including 1 case of adrenal cortical adenocarcinoma,1 case of renal neurogenic tumor,1 case of renal angiomyolipoma,1 case of adrenal ganglion cell neuroma,1 case of solitary fibrous tumor and 1 case of osteofibroma.There were 23 cases diagnosed as NETs by visual interpretation,of which 22 cases were NETs;9 cases were diagnosed as non-NETs,of which 4 cases were false negative.The sensitivity,specificity and accuracy of visual method to diagnose NETs were 84.62%,83.33%,84.38%,and the positive and negative predictive values were 95.65% and 55.56%,respectively.According to ROC analysis (T/L_ratio cut-off value=1.48),21 cases were diagnosed as NETs and they were all consistent with pathological results;11 cases were diagnosed as non-NETs and false negative results were found in 5 cases.The sensitivity,specificity and accuracy of T/L_ratio-ROC method to diagnose NETs were 80.80%,100%,84.38%,and the positive and negative predictive values were 100% and 54.55%,respectively. Conclusion Both visual interptetation and T/L_ratio-ROC method have good diagnostic efficacy for NETs based on ⁶⁸Ga-DOTATATE PET/CT imaging.They can be used for the localization and diagnosis of NETs.