Background <p>⁶⁸Ga-DOTATATE binds to somatostatin receptors (SSTR) and is used for PET/CT imaging for diagnosing meningioma and guiding postoperative radiotherapy. However, the relationship between the clinicopathological characteristics and the imaging features of ⁶⁸Ga-DOTATATE PET/CT in meningioma remains undetermined.</p> Methods <p>We conducted a retrospective study at a single neurosurgical center. Semiquantitative indices of ⁶⁸Ga-DOTATATE PET/CT, including maximum standardized uptake value (SUV-max), median standardized uptake value (SUV-median), mean standardized uptake value (SUV-mean), and metabolic tumor volume (MTV), were measured. The correlations between these parameters and clinicopathological characteristics were analyzed.</p> Results <p>Eighty patients were retrospectively analyzed, including 45 with WHO grade 1 meningiomas, 33 with grade 2, and 2 with grade 3. The median SUV-max value was significantly higher in meningiomas with high WHO grade (<i>P</i> = 0.017), positive SSTR2a expression (<i>P</i> = 0.023), and in male patients (<i>P</i> = 0.002). Bulk RNA data was available in forty patients. RNA expression of SSTR2 was significantly elevated in the SSTR2a-positive group and correlated positively with SUV-max, SUV-median, and SUV-mean. Furthermore, the high RNA scores risk group exhibited significantly higher SUV-max compared to the intermediate- and low-risk groups. Of note, an SUV-max &gt; 15.55 (<i>P</i> = 0.014) was independently associated with high WHO grade. Lastly, a nomogram incorporating SUV-max, gender, and surgical history demonstrated robust performance in preoperatively identifying patients at risk for high WHO grade, offering the potential utility of ⁶⁸Ga-DOTATATE PET/CT in clinical practice.</p> Conclusion <p>SUV-max of ⁶⁸Ga-DOTATATE PET/CT was significantly higher in high grade and high RNA score risk groups of meningioma. Of note, an SUV-max &gt; 15.55 was independently associated with high WHO grade.</p>