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Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy



To evaluate DW MR tumour volumetry and post-CRT ADC in rectal cancer as predicting factors of CR using high b values to eliminate perfusion effects.


One hundred rectal cancer patients who underwent 1.5-T rectal MR and DW imaging using three b factors (0, 150, and 1,000 s/mm2) were enrolled. The tumour volumes of T2-weighted MR and DW images and pre- and post-CRT ADC150–1000 were measured. The diagnostic accuracy of post-CRT ADC, T2-weighted MR, and DW tumour volumetry was compared using ROC analysis.


DW MR tumour volumetry was superior to T2-weighted MR volumetry comparing the CR and non-CR groups (P < 0.001). Post-CRT ADC showed a significant difference between the CR and non-CR groups (P = 0.001). The accuracy of DW tumour volumetry (Az = 0.910) was superior to that of T2-weighed MR tumour volumetry (Az = 0.792) and post-CRT ADC (Az = 0.705) in determining CR (P = 0.015). Using a cutoff value for the tumour volume reduction rate of more than 86.8 % on DW MR images, the sensitivity and specificity for predicting CR were 91.4 % and 80 %, respectively.


DW MR tumour volumetry after CRT showed significant superiority in predicting CR compared with T2-weighted MR images and post-CRT ADC.

Key Points

Diffusion-weighted MR (DWMR) imaging offers new information about rectal cancer.

DWMR helps to predict complete remission after chemoradiotherapy in patients with advanced rectal cancer.

DWMR provides more accurate diagnostic information than T2-weighted MRI.

Apparent diffusion coefficients can predict CR, but they have certain clinical limitations.

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Fig. 1
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Fig. 4



Apparent diffusion coefficient

AUC (Az):

Area under the ROC curve


Complete response


preoperative chemoradiation therapy


Diffusion weighted


Receiver-operating characteristic


Region of interest


Signal intensity


Tumour volume


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This article was presented as a scientific paper at the RSNA 97th Scientific Assembly and Annual Meeting (2011 RSNA).

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Correspondence to Ah Young Kim.

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Ha, H.I., Kim, A.Y., Yu, C.S. et al. Locally advanced rectal cancer: diffusion-weighted MR tumour volumetry and the apparent diffusion coefficient for evaluating complete remission after preoperative chemoradiation therapy. Eur Radiol 23, 3345–3353 (2013).

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  • Rectal cancer
  • Staging
  • MRI
  • Diffusion
  • Complete remission