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Whole-tumour diffusion kurtosis MR imaging histogram analysis of rectal adenocarcinoma: Correlation with clinical pathologic prognostic factors

  • Gastrointestinal
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To investigate potential relationships between diffusion kurtosis imaging (DKI)-derived parameters using whole-tumour volume histogram analysis and clinicopathological prognostic factors in patients with rectal adenocarcinoma.

Material and methods

79 consecutive patients who underwent MRI examination with rectal adenocarcinoma were retrospectively evaluated. Parameters D, K and conventional ADC were measured using whole-tumour volume histogram analysis. Student’s t-test or Mann-Whitney U-test, receiver operating characteristic curves and Spearman’s correlation were used for statistical analysis.


Almost all the percentile metrics of K were correlated positively with nodal involvement, higher histological grades, the presence of lymphangiovascular invasion (LVI) and circumferential margin (CRM) (p<0.05), with the exception of between K10th, K90th and histological grades. In contrast, significant negative correlations were observed between 25th, 50th percentiles and mean values of ADC and D, as well as ADC10th, with tumour T stages (p< 0.05). Meanwhile, lower 75th and 90th percentiles of ADC and D values were also correlated inversely with nodal involvement (p< 0.05). Kmean showed a relatively higher area under the curve (AUC) and higher specificity than other percentiles for differentiation of lesions with nodal involvement.


DKI metrics with whole-tumour volume histogram analysis, especially K parameters, were associated with important prognostic factors of rectal cancer.

Key Points

K correlated positively with some important prognostic factors of rectal cancer.

K mean showed higher AUC and specificity for differentiation of nodal involvement.

DKI metrics with whole-tumour volume histogram analysis depicted tumour heterogeneity.

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Apparent diffusion coefficient


Carcinoembryonic antigen


Circumferential margin






Diffusion kurtosis imaging


Diffusion weighted imaging


Field of view


Interclass correlation coefficient




Lymphangiovascular invasion


Magnetic resonance imaging


Receiver operating characteristic


Region of interest


Single shot echo-planar imaging


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This work was supported by the fund of Science and Technology Project of Shanxi Province (No. 20150313007-5).

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Correspondence to Xiaotang Yang.

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The scientific guarantor of this publication is Xiaotang Yang.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution

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Cui, Y., Yang, X., Du, X. et al. Whole-tumour diffusion kurtosis MR imaging histogram analysis of rectal adenocarcinoma: Correlation with clinical pathologic prognostic factors. Eur Radiol 28, 1485–1494 (2018).

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