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Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner

  • Gastrointestinal
  • Published:
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Our goal was to investigate the correlation between histopathology and diffusion parameters by utilising the most repeatable region-of-interest (ROI) strategy for diffusion parameters in rectal cancer on a 3T scanner.


113 patients underwent DKI-MR and 66 of these patients received surgery without neoadjuvant chemoradiotherapy. Two readers independently measured the parameters using three slice protocols including single slice, three slices and whole-tumour slice (WTS), combined with one of two ROIs, including outline and round ROI. ANOVA, Kruskal-Wallis, a paired sample t-test, interclass correlation coefficient (ICC), Bland-Altman, Student’s t-tests, receiver operating characteristic curves and z statistic were used for statistical analysis.


There were no significant differences among the three slice protocols in ADC values (p = 0.822, 0.987), K values (p = 0.842, 0.859) and D values (p = 0.917, 0.988) using round and outline ROI, respectively. The ADC and D values derived from outline ROIs were higher than those from round ROIs (all p < 0.001 for ADC, all p < 0.001 for D), while K values derived from outline ROIs were lower than those from round ROIs (p < 0.001, p = 0.001, p < 0.001) using three slice protocols, respectively. The WTS-outline ROI resulted in the best intra- and inter-observer ICC. Utilising the WTS-outline ROI method, the AUC for assessment of well-differentiated tumours was 0.871 by K and 0.809 by ADC; and the AUC for T2 was 0.768 by K.


The most repeatable strategy was the WTS-outline ROI method. In addition to DWI, DKI also have diagnostic value for rectal cancer histopathological characteristics utilising the WTS-outline ROI on a 3T scanner.

Key Points

• DKI using a 3T scanner is feasible for assessing rectal cancer.

• ROI and slice protocol show considerable influence on DKI parameters.

• DKI parameters exhibit excellent repeatability using whole-tumour slice-outline ROI on 3T scanner.

• DKI has considerable diagnostic value for the estimation of rectal cancer characteristics.

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Apparent diffusion coefficient


American Joint Committee on Cancer


Area under curve


Bland-Altman limits of agreements


Circumferential resection margin


Corrected diffusion coefficient


Diffusion kurtosis imaging


Diffusion weighted imaging


Single-shot echo-planar imaging


Interclass correlation coefficient


Diffusion kurtosis coefficient


Lymphovascular invasion


Magnetic resonance imaging


Neoadjuvant chemoradiotherapy


Receiver operating characteristic


Region of interest


Standard deviation


Signal-to-noise ratio


Single slice


T2-weighted images


Three slices


Turbo spin echo


World Health Organization


Whole tumour slice


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This study has received funding by the National Natural Science Foundation of China (Grant No. 81501437).

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Corresponding authors

Correspondence to Tong Tong or Yajia Gu.

Ethics declarations


The scientific guarantor of this publication is Yajia Gu.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China and MR Collaboration NE Asia, Siemens Healthineers, Shanghai, China

Statistics and biometry

Huixun Jia, MD, Department of Clinical Statistics Center, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China kindly provided statistical advice for this manuscript.

Informed consent

This was a retrospective study and did not require informed consent.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution

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Sun, Y., Xiao, Q., Hu, F. et al. Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner. Eur Radiol 28, 5211–5220 (2018).

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