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• Clinical Article •
The value of combining whole-tumor ADC histogram parameters with imaging biomarkers in predicting perineural and lymphovascular invasion in rectal adenocarcinoma
WANG Haisheng  YUAN Long  ZHU Kaibo  XI Huaze  LIU Jianqiang  LUO Pan  GAO Rong  ZHOU Junlin  LIU Hong 

Cite this article as: WANG H S, YUAN L, ZHU K B, et al. The value of combining whole-tumor ADC histogram parameters with imaging biomarkers in predicting perineural and lymphovascular invasion in rectal adenocarcinoma[J]. Chin J Magn Reson Imaging, 2025, 16(3): 63-69, 95. DOI:10.12015/issn.1674-8034.2025.03.010.


[Abstract] Objective To explore the value of combining whole-tumor apparent diffusion coefficient (ADC) histogram parameters with imaging biomarkers in predicting perineural invasion (PNI) and lymphovascular invasion (LVI) in rectal adenocarcinoma.Materials and Methods A retrospective analysis was conducted on the preoperative clinical and magnetic resonance imaging (MRI) data of 102 patients with pathologically confirmed rectal adenocarcinoma. Based on pathological results, patients were divided into two groups: the PNI/LVI-positive group (with either or both PNI and LVI positive) and the PNI/LVI-negative group (both PNI and LVI negative). Using FireVoxel software, regions of interest (ROIs) were delineated to obtain ADC histogram parameters of the primary tumor, including ADC mean (ADC-mean), standard deviation, coefficient of variation, entropy, skewness, and the 1st, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 99th percentiles of ADC (ADC-1%, ADC-5%, ADC-10%, ADC-25%, ADC-50%, ADC-75%, ADC-90%, ADC-95%, ADC-99%). Differences in ADC histogram parameters, MRI assessment extramural venous invasion (mrEMVI) status, tumor location, mrT stage, and mrN stage between the PNI/LVI-positive and negative groups were analyzed. Parameters with statistically significant differences (P < 0.05) were selected through univariate analysis and used to construct a multivariate logistic regression model (ADC histogram model). Additionally, non-histogram parameters that were also statistically significant (P < 0.05) in univariate analysis were included in a multivariate logistic regression analysis to establish a combined predictive model. The predictive performance of the ADC histogram model and the combined model was evaluated using receiver operating characteristic (ROC) curve analysis, and the DeLong test was used to compare the differences in the area under the curve (AUC) between the models.Results Significant differences were observed between the PNI/LVI-positive and negative groups in ADC-mean, standard deviation, ADC-1%, ADC-75%, ADC-95%, ADC-99%, and mrEMVI (P < 0.05). Among these continuous variables, ADC-99% had the highest diagnostic performance (AUC, sensitivity, and specificity were 0.835, 77.1%, and 86.6%, respectively). The combined model, constructed using ADC-mean, standard deviation, ADC-1%, ADC-75%, ADC-95%, ADC-99%, and mrEMVI, had an AUC, sensitivity, and specificity of 0.918, 89.6%, and 82.9%, respectively, outperforming the histogram model (AUC = 0.898) and individual whole-tumor ADC histogram parameters (AUC = 0.670 to 0.835). In addition to the combined model and the histogram model, there were statistically significant differences between the two models and the histogram parameters (P < 0.05).Conclusions Whole-tumor ADC histogram parameters and imaging biomarkers (mrEMVI) can be used to predict the neurovascular status of rectal adenocarcinoma preoperatively. The predictive value is higher when both are combined.
[Keywords] rectal adenocarcinoma；perineural and lymphovascular invasion；magnetic resonance imaging；apparent diffusion coefficient；histogram；imaging biomarkers

WANG Haisheng   YUAN Long   ZHU Kaibo   XI Huaze   LIU Jianqiang   LUO Pan   GAO Rong   ZHOU Junlin   LIU Hong*  

Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China

Corresponding author: LIU H, E-mail: liu20190410@163.com

Conflicts of interest   None.

Received  2024-11-27
Accepted  2025-03-07
DOI: 10.12015/issn.1674-8034.2025.03.010
Cite this article as: WANG H S, YUAN L, ZHU K B, et al. The value of combining whole-tumor ADC histogram parameters with imaging biomarkers in predicting perineural and lymphovascular invasion in rectal adenocarcinoma[J]. Chin J Magn Reson Imaging, 2025, 16(3): 63-69, 95. DOI:10.12015/issn.1674-8034.2025.03.010.

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