Share：
Share this content in WeChat
X
[Chinese] [PDF] 5 1
• Clinical Articles •
Intravoxel incoherent motion histogram parameters combined with clinical features to predict the response of neoadjuvant therapy in patients with rectal cancer
LIN Libo  HE Yuxuan  ZHANG Yi  ZHOU Peng  CHEN Xiaoli  XU Hao 

Cite this article as: LIN L B, HE Y X, ZHANG Y, et al. Intravoxel incoherent motion histogram parameters combined with clinical features to predict the response of neoadjuvant therapy in patients with rectal cancer[J]. Chin J Magn Reson Imaging, 2026, 17(3): 39-45, 53. DOI:10.12015/issn.1674-8034.2026.03.006.


[Abstract] Objective To explore the predictive value of intravoxel incoherent motion (IVIM) histogram parameters combined with clinical features for pathologic complete response after neoadjuvant therapy in patients with locally advanced rectal cancer.Materials and Methods Clinical and imaging data of 197 patients (training set: 130, validation set: 67) with rectal cancer who underwent neoadjuvant therapy and radical surgery in Sichuan Cancer Hospital from January 2019 to December 2025 were retrospectively analyzed. Patients were categorized into significantly response and non-significantly response groups based on postoperative pathological findings. The mean (Mean), median (Median), standard deviation (SD), maximum (Maximum), and variance (Variance) of the histogram parameters of true diffusion coefficient (D), pseudo diffusion coefficient (D*), and perfusion fraction (f) were obtained based on IVIM images. Multivariate logistic regression analyses was used to establish combined parameters model. The area under curve (AUC) of receiver operating characteristic, sensitivity, accuracy, and specificity were used to assess the diagnostic performance. DeLong test was used for comparisons of the AUCs among independent risk predictors and combined parameters model.Results The values of fMean, fMedian, fSD, fMaximum, fVariance, D*Mean, D*Median, D*SD, and D*Variance were significantly higher in the significantly response group compared with the non-significantly response group in the training set (all P < 0.05). No significant difference were found in the D values between the two groups (all P > 0.05). The AUC of combined parameters model combing four independent risk factors was 0.894 [95% confidence interval (CI): 0.827 to 0.941] and 0.831 (95% CI: 0.714 to 0.928) in the training set and validation set, respectively, which was significantly higher than any other independent risk factors according to DeLong test (all P < 0.05). The accuracy, sensitivity and specificity of the combined parameters model was 0.854 (95% CI: 0.781 to 0.909), 0.711 (95% CI: 0.541 to 0.845), 0.913 (95% CI: 0.835 to 0.961) and 0.806 (95% CI: 0.701 to 0.896), 0.731 (95% CI: 0.522 to 0.884), 0.854 (95% CI: 0.708 to 0.944) in the training set and validation set, respectively.Conclusions IVIM histogram parameters can provide some basis for predicting the efficacy of neoadjuvant therapy in patients with rectal cancer, and the diagnostic efficacy of the model can be improved after further combining clinical features.
[Keywords] rectal cancer；magnetic resonance imaging；neoadjuvant therapy；diffusion weighted imaging；intravoxel incoherent motion；pathological complete response

LIN Libo   HE Yuxuan   ZHANG Yi   ZHOU Peng   CHEN Xiaoli   XU Hao*  

Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu 610041, China

Corresponding author: XU H, E-mail: 378531592@qq.com

Conflicts of interest   None.

Received  2025-11-10
Accepted  2026-03-10
DOI: 10.12015/issn.1674-8034.2026.03.006
Cite this article as: LIN L B, HE Y X, ZHANG Y, et al. Intravoxel incoherent motion histogram parameters combined with clinical features to predict the response of neoadjuvant therapy in patients with rectal cancer[J]. Chin J Magn Reson Imaging, 2026, 17(3): 39-45, 53. DOI:10.12015/issn.1674-8034.2026.03.006.

[1]
ZHENG R S, CHEN R, HAN B F, et al. Cancer incidence and mortality in China, 2022[J]. Chin J Oncol, 2024, 46(3): 221-231. DOI: 10.3760/cma.j.cn112152-20240119-00035.
[2]
D'ANDREA A P, MCLEMORE E C, BONACCORSO A, et al. Transanal total mesorectal excision (taTME) for rectal cancer: beyond the learning curve[J]. Surg Endosc, 2020, 34(9): 4101-4109. DOI: 10.1007/s00464-019-07172-4.
[3]
RENEHAN A G, MALCOMSON L, EMSLEY R, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis[J]. Lancet Oncol, 2016, 17(2): 174-183. DOI: 10.1016/S1470-2045(15)00467-2.
[4]
LI M Y, XIAO Q Y, VENKATACHALAM N, et al. Predicting response to neoadjuvant chemoradiotherapy in rectal cancer: from biomarkers to tumor models[J/OL]. Ther Adv Med Oncol, 2022, 14: 17588359221077972 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/35222695/. DOI: 10.1177/17588359221077972.
[5]
PETRELLI F, TREVISAN F, CABIDDU M, et al. Total neoadjuvant therapy in rectal cancer: a systematic review and meta-analysis of treatment outcomes[J]. Ann Surg, 2020, 271(3): 440-448. DOI: 10.1097/SLA.0000000000003471.
[6]
BOSSET J F, CALAIS G, MINEUR L, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study[J]. Lancet Oncol, 2014, 15(2): 184-190. DOI: 10.1016/S1470-2045(13)70599-0.
[7]
GLYNNE-JONES R, WYRWICZ L, TIRET E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2017, 28(suppl_4): iv22-iv40. DOI: 10.1093/annonc/mdx224.
[8]
YANG A, ZHOU P. Progress of quantitative prediction of the pathologic complete response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer with functional MRI[J]. Chin J Magn Reson Imaging, 2024, 15(7): 210-215. DOI: 10.12015/issn.1674-8034.2024.07.035.
[9]
PALMISANO A, DI CHIARA A, ESPOSITO A, et al. MRI prediction of pathological response in locally advanced rectal cancer: when apparent diffusion coefficient radiomics meets conventional volumetry[J/OL]. Clin Radiol, 2020, 75(10): 798.e1-798.e11 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/32712007/. DOI: 10.1016/j.crad.2020.06.023.
[10]
JIMÉNEZ DE LOS SANTOS M E, REYES-PÉREZ J A, DOMÍNGUEZ OSORIO V, et al. Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer[J]. World J Gastroenterol, 2022, 28(23): 2609-2624. DOI: 10.3748/wjg.v28.i23.2609.
[11]
JIMÉNEZ DE LOS SANTOS M E, REYES-PÉREZ J A, SANDOVAL-NAVA R M, et al. The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer[J/OL]. Acta Radiol Open, 2020, 9(9): 2058460120957295 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/32974055/. DOI: 10.1177/2058460120957295.
[12]
YUAN W J, LV X, ZHAO J X, et al. Volumetric histogram analysis of amide proton transfer-weighted imaging for predicting complete tumor response to neoadjuvant chemoradiotherapy in locally advanced rectal adenocarcinoma[J]. Eur Radiol, 2025, 35(6): 3158-3168. DOI: 10.1007/s00330-024-11220-6.
[13]
ZHAO J, LI H B. Application progress of intravoxel incoherent motion imaging in clinical diagnosis and treatment of rectal cancer[J]. Chin J Magn Reson Imaging, 2021, 12(12): 108-111 . DOI: 10.12015/issn.1674-8034.2021.12.026.
[14]
FENG T, XU S Y, LIU Y Y, et al. 3.0T multimodal MRI for evaluating T stage and therapeutic efficacy of neoadjuvant for rectal cancer[J]. Chin J Med Imaging Technol, 2023, 39(12): 1877-1882 . DOI: 10.13929/j.issn.1003-3289.2023.12.031.
[15]
HU H B, JIANG H J, WANG S, et al. 3.0 T MRI IVIM-DWI for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer[J]. Abdom Radiol (NY), 2021, 46(1): 134-143 . DOI: 10.1007/s00261-020-02594-4.
[16]
LI H, YUAN Y, CHEN X L, et al. Value of intravoxel incoherent motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rectal cancer[J/OL]. Eur J Radiol, 2022, 146: 110106 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/34922118/. DOI: 10.1016/j.ejrad.2021.110106.
[17]
JIN Z C, ZHOU D, YANG T H, et al. Predictive value of inflammatory indicators on the efficacy of preoperative neoadjuvant chemotherapy in patients with locally advanced rectal cancer[J/OL]. Int J Clin Pract, 2024, 2024: 3981447 [2025-11-09]. https://onlinelibrary.wiley.com/doi/10.1155/2024/3981447. DOI: 10.1155/2024/3981447.
[18]
SHAO Z Y, ZOU Y H, ZOU C L, et al. Nutritional indicators as predictive and prognosis biomarkers for neoadjuvant chemoradiotherapy outcomes in patients with locally advanced rectal cancer[J/OL]. Support Care Cancer, 2025, 33(10): 834 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/40908374/. DOI: 10.1007/s00520-025-09911-x.
[19]
AL-RASHID F, ROBITAILLE S, LIBERMAN A S, et al. Trajectory of change of low anterior resection syndrome over time after restorative proctectomy for rectal adenocarcinoma[J]. Tech Coloproctol, 2022, 26(3): 195-203 . DOI: 10.1007/s10151-021-02561-1.
[20]
THEODOROPOULOS G E, LIAPI A, SPYROPOULOS B G, et al. Temporal changes of low anterior resection syndrome score after sphincter preservation: a prospective cohort study on repetitive assessment of rectal cancer patients[J]. J Invest Surg, 2022, 35(2): 354-362 . DOI: 10.1080/08941939.2020.1864684.
[21]
ZHOU X Y, YANG J, LIU X H, et al. Multi-directional MRI radiomics to predict the efficacy of neoadjuvant chemoradiotherapy for locally advanced rectal cancer[J]. Radiol Pract, 2024, 39(2): 218-226 . DOI: 10.13609/j.cnki.1000-0313.2024.02.013.
[22]
CHAND M, EVANS J, SWIFT R I, et al. The prognostic significance of postchemoradiotherapy high-resolution MRI and histopathology detected extramural venous invasion in rectal cancer[J]. Ann Surg, 2015, 261(3): 473-479 . DOI: 10.1097/SLA.0000000000000848.
[23]
MACE A G, PAI R K, STOCCHI L, et al. American Joint Committee on Cancer and College of American Pathologists regression grade: a new prognostic factor in rectal cancer[J]. Dis Colon Rectum, 2015, 58(1): 32-44 . DOI: 10.1097/DCR.0000000000000266.
[24]
WEN L, HOU J, ZHOU J M, et al. Intravoxel incoherent motion diffusion-weighted imaging for discriminating the pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J/OL]. Sci Rep, 2017, 7: 8496 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/28819296/. DOI: 10.1038/s41598-017-09227-9.
[25]
CHEN K, SHE H L, WU T, et al. Comparison of percentage changes in quantitative diffusion parameters for assessing pathological complete response to neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis[J]. Abdom Radiol (NY), 2021, 46(3): 894-908 . DOI: 10.1007/s00261-020-02770-6.
[26]
PORTALE G, BARTOLOTTA P, AZZOLINA D, et al. Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis[J/OL]. Langenbecks Arch Surg, 2023, 408(1): 85 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/36781510/. DOI: 10.1007/s00423-023-02786-8.
[27]
SHI X Y, ZHAO M, SHI B, et al. Pretreatment blood biomarkers combined with magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J/OL]. Front Oncol, 2022, 12: 916840 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/36781510/. DOI: 10.3389/fonc.2022.916840.
[28]
WANG Y J, CHEN L J, ZHANG B Y, et al. Pretreatment inflammatory-nutritional biomarkers predict responses to neoadjuvant chemoradiotherapy and survival in locally advanced rectal cancer[J/OL]. Front Oncol, 2021, 11: 639909 [2025-11-09]. https://pubmed.ncbi.nlm.nih.gov/33816284/. DOI: 10.3389/fonc.2021.639909.
[29]
YILMAZ S, LISKA D, CONCES M L, et al. What predicts complete response to total neoadjuvant therapy in locally advanced rectal cancer [J]. Dis Colon Rectum, 2025, 68(1): 60-68 . DOI: 10.1097/DCR.0000000000003395.
[30]
LORD A C, D'SOUZA N, SHAW A, et al. MRI-diagnosed tumor deposits and EMVI status have superior prognostic accuracy to current clinical TNM staging in rectal cancer[J]. Ann Surg, 2022, 276(2): 334-344 . DOI: 10.1097/SLA.0000000000004499.
[31]
CAMILLI M, IANNACCONE G, LA VECCHIA G, et al. Platelets: the point of interconnection among cancer, inflammation and cardiovascular diseases[J]. Expert Rev Hematol, 2021, 14(6): 537-546 . DOI: 10.1080/17474086.2021.1943353.
[32]
CANTRELL R, PALUMBO J S. The thrombin-inflammation axis in cancer progression[J]. Thromb Res, 2020, 191(Suppl 1): S117-S122 . DOI: 10.1016/S0049-3848(20)30408-4.

PREV Differentiating pulmonary adenocarcinoma from inflammatory pulmonary masses using a multi-sequence MRI radiomics model
NEXT The value of deep learning models based on multiparameter MRI in the preoperative prediction of tumor deposits in rectal cancer
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn