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• Reviews •
Advances in radiomics for rectal cancer immunotherapy: From treatment response assessment to prognostic prediction
HE Enyu  WANG Zheng 

Cite this article as HE E Y, WANG Z. Advances in radiomics for rectal cancer immunotherapy: From treatment response assessment to prognostic prediction[J]. Chin J Magn Reson Imaging, 2026, 17(8): 219-225. DOI:10.12015/issn.1674-8034.2026.08.026.


[Abstract] Rectal cancer is the third most common malignancy worldwide, and its disease burden continues to intensify. Immunotherapy for rectal cancer has garnered increasing attention. Radiomics, as a medical image analysis technique, provides a novel tool for the precise assessment of rectal cancer immunotherapy. By extracting quantitative features from multi-modal images, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), it can effectively predict microsatellite instability (MSI) status, identify pseudoprogression, and evaluate immunotherapy response. However, it also faces challenges in data standardization (such as scanner variability and segmentation heterogeneity), multi-modal fusion (such as stringent cross-modal registration accuracy and complex modality-specific preprocessing), and clinical translation (such as lack of external validation and insufficient model interpretability). Existing reviews predominantly focus on neoadjuvant chemoradiotherapy but lack specific focus on this particular direction of rectal cancer immunotherapy; moreover, they lack in-depth analysis and integrated discussion of critical bottlenecks such as identifying benefiting populations and differentiating pseudoprogression. Therefore, this article reviews the current application status, technical workflow, and challenges of radiomics in rectal cancer immunotherapy, and analyzes its application value and limitations in pre-treatment assessment, efficacy evaluation, and post-treatment follow-up. The aim is to provide new insights for establishing standardized workflows, conducting prospective multi-center validation studies, and constructing full-cycle decision-support systems. Future research should prioritize developing standardized imaging protocols tailored to immunotherapy scenarios, building multi-modal multi-omics fusion models, developing AI algorithms with clinical semantic interpretability, and launching large-scale prospective clinical trials to facilitate the translation of radiomics from retrospective research to clinical decision-support tools.
[Keywords] rectal cancer；immunotherapy；efficacy evaluation；prognosis prediction；biomarkers；radiomics；magnetic resonance imaging

HE Enyu1   WANG Zheng2*  

1 Guangxi Medical University, Nanning 530000, China

2 Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530000, China

Corresponding author: WANG Z, E-mail: 285484743@qq.com

Conflicts of interest   None.

Received  2026-03-13
Accepted  2026-07-17
DOI: 10.12015/issn.1674-8034.2026.08.026
Cite this article as HE E Y, WANG Z. Advances in radiomics for rectal cancer immunotherapy: From treatment response assessment to prognostic prediction[J]. Chin J Magn Reson Imaging, 2026, 17(8): 219-225. DOI:10.12015/issn.1674-8034.2026.08.026.

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