September 17, 2025

Advanced Diffusion-Weighted Imaging Biomarkers for Non-Invasive Characterization of Rectal Cancer Heterogeneity: Restricted Spectrum Imaging

Key Points

RSI-derived parameters improved non-invasive assessment of rectal cancer heterogeneity, enhancing patient outcomes.
The highest accuracy in characterizing stroma status was achieved with RSI3-C2 (AUC=0.763), indicating its potential utility.
Utilizing 3.0T MRI with restricted spectrum imaging, this prospective study correlated imaging findings with histopathology.
The findings suggest that RSI parameters may facilitate personalized treatment strategies and predict treatment responses.

Abstract

Motivation: Accurate non-invasive assessment of rectal cancer microenvironment remains challenging. Goal(s): Accurate non-invasive assessment of rectal cancer microenvironment remains challenging. Approach: Prospective study of 63 rectal cancer patients using 3.0T MRI with restricted spectrum imaging (RSI) based diffusion-weighted imaging, correlating imaging findings with histopathology. Results: RSI-derived parameters, particularly RSI3-C1 and RSI3-C2, showed significant associations with tumor stroma, Ki67 status, and differentiation. RSI3-C2 demonstrated highest accuracy for characterizing stroma status (AUC=0.763), while RSI3-C1 was best for Ki67 status (AUC=0.726) and differentiation (AUC=0.731). Impact: RSI-derived parameters offer promising non-invasive biomarkers for characterizing rectal cancer microenvironment heterogeneity. This approach could enhance pre-treatment assessment, facilitate personalized treatment strategies, and improve patient outcomes. Further research may explore RSI's potential in treatment response prediction and monitoring.

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