探讨弥散加权成像（DWI）、体素内不相干运动（IVIM）和弥散峰度成像（DKI）评估直肠癌患者病理预后因素。 共162例患者（105名男性；平均年龄61.8±13.1岁）岁）计划接受根治性手术的患者被纳入这项前瞻性研究。病理预后因素包括组织学分化、淋巴结转移（LNM）和壁外血管侵犯（EMVI）。使用单变量和多变量逻辑回归获得 DWI、IVIM 和 DKI 参数并与预后因素相关。使用受试者工作特征（ROC）曲线分析评估其评估值。多变量逻辑回归分析显示，较高的平均峰度（MK）（比值比（OR） = 194.931，p < 0.001）和较低的表观扩散系数（ADC）（OR = 0.077，p = 0.025）与分化较差的肿瘤独立相关。较高的灌注分数 (f) (OR = 575.707, p = 0.023) 和较高的 MK (OR = 173.559, p < 0.001) 与 LNM 独立相关。 f 较高（OR = 1036.116，p = 0.024），较高 MK（OR = 253.629，p < 0.001），较低平均扩散率（MD）（OR = 0.125，p = 0.038）和较低 ADC（OR = 0）。 094、p = 0.022）与 EMVI 独立相关。 MK 组织学分化的 ROC 曲线下面积 (AUC) 显着高于 ADC（0.771 vs. 0.638，p = 0.035）。 LNM 阳性的 MK 的 AUC 高于 f（0.770 vs. 0.656，p = 0.048）。在评估 EMVI 时，MK 联合 MD 的 AUC（0.790）在 f（0.663）、MK（0.779）、MD（0.617）和 ADC（0.610）中最高。DKI 参数可作为评估病理学的影像生物标志物。扩散峰度成像（DKI）参数，特别是平均峰度（MK），是评估直肠癌组织学分化、淋巴结转移和壁外血管侵犯的有前景的生物标志物。这些发现表明 DKI 在直肠癌术前评估中的潜力。在评估可切除直肠癌的组织学分化方面，平均峭度优于表观扩散系数。灌注分数和平均峰度是评估直肠癌淋巴结转移的独立指标。平均峰度和平均扩散率在评估壁外血管侵犯方面表现出卓越的准确性。© 2024。作者获得欧洲放射学会的独家许可。

To explore diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for assessing pathological prognostic factors in patients with rectal cancer.A total of 162 patients (105 males; mean age of 61.8 ± 13.1 years old) scheduled to undergo radical surgery were enrolled in this prospective study. The pathological prognostic factors included histological differentiation, lymph node metastasis (LNM), and extramural vascular invasion (EMVI). The DWI, IVIM, and DKI parameters were obtained and correlated with prognostic factors using univariable and multivariable logistic regression. Their assessment value was evaluated using receiver operating characteristic (ROC) curve analysis.Multivariable logistic regression analyses showed that higher mean kurtosis (MK) (odds ratio (OR) = 194.931, p < 0.001) and lower apparent diffusion coefficient (ADC) (OR = 0.077, p = 0.025) were independently associated with poorer differentiation tumors. Higher perfusion fraction (f) (OR = 575.707, p = 0.023) and higher MK (OR = 173.559, p < 0.001) were independently associated with LNMs. Higher f (OR = 1036.116, p = 0.024), higher MK (OR = 253.629, p < 0.001), lower mean diffusivity (MD) (OR = 0.125, p = 0.038), and lower ADC (OR = 0.094, p = 0.022) were independently associated with EMVI. The area under the ROC curve (AUC) of MK for histological differentiation was significantly higher than ADC (0.771 vs. 0.638, p = 0.035). The AUC of MK for LNM positivity was higher than f (0.770 vs. 0.656, p = 0.048). The AUC of MK combined with MD (0.790) was the highest among f (0.663), MK (0.779), MD (0.617), and ADC (0.610) in assessing EMVI.The DKI parameters may be used as imaging biomarkers to assess pathological prognostic factors of rectal cancer before surgery.Diffusion kurtosis imaging (DKI) parameters, particularly mean kurtosis (MK), are promising biomarkers for assessing histological differentiation, lymph node metastasis, and extramural vascular invasion of rectal cancer. These findings suggest DKI's potential in the preoperative assessment of rectal cancer.Mean kurtosis outperformed the apparent diffusion coefficient in assessing histological differentiation in resectable rectal cancer. Perfusion fraction and mean kurtosis are independent indicators for assessing lymph node metastasis in rectal cancer. Mean kurtosis and mean diffusivity demonstrated superior accuracy in assessing extramural vascular invasion.© 2024. The Author(s), under exclusive licence to European Society of Radiology.