ArticleCancer imaging : the official publication of the International Cancer Imaging Society2026
Response assessment in rectal cancer undergoing total neoadjuvant therapy: decision tree analysis integrating contrast enhanced T1-weighted MRI.
Article in Cancer imaging : the official publication of the International Cancer Imaging Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study assesses the role of contrast enhanced T1-weighted imaging (CE-T1WI) in improving response assessment for rectal cancer patients undergoing total neoadjuvant therapy (TNT) and its integration with T2-weighted imaging (T2WI) and DWI using decision tree analysis.
methodsA retrospective analysis was conducted on rectal cancer patients between January 2020 and December 2022 who underwent TNT followed by MRI-based response assessment, including T2WI, DWI, and CE-T1WI. Complete response (CR) was defined as pathologic CR or sustained clinical CR for ≥2 years. Diagnostic performance was assessed using receiver operating characteristic analysis. Logistic regression was performed to identify predictors of CR. Finally, a decision tree model was constructed to determine the optimal combination of sequences for predicting CR.
resultsA total of 124 rectal cancer patients (mean age 58 ± 12 years; 89 men) were analyzed, of whom 45 (36%) achieved CR. CE-T1WI demonstrated superior predictive performance (AUC = 82.3% [75.0−88.7]) compared to DWI (78.6% [71.1−85.9]) and T2WI (74.5% [66.5−82.4]). In the two sequences combinations, the combination of DWI and CE-T1WI achieved the highest AUC of 82.9% (75.7−89.8), with an accuracy of 85.5% (79.0−91.9), sensitivity of 73.4% (60.0−86.0) and specificity of 92.4% (85.9−97.6), outperforming the other combinations. Finally, the decision tree model integrating three sequences achieved an AUC of 90.1% (83.7−95.6), with an accuracy of 86.4% (80.6−91.9), a sensitivity of 77.6% (62.5−91.8) and a specificity of 91.2% (81.7−97.6).
conclusionIntegrating CE-T1WI with other sequences enhances CR prediction in rectal cancer patients undergoing TNT, supporting its inclusion in routine MRI for improved response assessment.
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