Diffusion-weighted imaging in rectal cancer MRI from theory to practice.

Journal: Abdominal radiology (New York)
Published Date: Jul 11, 2025

Abstract

Diffusion-weighted imaging (DWI) has become a cornerstone of high-resolution rectal MRI, providing critical functional information that complements T2-weighted imaging (T2WI) throughout the management of rectal cancer. From baseline staging to restaging after neoadjuvant therapy and longitudinal surveillance during nonoperative management or post-surgical follow-up, DWI improves tumor detection, characterizes treatment response, and facilitates early identification of tumor regrowth or recurrence. This review offers a comprehensive overview of DWI in rectal cancer, emphasizing its technical characteristics, optimal acquisition strategies, and integration with qualitative and quantitative interpretive frameworks. The manuscript also addresses interpretive pitfalls, highlights emerging techniques such as intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), and small field-of-view DWI, and explores the growing role of radiomics and artificial intelligence in advancing precision imaging. DWI, when rigorously implemented and interpreted, enhances the accuracy, reproducibility, and clinical utility of rectal MRI.

Authors

  • Debora Mayumi Takamune
    Hospital Sírio-Libanês, São Paulo, Brazil.
  • João Miranda
    Mayo Clinic, Rochester, USA.
  • Miriana Mariussi
    Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Thais Reif de Paula
    University of Houston Fertitta Family College of Medicine, Houston, TX, USA.
  • Yousef Mazaheri
    Memorial Sloan Kettering Cancer Center, New York, USA.
  • Eyesha Younus
    Mayo Clinic, Rochester, USA.
  • Krishan R Jethwa
    Mayo Clinic, Rochester, USA.
  • Cody C Knudsen
    Mayo Clinic, Rochester, USA.
  • Valesca Bizinoto
    Universidade de São Paulo, São Paulo, Brazil.
  • Daniel Cardoso
    Hospital Sírio-Libanês, São Paulo, Brazil.
  • José de Arimateia Batista Araujo-Filho
    Hospital Sírio-Libanês, São Paulo, Brazil.
  • Carlos Frederico Sparapan Marques
    Universidade de São Paulo, São Paulo, Brazil.
  • Cesar Higa Nomura
    Universidade de São Paulo, São Paulo, Brazil.
  • Natally Horvat
    Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Keywords

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