Abdominal Imaging - Original Article

Apparent diffusion coefficient histogram analysis for predicting neoadjuvant chemoradiotherapy response in patients with rectal cancer


  • Andelib Babatürk
  • Ayşe Erden
  • İbrahim Ethem Geçim

Received Date: 14.01.2021 Accepted Date: 17.06.2021 Diagn Interv Radiol 2022;28(5):403-409


This study aimed to retrospectively evaluate the apparent diffusion coefficient (ADC) histograms in predicting chemoradiotherapy (CRT) response in patients with locally advanced rectal cancer (LARC).


A total of 51 patients who underwent surgery in our institution for rectal cancer following neoadjuvant CRT between November 2013 and July 2019 were enrolled. Conventional magnetic resonance (MR) and diffusion-weighted images obtained before and after CRT were evaluated retrospectively. All tumor-containing regions of interests were drawn in 3 selected axial images, and special software for histogram analysis was used to evaluate ADC distribution. ADC cutoff values from post-CRT ADC histogram were calculated from receiver operating characteristic (ROC) analysis for evaluating CRT response.


In histopathological analysis, 5 patients (9.8%) had minimal response (group 1), 31 patients (60.8%) had partial response (group 2), and 15 patients (29.4%) had complete or almost complete response (group 3). In the ADC histogram, minimum, maximum, 10th, 25th, 50th, 75th, and 90th percentile, mean ADC values, and skewness values of groups 2 and 3 showed significant changes before and after CRT, but no difference was found within group 1 values. The mean, 25th, 50th, 75th percent ADC values after CRT and skewness, and kurtosis values were significantly different between group 1 and group 3. Skewness value from the ADC histogram in postCRT magnetic resonance imaging had the best diagnostic performance with an area under the ROC curve of 0.851 (P =.003) for detecting group 3. The skewness cutoff calculated from the ROC analysis was 0.210 for evaluating CRT response. The sensitivity and specificity of the cut-off value were 100% and 61.4%, respectively.


The ADC histogram analysis seems to have potential application in predicting response to neoadjuvant CRT in patients with locally advanced rectal cancer.