Optimized Parameters of Diffusion-Weighted MRI for Prediction of the Response to Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

Figure 3

A 61-year-old woman with hematochezia in her stool for six months. (a–c) Baseline MR images before neoadjuvant therapy. (f–h) MR images after neoadjuvant therapy. (a) T2-weighted sagittal MR image shows irregular masses in the anterior rectal wall, mainly growing into the lumen. (b) Transverse-axis T2-weighted image shows irregular masses in the anterior rectal wall and enlarged lymph nodes (white arrows) outside the left mesorectal fascia. (c) Transverse and axial DWI images show the anterior rectal wall mass to be hyperintense. (e–g) The anterior rectal wall mass was significantly smaller than the anterior rectal wall mass on sagittal and axial images, corresponding to a slight thickening of the rectal wall. (d) Pathological images of the neoadjuvant anterior rectal biopsy show moderately differentiated adenocarcinoma with some mucoid changes (200x, hematoxylin and eosin (H&E) staining). (h) Postoperative pathological image of rectal cancer shows no tumor cells in the submucosa under the microscope and the presence of many mucus lakes in the submucosa and muscular layer. There were no epithelial elements in the mucus lakes, interstitial fibrosis, or chronic inflammatory cell infiltrations. A pTRG grade of 1 was given, which was in accordance with the change after radiotherapy and chemotherapy (200×, H&E staining).

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