DWI对局部进展期乳腺癌新辅助化疗疗效评价的初步研究

目的:探讨磁共振扩散加权成像(DWI)对局部进展期乳腺癌新辅助化疗疗效评价以及作为预测因子的可行性.方法:根据10例乳腺癌化疗后退缩情况将肿瘤分成缓解和进展两组,比较两组化疗前后ADC值和DWI信号强度的变化,并评价治疗前ADC值与化疗结束肿瘤退缩变化的相关性.结果:无论是治疗前还是治疗后,ADC值和DWI信号强度在缓解组和进展组间差异均无显著性意义(P＞0.05),但缓解组治疗后ADC值升高,而进展组则降低,尤其在b=1000和2000 s/mm2时明显.b=1000 s/mm2时,肿瘤高活性区和低活性区对治疗反应比较显示,肿瘤高活性区ADC值较低,治疗后ADC值升高(1.195±0.230和1.371±0.295);而肿瘤低活性区ADC值较高,治疗后ADC值反而下降(1.632±0.241和1.312±0.297);与病理对照显示,治疗后肿瘤细胞蜕变,并伴有明显的胶元和纤维化形成.治疗前ADC值与治疗后肿瘤退缩呈负相关,当b取1000和2000 s/mm2时相关更明显,前者为r= -0.802,P=0.005,后者的r = -0.745,P=0.013.结论:DWI可以对局部进展期乳腺癌新辅助化疗疗效作评价,并能对治疗疗效作出预测.     

表观扩散系数预测乳腺癌新辅助化疗反应初探

目的 探讨乳腺癌患者新辅助化疗前肿瘤表观扩散系数(ADC)及化疗第1周期后ADC的变化,预测新辅助化疗反应的价值.方法 20例21个病灶经穿刺活检证实为乳腺癌的患者分别于阿霉素类和紫杉类抗肿瘤新辅助化疗前1周之内、第1周期化疗后(18～21 d之内)、术前1周之内进行MR扩散加权成像(DWI)和增强扫描,根据增强MRI肿瘤的变化,将其分为反应组及相对无反应组,对2组肿瘤初始ADC及化疗第1周期后ADC的变化进行分析.结果 反应组15个病灶化疗前初始ADC为(0.98±0.15)×10-3 mm2/s,化疗第1周期后升高到(1.22±0.23)x 10-3 mm2/s,差异具有统计学意义(P<0.05);相对无反应组6个病灶化疗前初始ADC为(1.09±0.08)×10-3mm 2/s,第1周期后为(1.11±0.07)×10-3 mm2/s,差异无统计学意义(P>0.05);反应组初始ADC低于相对无反应组(P<0.05);肿瘤初始ADC与化疗第1周期后ADC的变化值呈负相关关系(r=-0.51,P<0.05).结论 初步研究结果表明,乳腺癌肿瘤初始ADC值及新辅助化疗第1周期后ADC值变化有可能成为预测乳腺癌新辅助化疗疗效的指标之一.     

不同组织分化类型与临床分期直肠癌的ADC值研究

目的 探讨表观扩散系数(ADC)在不同组织分化类型与临床分期直肠癌中的应用价值.方法 回顾性分析临床确诊的73例直肠癌患者的扩散加权成像(DWI)资料,测量其ADC值.根据术后病理组织分化类型分为6组:高分化(n=11)、高中分化(n=8)、中分化(n=29)、中低分化(n=7)、低分化(n=5)、黏液腺癌(n=13);根据TNM将临床分期分为4期:Ⅰ(n=13)、Ⅱ(n=16)、Ⅲ(n=34)、Ⅳ(n=10),对不同组织分化及临床分期直肠癌ADC值进行统计学分析,P≤0.05为差异有统计学意义.结果 不同组织分化类型直肠癌ADC值差异有统计学意义(F=30.993,P=0.000),组间ADC值两两比较:黏液腺癌与其余各组、高与中低、高与低、高中与中低、高中与低、中与低分化组间差异有统计学意义(P＜0.05);高与高中、高与中、高中与中、中与中低、中低与低分化组间差异无统计学意义(P＞0.05).黏液腺癌ADC值最高(1480.05±236.05)×10-3mm2/s,其余各组随着肿瘤分化程度的减低,ADC值有逐渐减低的趋势.不同临床分期直肠癌ADC值差异无统计学意义(F =5.695,P =0.127).结论 直肠癌ADC值可以作为判断肿瘤不同组织分化类型的生物影像指标,但对不同临床分期的判断无帮助.     

MR体素内不一致运动序列预测和评价宫颈癌放化疗效果

目的 探讨磁共振体素内不一致运动序列(IVIM)在预测和评价宫颈癌放化疗效果方面的价值.方法 对62例接受同步放化疗(放疗+同步顺铂化疗)的宫颈癌患者于治疗前、治疗后1个月分别行MRI常规序列和双指数模型的IVIM序列扫描.测量治疗前后肿瘤最大径并根据疗效进行分组,测量并比较治疗前不同疗效组间IVIM参数值差异和各组治疗前后参数值差异.结果 (1)肿瘤稳定(SD)组治疗后ADC、D值高于治疗前(P=0.016,0.001);(2)肿瘤部分缓解(PR)组治疗后ADC、D值高于治疗前(P=0.01,0.01),D*值低于治疗前(P=0.044);(3)肿瘤完全消失(CR)组治疗后ADC、D和f值均高于治疗前(P=0.000,0.000,0.03),D*值低于治疗前(P =0.011);(4)治疗前SD组ADC依次低于PR组和CR组(P =0.000,0.000),但PR组和CR组间差异无统计学意义(P =0.094);SD组D值依次低于PR组和CR组,三组间差异均有统计学意义(P =0.000,0.000,0.003);SD组D*值高于其他两组,但仅SD组和CR组间差异有统计学意义(P =0.003),SD组D*值高于PR组和CR组(P=0.000,0.004),PR组和CR组间差异无统计学意义(P =0.212).结论 宫颈癌治疗前IVIM序列有助于预测治疗效果,治疗前后IVIM参数值改变对评价治疗效果具有重要作用.     

ADC值与rADC值诊断脑肿瘤的应用价值

目的 研究磁共振扩散加权成像(DWI)表观扩散系数值(ADC)和相对表观扩散系数值(rADC)诊断脑肿瘤的应用价值.资料与方法 对69例拟诊脑肿瘤患者除常规序列及增强扫描外加作DWI,并测算肿瘤实质及肿瘤实质对侧镜面正常区的ADC和rADC值.结果 低级胶质瘤42例,高级胶质瘤15例,脑膜瘤12例.3组肿瘤的ADC值及rADC值差异均有统计学意义(ADC:F=13.882,P=0.000,rADC:F=19.858,P=0.000);低级胶质瘤与高级胶质瘤、脑膜瘤ADC值差异均有统计学意义(q=5.1499和6.4714,P＜0.01),低级胶质瘤与高级胶质瘤、脑膜瘤rADC值差异均有统计学意义(q=6.1344和7.7569,P＜0.01),高级胶质瘤与脑膜瘤差异无统计学意义(ADC:q=1.4697,P＞0.05,rADC:q=1.7915,P＞0.05).结论 ADC值和rADC值对胶质瘤的分级诊断很有价值.     

3.0T MR扩散加权成像对宫颈癌放化疗疗效的评估价值

目的：探讨扩散加权成像（DWI）对宫颈癌放化疗疗效的评估价值。方法：46名接受全程放化疗治疗的宫颈癌患者分别在治疗前、治疗2周后、外照射25次后及治疗结束后进行盆腔常规MRI及DWI扫描,每次扫描均测量肿瘤的直径及ADC值。根据治疗结束6个月后的随访结果将患者划分为完全有效组（CR）、部分有效组（PR）及无效组（SD）。计算并两两比较各次 MRI扫描测得的肿瘤ADC值及直径的动态变化值。结果：CR 组在治疗2周及外照射25次的 ADC值提高均高于 RP 组及 SD 组（P＜0．05）,治疗结束后 CR 组的 ADC 值与 PR 组及 SD 组间差异均有统计学意义（P＜0．05）。治疗前、放化疗2周后及外照射25次后各肿瘤组（CR、PR、SD组）的ADC 值、肿瘤最大直径之间差异均无统计学意义（P＞0．05）。结论：DWI可作为预测及监测宫颈癌放化疗疗效的有效方法。     

MR扩散成像对宫颈癌放化疗早期疗效的评价

目的：探讨MR扩散成像评价晚期宫颈癌放化疗早期疗效的价值。方法：对18例经病理证实为晚期宫颈癌并接受放化疗的患者,在治疗前和开始治疗后2周、及治疗结束后行常规MRI及DWI检查。测量治疗前和治疗后不同时间点肿瘤最大径和ADC值,按治疗后肿瘤直径的变化进行分组,分析各组治疗前和治疗后不同时间点ADC值差异。结果：治疗后2周ADC值升高,完全缓解（CR）组ADC值变化高于部分缓解（PR）组,差异具有统计学意义（P〈0.05）。结论：MR扩散成像可以作为晚期宫颈癌放化疗早期评价的指标,并可根据ADC值升高情况预测治疗效果。     

表观扩散系数ADC值与直肠癌侵袭性的相关性分析

目的:探讨3.0T磁共振扩散加权成像(DWI)的参数表观扩散系数(ADC)与直肠癌侵袭性之间的相关性.方法:对60例经病理证实的直肠癌患者行常规盆腔MRI及DWI扫描,测量整个肿瘤的ADC值.根据MRI图像及术后病理结果,得到肿瘤的病理类型、分化程度、T1-2(肿瘤局限于肠壁)与T3-4(肿瘤生长突破肠壁);N0(无淋巴结转移)与N1-2(有淋巴结转移);CRM阴性(无直肠系膜筋膜浸润)与CRM阳性(有直肠系膜筋膜浸润)、肿瘤的大体分型、部位、年龄及性别,进行相关性比较.结果:直肠癌的ADC值在分化程度(P-0.000)、T1-2与T3-4(P=0.015)、N0与N1-2(P=0.001)、直肠系膜筋膜受累与未受累(P=0.014)之间的差异均有统计学意义.与肿瘤的大体分型(P=0.971)、部位(P=0.960)、性别(P=0.592)、年龄(r=0.038,P=0.772)之间的差异无统计学意义.结论:直肠癌的ADC值可以作为评价其侵袭性及预后的一个定量指标.     

3.0 T磁共振扩散加权成像及表观扩散系数在淋巴瘤诊断及随访中的应用价值

目的 观察恶性淋巴瘤的扩散加权成像(DWI)特征及表观扩散系数(ADC)值在治疗前后的变化,探讨 DWI及ADC值在淋巴瘤诊断和随访中的应用价值.资料与方法 恶性淋巴瘤初发患者15例,男8例,女7例,平均年龄48.7岁.其中10例化疗后进行复查;健康志愿者10名,男5名,女5名,平均年龄48.4岁.在3.0 T MRI上行常规MRI及DWI检查.在ADC图上分别测量恶性淋巴瘤患者及健康志愿者颈部淋巴结的ADC值.10例复查患者在初次检查相一致部位再次测量淋巴结的ADC值,并进行前后对比,同时与健康志愿者进行比较.采用PSS 11.0统计软件,对淋巴瘤患者及正常对照组淋巴结的ADC值进行独立样本的t检验.结果 DWI与常规T2WI脂肪抑制序列比较,DWI能更敏感、直观地显示淋巴结.15例恶性淋巴瘤患者平均ADC值(753.33±31.28)×10-3 mm2/s,化疗后复查,平均ADC值(1088.32±51.28)×10-3 mm2/s.化疗前后ADC值差异有统计学意义(t=5.79,P＜0.05).健康志愿者颈部淋巴结平均ADC值(1264.20±71.60)×10-3 mm2/s.15例淋巴瘤患者治疗前ADC值与健康志愿者差异有统计学意义(t=6.53,P＜0.05),治疗后ADC值与正常人差异无统计学意义(t=1.97,P＞0.05).结论 3.0 T磁共振DWI及ADC值测量为淋巴瘤的诊断及疗效的观察提供了有价值的信息.     

DWI在软组织肿瘤中的应用价值

目的 :探讨DWI在软组织肿瘤中的应用价值。方法 :回顾性分析经病理证实的25例软组织肿瘤的DWI表现,其中恶性16例,良性9例;b值为0、800 s/mm~2;ROI置于肿瘤实性部分及同层面正常肌肉组织,尽量避开坏死、出血、瘢痕、钙化、肌间隙等部位,测量病灶与正常肌肉组织ADC值,比较良恶性肿瘤及正常肌肉组织ADC值的差异。结果:恶性肿瘤组ADC值低于良性肿瘤组(t=3.35,P0.05);恶性肿瘤组与正常肌肉组织ADC值差异无统计学意义(P0.05)。25例中瘤周水肿16例,其中恶性13例,良性3例,差异有统计学意义(P0.05)。结论 :DWI对鉴别良恶性软组织肿瘤具有重要价值。     

应用ROC曲线评价DWI诊断直肠癌的价值

目的应用受试者工作特征曲线(ROC曲线)评价DWI对直肠癌的诊断价值。方法选取60例经病理证实的直肠癌患者,所有患者术前均行高分辨MRI扫描检查,同时采用b值为600、1000 s/mm2对其进行弥散加权成像(DWI)检查,并计算直肠癌瘤体的表观弥散系数(ADC)值;选取15例非直肠癌患者作为对照组,并计算对照组直肠壁的ADC值。结果单独使用高分辨MRI及高分辨MRI联合DWI对直肠癌诊断的ROC曲线下面积分别为0.879、0.988;高分辨MRI结合DWI诊断直肠癌的灵敏度、特异度分别为90%,100%;同一b值下直肠癌瘤体的ADC值与对照组直肠壁比较有显著性差异(P<0.05),并确定不同b值下诊断直肠癌的最佳ADC阈值(1.856×10-3 mm/s2、1.560×10-3 mm/s2)。结论 ROC曲线评价显示DWI联合高分辨MRI对直肠癌具有较高的诊断准确度,DWI可以作为诊断直肠癌的重要补充序列。     

Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer.

PURPOSE: The purpose of this study was to assess the potential role of diffusion-weighted imaging (DWI) using low and high b-values to detect rectal cancer. METHODS: The subjects were 15 patients diagnosed endoscopically with rectal cancer (m in 1 patient, sm in 0, mp in 3, ss in 7, se in 1, a in 3) and 20 patients diagnosed endoscopically with colon cancer and no other lesions (control group). Magnetic resonance imaging was performed using a 1.5T system. DWI was performed in the axial plane using echo planar imaging sequence (repetition time/echo time 1200/66, field of view 306x350 mm, reconstruction matrix 156x256, pixel size 2.0x1.4x8.0 mm) and acquired with 2 b-values (50 and 800 s/mm2). Low and high b-value DW images were analyzed visually. A lesion was positive by detection of a focal area of high signal in the rectum in high b-value images. The apparent diffusion coefficient (ADC) values of areas of high signal in high b-value images were calculated from the low and high b-value images. RESULTS: High b-value images enabled visualization of all 15 rectal cancers. In the control group, 13 cases were classified as negative and 7 cases as positive for rectal cancer. Sensitivity for detection of rectal cancer was 100% (15/15), and specificity was 65% (13/20). The mean ADC values in 7 patients with false-positive lesions and in 15 patients with rectal cancer were 1.374x10(-3) mm2/s (standard deviation [SD]: 0.157) and 1.194x10(-3) mm2/s (SD: 0.152), respectively (P=0.026). CONCLUSION: DWI with low and high b-values may be used to screen for rectal cancer.     

Pathological correlation with diffusion restriction on diffusion-weighted imaging in patients with pathological complete response after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: preliminary results

Objective The objective of this study was to assess causative pathological factors associated with diffusion restriction on diffusion-weighted imaging (DWI) in patients who achieved pathological complete response (pCR) after treatment with neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer. Methods In total, 43 patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT, subsequent surgery and ultimately achieved pCR were enrolled. All patients underwent pre- and post-CRT 3.0 T rectal MRI with DWI. Two radiologists blinded to pathological staging reviewed pre- and post-CRT 3.0 T rectal MRI for the presence of diffusion restriction in the corresponding tumour areas on post-CRT DWI, with a third radiologist arbitrating any disagreement. The consensus of these findings was then correlated with pathological data such as intramural mucin and the degree of proctitis and mural fibrosis seen on surgical specimen. Additionally, the pre-CRT tumour volume was measured to define the effect of this variable on the degree of radiation proctitis and fibrosis, as well as the presence of intramural mucin. Results Diffusion restriction occurred in 18 subjects (41.9%), while 25 subjects remained diffusion restriction-free (58.1%). The diffusion restriction group tended to have more severe proctitis and mural fibrosis when compared with non-diffusion restriction group (p<0.001). Intramural mucin was also more common in the diffusion restriction group (p=0.052). Higher pre-CRT tumour volumes were significantly predictive of the degree of proctitis (p=0.0247) and fibrosis (p=0.0445), but not the presence of intramural mucin (p=0.0944). Proctitis and mural fibrosis severity were also identified as independent pathological risk factors for diffusion restriction on multivariate analysis (p=0.0073 and 0.0011, respectively). Conclusion Both radiation-induced proctitis and fibrosis were significant and independent predictors of diffusion restriction in patients achieving pCR after treatment with neoadjuvant CRT for locally advanced rectal cancer, and pre-CRT tumour volume significantly affects both variables.     

DKI推算序列优化直肠癌术前分期的应用研究

目的 探索基于扩散峰度成像(DKI)扫描参数的推算序列代替常规扩散加权成像(DWI)序列扫描的应用价值.方法 回顾性分析2019年11月至2020年10月瑞金医院确诊的直肠癌患者62例,其手术前2周内均行MR扫描,将DKI图像经后处理推算出b=1000 s/mm2扩散图像,两名医师分别对推算序列与常规DWI序列的b=1...     

定量MRI诊断直肠癌淋巴结转移的研究进展

评估直肠癌淋巴结转移对治疗和预后至关重要。常规MRI诊断直肠癌淋巴结转移主要依据淋巴结的短径和形态学特征,诊断效能较低。定量MRI包括动态增强MRI（DCE-MRI）、动态磁敏感增强MRI（DSC-MRI）、单指数模型扩散加权成像（DWI）、扩散峰度成像（DKI）、体素内不相干运动扩散加权成像（IVIM-DWI）等,可以对直肠癌淋巴结及原发灶进行定量分析,从而有助于诊断淋巴结转移。就常规MRI及定量MRI诊断直肠癌淋巴结转移的研究进展予以综述。     

直肠癌磁共振扩散加权成像 ADC 值与 Ki-67表达水平的相关性

目的：探讨直肠癌磁共振扩散加权成像(DWI)及表观扩散系数(ADC)值与 Ki-67表达水平的相关性。方法回顾性分析47例经手术病理证实的直肠癌患者的资料,术前行盆腔 MRI、直肠 DWI 及增强检查,按 Ki-67指数差异,将其分为 A~D 4组：A组 Ki-67<10%(-),B 组 Ki-6710%~25%(+),C 组 Ki-6726%~50%(++),D 组 Ki-67>50%(+++)。分别计算各组肿瘤的ADC 值并分析与 Ki-67表达水平的相关性。结果A 组(13例)肿瘤的平均 ADC 值为(1.280±0.200)×10-3 mm2/s;B 组(14例)平均 ADC 值为(1.044±0.046)×10-3 mm2/s;C 组(9例)平均 ADC 值为(0.987±0.256)×10-3 mm2/s;D 组(11例)平均 ADC 值(0.851±0.099)×10-3 mm2/s;Ki-67表达水平不同的直肠癌各组间平均 ADC 值差异明显(P =0.001);ADC 值与 Ki-67表达水平呈中等负相关(r=-0.577,P=0.000)。结论DWI 检查及 ADC 值测量在一定程度上可间接评估直肠肿瘤细胞增殖情况及预后。     

DWI联合T2WI在鉴别T2和T3期直肠癌术前分期中的应用价值

目的:探讨磁共振DWI联合T₂WI对T2和T3期直肠癌的术前分期价值。方法:将在本院初诊、术前未进行放化疗且有完整的病理资料和明确的TNM分期诊断结果的213例直肠癌患者纳入本研究。所有患者在术前行直肠标准方案MRI检查(T₁WI、高分辨小视野非抑脂FSE-T₂WI、DWI及增强扫描)。对DWI联合T₂WI及单独使用T₂WI对T2和T3期直肠癌的诊断效能(符合率、特异度、敏感度、阳性预测值及阴性预测值)进行分析和比较,并对两位阅片者诊断结果的一致性进行分析。结果:DWI联合T₂WI和单独使用T₂WI对T2期直肠癌的诊断符合率、敏感度、特异度、PPV和NPV分别为92.5%vs.84.0%、93.8%vs.56.9%、91.9%vs.95.9%、83.6%vs.86.0%和97.1%vs.83.5%;而在诊断T3期直肠癌时相应诊断结果分别为91.1%vs.79.3%、89.3%vs.85.5%、93.9%vs.69.5%、95.9%vs.81.8%和84.6%vs.75.0%。单独使用T₂WI对直肠癌术前T分期的诊断符合率为76.5%,而DWI联合T₂WI为89.2%,差异具有统计学意义(P<0.001)。两位研究者分别基于DWI联合T₂WI及单独T₂WI进行术前分期时均获得了较好的组间一致性,Kappa值均为0.848。结论:DWI联合T₂WI对T2和T3期直肠癌的术前分期诊断效能要优于单独使用T₂WI。     

Diffusion weighted imaging of female pelvic cancers: Concepts and clinical applications

Early applications of diffusion weighted magnetic resonance imaging (DWI) were limited to neuroimaging, concentrating either on stroke or brain tumours. With recent advances in MRI hardware and software DWI is now increasingly being investigated for cancer assessment throughout the body.Clinical applications of DWI relating to female pelvic cancers have largely concentrated on detection, localisation and staging of disease. More recently investigators have started to evaluate the ability of DWI for determining tumour histology and even predicting the outcome of chemoradiation treatment.This article reviews the physical concepts of MR diffusion weighting, illustrates the biophysical basis of diffusion contrast and reports the clinical applications of DWI for cervical, endometrial, ovarian, rectal and bladder tumours.     

Diffusion-weighted MRI in locally advanced rectal cancer

Background and purpose

The aim of this study was to assess the predictive potential of diffusion-weighted magnetic resonance imaging (MRI) for the selection of favorable pathological responders after radiochemotherapy for locally advanced rectal cancer.

Patients and methods

In 59 patients with locally advanced rectal cancer, the apparent diffusion coefficient (ADC) in the tumor was obtained at 3 Tesla before radiochemotherapy and surgery. The predictive potential for pathological complete response (pCR) and good response (GR) was assessed. GR was defined as pCR and near-pCR based on the tumor regression grade.

Results

The GR group consisted of 13 patients (22%) with 9 complete responders. Both the preradiochemotherapy ADC values and relative change in ADC (ΔADC) were predictive for pathological response. Preradiochemotherapy ADC values showed a positive predictive value of 42% for pCR and 67% for GR using a similar cut-off value of 0.97^*10^?3 mm²/s. For ΔADC, the optimal threshold for predicting GR or pCR was a 41% increase of the ADC. With this threshold, positive predictive values of 64% and 91% were found for pCR and GR, respectively.

Conclusion

Low preradiochemotherapy ADC values and high ΔADC correspond to pathological good response. Diffusion-weighted MRI may be used as an additional tool for selecting good treatment responders after radiochemotherapy.     

The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection

OBJECTIVE: To evaluate the clinical value of diffusion-weighted imaging (DWI) in combination with T(2)-weighted imaging (T(2)WI) for the detection of rectal cancer as compared with T(2)WI alone. MATERIALS AND METHODS: Forty-five patients with rectal cancer and 20 without rectal cancer underwent DWI with parallel imaging and T(2)WI on a 1.5 T scanner. Images were independently reviewed by two readers blinded to the results to determine the detectability of rectal cancer. The detectability of T(2)W imaging without and with DW imaging was assessed by means of receiver operating characteristic analysis. The interobserver agreement between the two readers was calculated with kappa statistics. RESULTS: The ROC analysis showed that each of two readers achieved more accurate results with T(2)W imaging combined with DW imaging than with T(2)W imaging alone significantly. The A(z) values for the two readers for each T(2)WI and T(2)WI combined with DWI were 0.918 versus 0.991 (p=0.0494), 0.934 versus 0.997 (p=0.0475), respectively. The values of kappa were 0.934 for T(2)WI and 0.948 for T(2)WI combined with DWI between the two readers. CONCLUSION: The addition of DW imaging to conventional T(2)W imaging provides better detection of rectal cancer.