A multivariate model of IVIM-DWI in the preoperative diagnosis of tumor budding grade in rectal cancer

Junyi Fu; Chenglong Zhao; Guangying Zheng; Aiyin Li; Gesheng Song

doi:10.3389/fonc.2025.1543607

A multivariate model of IVIM-DWI in the preoperative diagnosis of tumor budding grade in rectal cancer

Front Oncol. 2025 Jun 9:15:1543607. doi: 10.3389/fonc.2025.1543607. eCollection 2025.

Authors

Junyi Fu^#¹, Chenglong Zhao^#², Guangying Zheng³, Aiyin Li¹, Gesheng Song¹

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
² Department of Pathology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
³ Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.

^# Contributed equally.

Abstract

Objective: The aim of this study was to explore the application value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the preoperative evaluation of the tumor budding (TB) grade in patients with rectal cancer (RC).

Methods: Patients with RC who underwent rectum resection from January 2018 to October 2023 were collected retrospectively. All patients underwent magnetic resonance (MR) examination, including collection of IVIM sequences, within 1 week before surgery. Among them, 17 low-grade and 13 intermediate-grade budding cases were classified into the low-intermediate-grade group, while 30 high-grade budding cases were classified as high grade. After processing the IVIM sequences, the apparent diffusion coefficient (ADC) from the mono-exponential (ME) model; D, D*, and f from the bi-exponential (BE) model; and the DDC and α from the stretching (SE) model were obtained. Clinical factors, including age, gender, and CEA levels, and imaging factors, including location, mriT, and N stage, were collected. Differences between the low-intermediate- and high-grade groups were compared. The diagnostic efficiency was evaluated from the ROC curve, AUC, sensitivity, and specificity. Significance was set at p < 0.05.

Results: A total of 60 patients with RC were enrolled. Significant differences between low-intermediate and high grade were found in f value (p = 0.001), DDC value (p < 0.001), age (p = 0.002), location (p = 0.047), and mesorectal fascia (MRF) (p = 0.01). Multivariate binary logistic regression analysis identified f, DDC, MRF, and age as independent risk factors (p < 0.05). The AUC of the combined model (f, DDC, MRF, and age) was 0.920 (95% CI, 0.820-0.974), with a sensitivity and specificity of 1.000 and 0.767, respectively.

Conclusion: The combined model constructed using multiple IVIM mathematical model parameters and clinical and imaging factors could be used as a noninvasive tool to facilitate the preoperative auxiliary diagnosis of TB in RC.

Keywords: clinical pathology; diffusion weighted imaging; magnetic resonance imaging; rectal cancer; tumor budding.