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This study is to investigate optimum apparent diffusion coefficient (ADC) parameter for predicting lymphovascular invasion (LVI), lymph node metastasis (LNM) and histology type in resectable rectal cancer. 58 consecutive patients with resectable rectal cancer were retrospectively identified. The minimum, maximum, average ADC and ADC difference value were obtained on ADC maps. Maximum ADC and ADC difference value increased with the appearance of LVI ( r  = 0.501 and 0.495,  P  < 0.001, respectively) and development of N category ( r  = 0.615 and 0.695,  P  < 0.001, respectively). ADC difference value tended to rise with lower tumor differentiation ( r  = − 0.269,  P  = 0.041). ADC difference value was an independent risk factor for predicting LVI (odds ratio = 1.323;  P  = 0.005) and LNM (odds ratio = 1.526;  P  = 0.005). Maximum ADC and ADC difference value could distinguish N0 from N1 category, N0 from N1–N2, N0–N1 from N2 (all  P  < 0.001). Only ADC difference value could distinguish histology type ( P  = 0.041). ADC difference value had higher area under the receiver operating characteristic curve than maximum ADC in identifying LVI (0.828 vs 0.797), N0 from N1 category (0.947 vs 0.847), N0 from N1–N2 (0.935 vs 0.874), and N0–N1 from N2 (0.814 vs 0.770). ADC difference value may be superior to the other ADC value parameters to predict LVI, N category and histology type of resectable rectal cancer.

scientific reports

Assessment of histologic prognostic factors of resectable rectal cancer: comparison of diagnostic performance using various apparent diffusion coefficient parameters