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Background  To investigate whether MRI findings, including texture analysis, can differentiate KRAS mutation status in rectal cancer.    Methods  Totally, 158 patients with pathologically proved rectal cancers and preoperative pelvic MRI examinations were enrolled. Patients were stratified into two groups: KRAS wild-type group (KRAS wt  group) and KRAS mutation group (KRAS mt  group) according to genomic DNA extraction analysis. MRI findings of rectal cancers (including texture features) and relevant clinical characteristics were statistically evaluated to identify the differences between the two groups. The independent samples t test or Mann-Whitney U test were used for continuous variables. The differences of the remaining categorical polytomous variables were analyzed using the Chi-square test or Fisher exact test. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory power of MRI features. The area under the ROC curve (AUC) and the optimal cut-off values were calculated using histopathology diagnosis as a reference; meanwhile, sensitivity and specificity were determined.    Results  Mean values of six texture parameters (Mean, Variance, Skewness, Entropy, gray-level nonuniformity, run-length nonuniformity) were significantly higher in KRAS mt  group compared to KRAS wt  group ( p  < 0.0001, respectively). The AUC values of texture features ranged from 0.703~0.813. In addition, higher T stage and lower ADC values were observed in the KRAS mt  group compared to KRAS wt  group (t = 7.086,  p  = 0.029; t = − 2.708,  p  = 0.008).    Conclusion  The MRI findings of rectal cancer, especially texture features, showed an encouraging value for identifying KRAS status.

Characterizing MRI features of rectal cancers with different KRAS status