Abstract
OBJECTIVE: To assess the image quality of synthetic double inversion recovery (SyDIR) imaging and enhance the value of T2-weighted imaging (T2WI) in evaluating T stage for rectal cancer patients. METHODS: A total of 112 pathologically confirmed rectal cancer patients were retrospectively selected after undergoing MRI, including synthetic MRI. The image quality of T2WI and SyDIR imaging was compared based on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall picture quality, presence of motion artifacts, lesion edge sharpness, and conspicuity. The concordance between MRI and pathological staging results, using T2WI alone and the combination of T2WI and SyDIR for junior and senior radiologists, was assessed using the Kappa test. The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic efficacy of extramural infiltration in rectal cancer patients. RESULTS: No significant differences in imaging quality were observed between conventional T2WI and SyDIR (p = 0.07-0.53). The combination of T2WI and SyDIR notably improved the staging concordance between MRI and pathology for both junior (kappa value from 0.547 to 0.780) and senior radiologists (kappa value from 0.738 to 0.834). In addition, the integration of T2WI and SyDIR increased the AUC for diagnosing extramural infiltration for both junior (from 0.842 to 0.918) and senior radiologists (from 0.917 to 0.938). CONCLUSION: The combination of T2WI and SyDIR increased the consistency of T staging between MRI and pathology, as well as the diagnostic performance of extramural infiltration, which would benefit treatment selection. CRITICAL RELEVANCE STATEMENT: SyDIR sequence provides additional diagnostic value for T2WI in the T staging of rectal cancer, improving the agreement of T staging between MRI and pathology, as well as the diagnostic performance of extramural infiltration. KEY POINTS: Synthetic double inversion recovery (SyDIR) and T2WI have comparable image quality. SyDIR provides rectal cancer anatomical features for extramural infiltration detections. The combination of T2WI and SyDIR improves the accuracy of T staging in rectal cancer.