European Radiology

, Volume 29, Issue 12, pp 6469–6476 | Cite as

Rectal cancer: can T2WI histogram of the primary tumor help predict the existence of lymph node metastasis?

  • Lanqing Yang
  • Dan Liu
  • Xin Fang
  • Ziqiang Wang
  • Yue Xing
  • Ling Ma
  • Bing WuEmail author



To explore if there is a correlation between T2WI histogram features of the primary tumor and the existence of regional lymph node (LN) metastasis in rectal cancer.


Eighty-eight patients with pathologically proven rectal adenocarcinoma, who received direct surgical resection and underwent preoperative rectal MRIs, were enrolled retrospectively. Based on pathological analysis of surgical specimen, patients were classified into negative LN (LN−) and positive LN (LN+) groups. The degree of differentiation and pathological T stage were recorded. Clinical T stage, tumor location, and maximum diameter of tumor were evaluated of each patient. Whole-tumor texture analysis was independently performed by two radiologists on axial T2WI, including skewness, kurtosis, energy, and entropy.


The interobserver agreement was overall good for texture analysis between two radiologists, with intraclass correlation coefficients (ICCs) ranging from 0.626 to 0.826. The LN− group had a significantly higher skewness (p < 0.001), kurtosis (p < 0.001), and energy (p = 0.004) than the LN+ group, and a lower entropy (p = 0.028). These four parameters showed moderate to good diagnostic power in predicting LN metastasis with respective AUC of 0.750, 0.733, 0.669, and 0.648. In addition, they were both correlated with LN metastasis (rs = − 0.413, − 0.385, − 0.28, and 0.245, respectively). The multivariate analysis showed that lower skewness was an independent risk factor of LN metastasis (odds ratio, OR = 9.832; 95%CI, 1.171–56.295; p = 0.01).


Signal intensity histogram parameters of primary tumor on T2WI were associated with regional LN status in rectal cancer, which may help improve the prediction of nodal stage.

Key Points

• Histogram parameters of tumor on T2WI may help to reduce uncertainty when assessing LN status in rectal cancer.

• Histogram parameters of tumor on T2WI showed a significant difference between different regional LN status groups in rectal cancer.

• Skewness was an independent risk factor of regional LN metastasis in rectal cancer.


Rectal neoplasms Lymphatic metastasis Magnetic resonance imaging Computer-assisted image analysis 



Intraclass correlation coefficients


Lymph node negative


Lymph node


Lymph node positive


Odds ratio



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Wu Bing.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lanqing Yang
    • 1
  • Dan Liu
    • 1
  • Xin Fang
    • 1
  • Ziqiang Wang
    • 2
  • Yue Xing
    • 3
  • Ling Ma
    • 4
  • Bing Wu
    • 1
    Email author
  1. 1.Department of Radiology, West China HospitalSichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Colorectal Surgery, West China HospitalSichuan UniversityChengduPeople’s Republic of China
  3. 3.Sir Peter Mansfield Imaging Center, School of MedicineNottinghamUK
  4. 4.GE HealthcareShanghaiPeople’s Republic of China

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