Histogram analysis of amide proton transfer imaging for predicting response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma

Motivation: Predicting response to neoadjuvant chemoradiotherapy (nCRT) is crucial for early stratified management of locally advanced rectal cancer (LARC) patients; however, current radiological studies remain inconclusive. Goal(s): To investigate the potential of histogram analysis applied to pre-treatment amide proton transfer-weighted (APTw) imaging in predicting complete pathological regression (pCR) in patients with LARC undergoing nCRT. Approach: Based on histologic assessment, the patients were divided into a pCR or a non-pCR group. APTw histogram features, apparent diffusion coefficient (ADC), and clinical parameters were analyzed. Results: Histogram analysis of pre-treatment APTw may hold promise as a novel approach for predicting the response of LARC patients to nCRT. Impact: Through the establishment of models and model comparison, the APTw-histogram model and the APTw-clinical combined model demonstrated strong diagnostic efficacy and clinical practicality in predicting LARC patients' responsiveness to nCRT, offering new insights for early clinical decision-making.