Histological differentiation and Ki-67 expression in rectal cancer based on time-dependent diffusion MRI-derived microstructure parameters: A systematic review.
DOI:
https://doi.org/10.51168/sjhrafrica.v4i12.2449Keywords:
Diffusion-weighted imaging, Histological differentiation, Intracellular volume fraction, Ki-67, Microstructure imaging, Rectal cancer, Time-dependent diffusion magnetic resonance imagingAbstract
Background
Histological differentiation and Ki-67 expression are key indicators of tumor aggressiveness in rectal cancer but are currently assessed postoperatively. Time-dependent diffusion MRI (td-dMRI) has emerged as an advanced imaging technique capable of probing tissue microstructure beyond conventional apparent diffusion coefficient (ADC) measurements.
Purpose: To systematically evaluate the diagnostic and predictive value of td-dMRI–derived microstructure parameters for assessing histological differentiation and Ki-67 expression in rectal cancer.
Methods
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched from database inception to 31 January 2026. Eligible studies included peer-reviewed human investigations evaluating time-dependent diffusion magnetic resonance imaging (MRI) techniques with quantitative microstructure parameter extraction and histopathological correlation for tumor differentiation and/or Ki-67 expression in rectal cancer. Risk of bias was assessed using the QUADAS-2 tool. Due to methodological heterogeneity, findings were synthesized narratively.
Results
Three single-center studies published between 2025 and 2026 were included. Across studies, intracellular volume fraction and cellularity-related parameters consistently demonstrated significant associations with histological differentiation and, in one study, Ki-67 expression. Multiparametric models incorporating microstructure parameters outperformed ADC-only approaches for characterizing tumor aggressiveness.
Conclusion
td-dMRI-derived microstructure parameters, particularly intracellular volume fraction, showed promise as non-invasive imaging biomarkers of histological differentiation and proliferative activity in rectal cancer. Larger, standardized multicentre studies are required to validate their clinical utility.
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