{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T11:00:32Z","timestamp":1765191632329,"version":"3.46.0"},"reference-count":30,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Technological Development, and Innovation of the Republic of Serbia","award":["451-03-136\/2025-03\/200223"],"award-info":[{"award-number":["451-03-136\/2025-03\/200223"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomedicines"],"abstract":"<jats:p>Background: Reliable and accurate prediction of treatment response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) is usually demanding and continues to pose a challenge. Kurtosis as a histogram parameter calculated on T2-weighted MRI sequences might be an additional tool, as it represents a quantitative biomarker for response prediction. It is defined as a measure of distributions\u2019 tails relative to the center of the distribution curve, which reflects tissue heterogeneity. The aim of the study was to evaluate the added value of T2-weighted kurtosis in predicting pathological response to nCRT in patients with LARC. Methods: a single-center cohort study included 71 patients with LARC who underwent both initial and post-nCRT MRI examinations followed by surgical resection in the form of the total mesorectal excision (TME). Histogram analysis was performed using software MIPAV (Medical Image Processing, Analysis, and Visualization, version 11.3.2, developed by the National Institutes of Health, Bethesda, MD, USA) on T2-weighted sequences, extracting kurtosis along with other histogram parameters. Pathological tumor regression grade (pTRG) in accordance with Mandard classification was considered the gold standard. Patients were classified as responders (pTRG 1\u20132) or non-responders (pTRG 3\u20135). Results: while other histogram parameters did not show statistically significant differences between groups, post-treatment values of kurtosis were significantly higher in responders compared to non-responders (4.28 \u00b1 0.73 vs. 3.01 \u00b1 0.17, p = 0.024). The F1 score as a classification metric (0.821) indicates an improvement in classification performance following therapy. Conclusions: T2-weighted kurtosis might be a significant tool in predicting pathological response to nCRT, representing a potentially valuable quantitative biomarker that could improve treatment response assessment.<\/jats:p>","DOI":"10.3390\/biomedicines13123003","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:35:51Z","timestamp":1765190151000},"page":"3003","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Potential Role of T2-Weighted Kurtosis in Improving Response Prediction of Locally Advanced Rectal Cancer as Additional Tool Gained from Standard MRI Examination"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8239-1724","authenticated-orcid":false,"given":"Aleksandra","family":"Jankovic","sequence":"first","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7455-5584","authenticated-orcid":false,"given":"Marko \u017d.","family":"Dakovi\u0107","sequence":"additional","affiliation":[{"name":"School of Physical Chemistry, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5856-2626","authenticated-orcid":false,"given":"Milica Badza","family":"Atanasijevic","sequence":"additional","affiliation":[{"name":"School of Electrical Engineering, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Innovation Center, School of Electrical Engineering in Belgrade, 11120 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7525-7615","authenticated-orcid":false,"given":"Milica","family":"Mitrovic-Jovanovic","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-1574","authenticated-orcid":false,"given":"Katarina","family":"Stosic","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5799-656X","authenticated-orcid":false,"given":"Dimitrije","family":"Sarac","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelena","family":"Sisevic","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6640-234X","authenticated-orcid":false,"given":"Dusan","family":"Saponjski","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Dimitrijevi\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Miladinov","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelenko","family":"Jelenkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljubica","family":"Lazic","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goran","family":"Barisic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Digestive Surgery\u2014First Surgical Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5796-835X","authenticated-orcid":false,"given":"Aleksandra","family":"Djuric-Stefanovic","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4826-0218","authenticated-orcid":false,"given":"Jelena","family":"Kovac","sequence":"additional","affiliation":[{"name":"Department for Digestive Radiology, Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3355","DOI":"10.1200\/JCO.24.01160","article-title":"Management of Locally Advanced Rectal Cancer: ASCO Guideline","volume":"42","author":"Scott","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"103015","DOI":"10.1016\/j.ctrv.2025.103015","article-title":"Advances in the management of locally advanced rectal cancer: A shift toward a patient-centred approach to balance outcomes and quality of life","volume":"140","author":"Airoldi","year":"2025","journal-title":"Cancer Treat Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1038\/s41575-020-0275-y","article-title":"The multidisciplinary management of rectal cancer","volume":"17","author":"Keller","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","first-page":"iv22","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.soc.2021.11.008","article-title":"Neoadjuvant Therapy for Rectal Cancer","volume":"31","author":"Smith","year":"2022","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1002\/1097-0142(19940601)73:11<2680::AID-CNCR2820731105>3.0.CO;2-C","article-title":"Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations","volume":"73","author":"Mandard","year":"1994","journal-title":"Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e2431523","DOI":"10.2214\/AJR.24.31523","article-title":"MRI for Rectal Cancer: Updates and Controversies-AJR Expert Panel Narrative Review","volume":"224","author":"Khasawneh","year":"2025","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_8","first-page":"62","article-title":"Magnetic resonance imaging in restaging rectal cancer after neoadjuvant chemoradiotherapy","volume":"20","author":"Zhan","year":"2015","journal-title":"J. BUON"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.3348\/kjr.2018.0611","article-title":"Response Assessment with MRI after Chemoradiotherapy in Rectal Cancer: Current Evidences","volume":"20","author":"Seo","year":"2019","journal-title":"Korean J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13244-019-0706-x","article-title":"Response evaluation after neoadjuvant treatment for rectal cancer using modern MR imaging: A pictorial review","volume":"10","author":"Lambregts","year":"2019","journal-title":"Insights Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1038\/bjc.2014.512","article-title":"Improving tumour heterogeneity MRI assessment with histograms","volume":"111","author":"Just","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1148\/radiol.2016150702","article-title":"Intravoxel Incoherent Motion-derived Histogram Metrics for Assessment of Response after Combined Chemotherapy and Radiation Therapy in Rectal Cancer: Initial Experience and Comparison between Single-Section and Volumetric Analyses","volume":"280","author":"Nougaret","year":"2016","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s13244-012-0196-6","article-title":"Assessment of tumor heterogeneity: An emerging imaging tool for clinical practice?","volume":"3","author":"Davnall","year":"2012","journal-title":"Insights Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00330-017-5094-3","article-title":"Whole-tumour diffusion kurtosis MR imaging histogram analysis of rectal adenocarcinoma: Correlation with clinical pathologic prognostic factors","volume":"28","author":"Cui","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Peng, Y., Tang, H., Hu, X., Shen, Y., Kamel, I., Li, Z., and Hu, D. (2019). Rectal Cancer Invasiveness: Whole-Lesion Diffusion-Weighted Imaging (DWI) Histogram Analysis by Comparison of Reduced Field-of-View and Conventional DWI Techniques. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-55059-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1007\/s00330-024-11081-z","article-title":"Added value of histogram analysis of intravoxel incoherent motion and diffusion kurtosis imaging for the evaluation of complete response to neoadjuvant therapy in locally advanced rectal cancer","volume":"35","author":"Zhang","year":"2025","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wang, K.X., Yu, J., and Xu, Q. (2023). Histogram analysis of dynamic contrast-enhanced magnetic resonance imaging to predict extramural venous invasion in rectal cancer. BMC Med. Imaging, 23.","DOI":"10.1186\/s12880-023-01027-0"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.2174\/1573405618666220303111026","article-title":"Complete Response Evaluation of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiotherapy Using Textural Features Obtained from T2 Weighted Imaging and ADC Maps","volume":"18","author":"Azamat","year":"2022","journal-title":"Curr. Med. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1148\/rg.2019180114","article-title":"MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management","volume":"39","author":"Horvat","year":"2019","journal-title":"Radiographics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3724","DOI":"10.1200\/JCO.2016.68.3698","article-title":"Timing Is Everything: What Is the Optimal Duration After Chemoradiation for Surgery for Rectal Cancer?","volume":"34","author":"Goodman","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3753","DOI":"10.1200\/JCO.2011.34.9068","article-title":"Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience","volume":"29","author":"Patel","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.ejso.2022.02.012","article-title":"Initial magnetic resonance imaging tumour regression grade (mrTRG) as response evaluation after neoadjuvant treatment predicts sustained complete response in patients with rectal cancer","volume":"48","author":"Suzuki","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/bjs\/znad051","article-title":"Watch and wait after neoadjuvant treatment in rectal cancer: Comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)","volume":"110","author":"Temmink","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/DCR.0000000000001224","article-title":"Magnetic Resonance Texture Analysis in Identifying Complete Pathological Response to Neoadjuvant Treatment in Locally Advanced Rectal Cancer","volume":"62","author":"Aker","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/RLI.0000000000000116","article-title":"Texture analysis as imaging biomarker of tumoral response to neoadjuvant chemoradiotherapy in rectal cancer patients studied with 3-T magnetic resonance","volume":"50","author":"Ganeshan","year":"2015","journal-title":"Invest. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.3748\/wjg.v28.i23.2609","article-title":"Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer","volume":"28","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"403","DOI":"10.5152\/dir.2022.201112","article-title":"Apparent diffusion coefficient histogram analysis for predicting neoadjuvant chemoradiotherapy response in patients with rectal cancer","volume":"28","author":"Erden","year":"2022","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/jmri.25117","article-title":"Diffusion-weighted imaging: Apparent diffusion coefficient histogram analysis for detecting pathologic complete response to chemoradiotherapy in locally advanced rectal cancer","volume":"44","author":"Choi","year":"2016","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Trebeschi, S., van Griethuysen, J.J.M., Lambregts, D.M.J., Lahaye, M.J., Parmar, C., Bakers, F.C.H., Peters, N.H.G.M., Beets-Tan, R.G.H., and Aerts, H.J.W.L. (2017). Deep Learning for Fully-Automated Localization and Segmentation of Rectal Cancer on Multiparametric MR. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-05728-9"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Jankovic, A., Kovac, J.D., Dakovic, M., Mitrovic, M., Saponjski, D., Milicevic, O., Djuric-Stefanovic, A., and Barisic, G. (2023). MRI Tumor Regression Grade Combined with T2-Weighted Volumetry May Predict Histopathological Response in Locally Advanced Rectal Cancer following Neoadjuvant Chemoradiotherapy-A New Scoring System Proposal. Diagnostics, 13.","DOI":"10.3390\/diagnostics13203226"}],"container-title":["Biomedicines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9059\/13\/12\/3003\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:58:55Z","timestamp":1765191535000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9059\/13\/12\/3003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["biomedicines13123003"],"URL":"https:\/\/doi.org\/10.3390\/biomedicines13123003","relation":{},"ISSN":["2227-9059"],"issn-type":[{"value":"2227-9059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}