Shear-wave elastography predicts T-restaging and pathologic complete response of rectal cancer post neoadjuvant chemoradiotherapy

Purpose To investigate the value of shear-wave elastography (SWE) in assessing the response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer. Methods In this study, 455 participants with locally advanced rectal cancer who underwent nCRT at our hospital between September 2021 and December 2022 were prospectively enrolled. The participants were randomly divided into training and test cohorts in a 3:2 ratio. Clinical baseline data, endorectal ultrasound examination data, and SWE measurements were collected for all participants. Logistic regression models were used to predict whether rectal cancer after nCRT had a low T staging (ypT 0–2 stage, Model A) and pathological complete response (pCR) (Model B). Paired Chi-square tests were used to compare the diagnostic performances of the radiologists to those of Models A and B. Results In total, 256 participants were included. The area under the receiver operating characteristic curve of Models A and B in the test cohort were 0.94 (0.87, 1.00) and 0.88 (0.80, 0.97), respectively. The optimal diagnostic thresholds for Models A and B were 14.9 kPa for peritumoral mesangial Emean and 15.2 kPa for tumor Emean, respectively. The diagnostic performance of the radiologists was significantly lower than that of Models A and B, respectively ( p