Wang B, Gu JM, Wu B. Magnetic resonance imaging-pathology correlation after neoadjuvant therapy for rectal cancer: Implications for surgical prognosis. World J Gastrointest Surg 2026; 18(7): 119575 [DOI: 10.4240/wjgs.119575]
Corresponding Author of This Article
Bing Wu, MD, Chief Physician, Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. bingwu1453@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Wang B, Gu JM, Wu B. Magnetic resonance imaging-pathology correlation after neoadjuvant therapy for rectal cancer: Implications for surgical prognosis. World J Gastrointest Surg 2026; 18(7): 119575 [DOI: 10.4240/wjgs.119575]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 119575 Published online Jul 27, 2026. doi: 10.4240/wjgs.119575
Magnetic resonance imaging-pathology correlation after neoadjuvant therapy for rectal cancer: Implications for surgical prognosis
Bo Wang, Jia-Min Gu, Bing Wu
Bo Wang, Jia-Min Gu, Bing Wu, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang B is responsible for research design, data collection and organization, statistical analysis, writing the initial draft of the paper, and completing multiple revisions; Wu B conducted comprehensive review and quality control; Gu JM participated in the literature research, data proofreading, and paper revision; and all authors have read and approved the final manuscript and have agreed to its submission.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to declare in this study.
Corresponding author: Bing Wu, MD, Chief Physician, Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. bingwu1453@163.com
Received: February 10, 2026 Revised: March 10, 2026 Accepted: April 10, 2026 Published online: July 27, 2026 Processing time: 167 Days and 1.2 Hours
Abstract
Magnetic resonance imaging (MRI) has high soft-tissue resolution; thus, it is an important imaging modality for evaluating treatment responses. However, treatment-induced fibrosis, inflammation, and mucin pool formation lead to a cross between imaging and pathological phenotypes, which considerably increases the uncertainty of interpretation. This paper systematically reviews the research progress of comparative studies on MRI assessment and postoperative pathology after neoadjuvant therapy for rectal cancer and its significance in predicting surgical prognosis. This paper proposes a standardized framework for MRI assessment of rectal cancer, emphasizing the stable extraction of key risk indicators through the integrated interpretation of multisequence images based on unified scanning protocols and structured reporting. This study focused on parameters directly related to surgical decision-making, such as primary tumor bed staging, lymph node status, risk of circumferential resection margin involvement, and extramural venous invasion and evaluated the consistency between their imaging manifestations and pathological results, as well as the clinical translational value. The results showed that imaging-pathological inconsistency was jointly affected by factors such as histological heterogeneity, upper limit of spatial resolution, differences in diagnosis and treatment processes, and time-dependent tumor regression. Clinical practice should combine multimodal information and dynamic assessment to transform imaging findings into an actionable basis for risk stratification to improve the accuracy of individualized treatment decisions and enhance the clinical usability of imaging indicators.
Core Tip: This study reviews advances in correlating magnetic resonance imaging assessments with postoperative pathology for rectal cancer neoadjuvant therapy and proposes a standardized framework to extract key risk indicators (e.g., tumor bed staging, circumferential resection margin/extramural venous invasion status) amid treatment-induced changes. It highlights factors affecting imaging-pathology consistency and advocates combining multimodal and dynamic data to enhance risk stratification and surgical decision-making.
