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BackgroundConventional MRI staging can be challenging in the preoperative assessment of rectal cancer. Deep learning methods based on MRI have shown promise in cancer diagnosis and prognostication. However, the value of deep learning in rectal cancer T‐staging is unclear.PurposeTo develop a deep learning model based on preoperative multiparametric MRI for evaluation of rectal cancer and to investigate its potential to improve T‐staging accuracy.Study TypeRetrospective.PopulationAfter cross‐validation, 260 patients (123 with T‐stage T1‐2 and 134 with T‐stage T3‐4) with histopathologically confirmed rectal cancer were randomly divided to the training (N = 208) and test sets (N = 52).Field Strength/Sequence3.0 T/Dynamic contrast enhanced (DCE), T2‐weighted imaging (T2W), and diffusion‐weighted imaging (DWI).AssessmentThe deep learning (DL) model of multiparametric (DCE, T2W, and DWI) convolutional neural network were constructed for evaluating preoperative diagnosis. The pathological findings served as the reference standard for T‐stage. For comparison, the single parameter DL‐model, a logistic regression model composed of clinical features and subjective assessment of radiologists were used.Statistical TestsThe receiver operating characteristic curve (ROC) was used to evaluate the models, the Fleiss' kappa for the intercorrelation coefficients, and DeLong test for compare the diagnostic performance of ROCs. P‐values less than 0.05 were considered statistically significant.ResultsThe Area Under Curve (AUC) of the multiparametric DL‐model was 0.854, which was significantly higher than the radiologist's assessment (AUC = 0.678), clinical model (AUC = 0.747), and the single parameter DL‐models including T2W‐model (AUC = 0.735), DWI‐model (AUC = 0.759), and DCE‐model (AUC = 0.789).Data ConclusionIn the evaluation of rectal cancer patients, the proposed multiparametric DL‐model outperformed the radiologist's assessment, the clinical model as well as the single parameter models. The multiparametric DL‐model has the potential to assist clinicians by providing more reliable and precise preoperative T staging diagnosis.Evidence Level3Technical EfficacyStage 2

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