101 Comparison of MRI response evaluation methods in rectal cancer: a multicentre and multireader validation study 6 the Netherlands. Considering that Dutch guidelines for image acquisition are in line with international guidelines, we are confident that the dataset offers a representative sample including a representation of all commonly used MRI vendors and protocol variations reflective of everyday clinical practice in the Netherlands as well as worldwide. In conclusion, this multireader and multicentre validation study has shown that out of four previously published methods for rectal tumor response evaluation after CRT (mrTRG, modified mrTRG, DWI patterns, and the split scar sign), the methods incorporating DWI showed the most favorable overall results taking into account its high specificity, interobserver agreement, and strong reader preference. Both reader experience and image quality had a clear impact on diagnostic performance and interobserver agreement, which emphasizes the need for good quality imaging using state-of-the-art MRI protocols, and the importance of dedicated radiologist training to gain sufficient expertise.
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