## 4 Discussions  
The total mesorectal excision introduction and the use of multidisciplinary team in the management of patients affected by locally recurrent rectal cancer has determined a reduction of local colorectal recurrence rate [11; 12]. \begin{table}
\begin{tabular}{c c c c} \hline \hline \multicolumn{1}{c}{**Univariate Regression Analysis**} & \begin{tabular}{c} **Coefficients** \\ **\(\times\)10\({}^{-3}\)** \\ \end{tabular} & \begin{tabular}{c} **Odds** \\ **Ratio** \\ \end{tabular} & \(p\)**Value** \\ \hline ADC Mean & \(-0.1\) & \(-1.9\) & **0.05** \\ \hline ADC STD & \(-0.4\) & \(-1.6\) & \(0.12\) \\ \hline Kurtosis Mean & \(0.2\) & \(3.8\) & **\textless{}<0.01** \\ \hline Kurtosis STD & \(0.1\) & \(0.9\) & \(0.37\) \\ \hline MD Mean & \(-0.0\) & \(-0.7\) & \(0.51\) \\ \hline MD STD & \(-0.1\) & \(-0.8\) & \(0.44\) \\ \hline fp Mean & \(0.8\) & \(1.7\) & **0.09** \\ \hline fp STD & \(1.3\) & \(1.5\) & \(0.13\) \\ \hline Dt Mean & \(0.9\) & \(1.0\) & \(0.32\) \\ \hline Dt STD & \(-0.2\) & \(-0.7\) & \(0.47\) \\ \hline Dp Mean & \(-0.2\) & \(-2.4\) & **0.02** \\ \hline Dp STD & \(1.0\) & \(1.0\) & \(0.30\) \\ \hline \multirow{3}{*}{\
\begin{tabular}{c} **Multivariate Regression Analysis** \\ **\(\times\)10\({}^{-3}\)** \\ \end{tabular} } &
\begin{tabular}{c} **Coefficients** \\ **Ratio** \\ \end{tabular} & \(p\)**Value** \\ \hline ADC Mean & \(0.3\) & \(2.2\) & **0.02** \\ \hline Kurtosis Mean & \(0.5\) & \(3.6\) & **\textless{}<0.01** \\ \hline fp Mean & \(0.04\) & \(0.1\) & \(0.94\) \\ \hline Dp Mean & \(-0.4\) & \(-0.5\) & \(0.63\) \\ \hline \end{tabular} Note. In bold were reported the statistically significant parameters in the differentiation of recurrence versus fibrosis/scar tissue.  
\end{table} 
Table 4: Univariate and multivariate regression analysis results. Figure 4: Case with fibrosis tissue after rectal TME: ADC map in (**A**), Dt map in (**B**), fp map in (**C**), Dp map in (**D**), MD map in (**E**) and the mean of diffusional Kurtosis map in (**F**). Several researchers reported in literature that local colorectal recurrence risk is linked to several tumor characteristics such as advanced tumor stage, tumor location in the lower third of the rectum, tumor budding presence, poorly differentiated tumor histology, positive nodal status, of the circumferential resection margin involvement, perineural spread, and extramural venous invasion [25; 26; 27; 28; 29; 30]. In addition, the surgical approach plays an essential role in the LCR rate increase. In fact, a mesoretum incomplete resection is linked to a significantly higher risk of five-year local recurrence with respect to those with TME. The local and distant recurrence risk is significantly higher in cases where TME plane is intramesorectal or along musculars propria, compared to those where TME plane is mesorectal [31; 32; 33; 34]. Rectal cancer recurrence is a difficult to treat condition; its earlier identification could help to increase overall survival of colorectal cancer patients [31; 32; 33; 34]. MRI is recommended in the patients follow-up who have undergone rectal adenocarcinoma transanal resection, while for patients subjected to TME, Computed Tomography (CT) is the primary modality of follow-up and MR is considered as a problem-solving tool [33; 34; 35]. Regarding this, the diffusion-weighted imaging could be considered as quiet a reliable imaging modality for colorectal cancer recurrence, but more studies should be carried out. Studies have confirmed DWI utility in recurrences detection of other pelvic tumors such as prostate cancer [35], and its value in the response evaluation after neoadjuvant therapy is well documented [11; 12; 19; 20; 21; 22; 23]. DWI has already shown its feasibility in rectal cancer complete responders' detection [20; 21; 22; 23]. [PERSON] et al. [36] assessed if the addition of gadolinium-enhanced MRI and DWI can improve T2 sequence performance for LCR diagnosis on 43 patients.