Rectal adenocarcinoma is a common malignant tumor of the digestive tract. However, it is difficult to obtain tumor microstructural information using conventional magnetic resonance imaging (MRI). Dynamic contrast‑enhanced (DCE)‑MRI and intravoxel incoherent motion (IVIM) have been used in tumor research. The present study aimed to explore the application of DCE‑MRI and IVIM in the risk stratification of resectable rectal adenocarcinoma. To achieve this, 75 patients with rectal adenocarcinoma confirmed via postoperative pathological examination who underwent high‑resolution MRI, IVIM and DCE‑diffusion‑weighted imaging before surgery were retrospectively enrolled and divided into very low‑risk (19 cases), low‑risk (29 cases) and medium‑risk (27 cases) groups. The quantitative parameters of DCE‑MRI and IVIM were obtained using the GenIQ and Medical Imaging Interaction Toolkit software, respectively. One‑way analysis of variance or the Kruskal‑Wallis H test were used to analyze the differences in the measured parameters between the different risk groups. Receiver operating characteristic curves were used to analyze the diagnostic efficacy of each parameter. The differences in rate constant (K_ep), perfusion fraction (f) and false diffusion coefficient (D^*) between the different risk stratification groups were statistically significant (P<0.05). When the very low‑ and low‑risk groups were compared, f + D^* had the highest diagnostic efficiency [area under the curve (AUC)=0.719], with a sensitivity and specificity of 100 and 51.70%, respectively. When the low‑ and medium‑risk groups were compared, K_ep had the highest diagnostic efficiency (AUC=0.602), with a sensitivity and specificity of 72.41 and 55.56%, respectively. When the very low‑risk and medium‑risk groups were compared, K_ep + f + D^* had the highest diagnostic efficiency (AUC=0.887), with a sensitivity and specificity of 100 and 70.4%, respectively. Thus, DCE‑MRI and IVIM can aid the prognostic risk stratification of resectable rectal adenocarcinoma, and K_ep, f and D^* are potential quantitative imaging parameters for the risk stratification of rectal adenocarcinoma.

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