PURPOSE: To compare image quality and clinical utility of a T2-weighted (T2W) 3-dimensional (3D) fast spin echo (FSE) sequence using deep learning reconstruction (DLR) versus conventional reconstruction for rectal magnetic resonance imaging (MRI).

METHODS: The study included 50 patients with rectal cancer who underwent rectal MRI consecutively between July 7, 2020 and January 20, 2021 using a T2W 3D FSE sequence with DLR and conventional reconstruction. Three radiologists reviewed the two sets of images, scoring overall SNR, motion artifacts, and overall image quality on a 3-point scale and indicating clinical preference for DLR or conventional reconstruction based on those three criteria as well as image characterization of bowel wall layer definition, tumor invasion of muscularis propria, residual disease, fibrosis, nodal margin, and extramural venous invasion.

RESULTS: Image quality was rated as moderate or good for both DLR and conventional reconstruction for most cases. DLR was preferred over conventional reconstruction in all of the categories except for bowel wall layer definition.

CONCLUSION: Both conventional reconstruction and DLR provide acceptable image quality for T2W 3D FSE imaging of rectal cancer. DLR was clinically preferred over conventional reconstruction in almost all categories.