Objective To analyze the value of diffusion kurtosis imaging (DKI) in predicting early curative effect of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Methods The MRI data of 36 patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy in the hospital from September 2014 to June 2017 were analyzed retrospectively. DKI was performed to obtain ADC, D, K and other quantitative values before the treatment and after 2 weeks and 3 weeks of treatment. The value of DKI in predicting early curative effect of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer was analyzed. Results The effective rate of neoadjuvant chemoradiotherapy in the 36 cases was 41.67% (15/36), and the ADC values of the effective group were higher than those of the ineffective group after 2 weeks and 3 weeks of treatment (P<0.05).D values of the effective group were significantly lower than those of the ineffective group before neoadjuvant chemotherapy and after 2 weeks of treatment (P<0.05). Besides, △D values were higher than those of the ineffective group after 2 weeks and 3 weeks of treatment (P<0.05). However, there was no statistically significant difference in K values or △K values between the two groups at any time point (P>0.05). There was an obvious correlation between ADC, △ADC, D, △D, △K and TRG score(P<0.05), but the correlation of K value was not significant (P>0.05). The efficiencies of △ADC and △D were the best in predicting early curative effect of neoadjuvant chemoradiotherapy. The areas under the ROC curve were 0.769 and 0.845, and the sensitivities and specificities were 57.25%, 100% and 100%, 62.49%, respectively. Conclusion DKI is an effective way to predict the early curative effect of neoadjuvant chemoradiotherapy for locally advanced rectal cancer, which is of guiding value in the treatment of such patients.