Esophageal Cancer Staging with Endoscopic MR Imaging: Pilot Study

Abstract

The authors defined esophageal anatomy and evaluated esophageal cancer staging in a pilot group by comparing endoscopic magnetic resonance (MR) imaging results with pathologic and endoscopic ultrasonographic (US) results when available. A porcine esophagus, one volunteer, and 23 patients suspected of having esophageal cancer were imaged at 0.5 T. MR imaging was successful in 21 patients. Eight of these patients underwent esophagectomy (one after chemotherapy, which invalidated comparison with MR imaging; another did not undergo lymphadenectomy) and one underwent laparoscopy and nodal staging only; eight underwent US. When verified with pathologic staging, endoscopic MR imaging was accurate in six of seven patients (T stage) and five of six patients (N stage; nodal areas too obscured by artifact for comparison in one case). MR imaging and US results concurred in seven of eight (T stage) and five of eight (N stage) patients. No complications were observed. Endoscopic MR imaging is safe and probably comparable to endoscopic US, but with a tendency to overstage the disease.

MR imaging of gastric cancer in vitro: accuracy of invasion depth diagnosis

“…Scan time could be reduced to some extent using an ultra-high field scanner [29,30], a parallel imaging technique [31], and an endoscopic surface coil [32,33]. The results of the present study may encourage further development of the endoscopic surface coil.…”

The appearances of oesophageal carcinoma demonstrated on high-resolution, T2-weighted MRI, with histopathological correlation

“…There are some technical difficulties associated with the technique, with failure in up to 17% of cases due to inability to pass the endoscope through stenotic tumours [4]. Endoluminal magnetic resonance imaging (MRI) is also being developed as a potential method of local staging for oesophageal carcinoma [5]. However the difficulties with stenotic tumours persist with this technique.…”

Diagnostic radiology and nuclear medicine

“…Initial results with endoluminal MRI show it is a safe procedure and the results are comparable with those obtained with EUS [23,24]. In particular, in vivo endoscopic MR imaging was concordant for T stage with histopathology in six of seven (86%) patients and with EUS in seven of eight patients (87.5%), but showed a tendency to overstage the disease [24]. MRI advances with stronger gradients and parallel imaging may enhance its role in defining local extension.…”

“…Early work with this technique demonstrated the normal esophageal wall as a threelayered structure of alternating high and low signal intensity, whereas tumor manifested as distinct low intensity on both T1 and T2-weighted sequences [22]. Initial results with endoluminal MRI show it is a safe procedure and the results are comparable with those obtained with EUS [23,24]. In particular, in vivo endoscopic MR imaging was concordant for T stage with histopathology in six of seven (86%) patients and with EUS in seven of eight patients (87.5%), but showed a tendency to overstage the disease [24].…”

“…A ''long-term averaging'' (LOTA) pulse sequence to improve mediastinal imaging combined with gadolinium-enhanced techniques in a recent prospective study showed that MRI can be almost as accurate as EUS in N-staging, with a sensitivity of 100% and a specificity of 78% [53]. Metastatic lymph nodes can be identified with MRI as low signal intensity on T1 and altered signal intensity on T2-weighted sequences [22][23][24], though this does not have proven reliability and has limited clinical application. The recent development of lymph node-specific contrast agents is an area that holds considerable promise for differentiating benign and malignant lymph nodes.…”