Detecting lymph node metastasis of esophageal cancer on dual-energy computed tomography

Abstract

Background Using conventional computed tomography (CT), the accurate diagnosis of lymph node (LN) metastasis of esophageal cancer is difficult. Purpose To examine dual-energy CT parameters to predict LN metastasis preoperatively in patients with esophageal cancer. Material and Methods Twenty-six consecutive patients who underwent dual-energy CT before an esophageal cancer surgery (19 patients with LN metastases) were analyzed. The included LNs had a short-axis diameter of ≥4 mm and were confirmed to be resected on postoperative CT. Their short-axis diameter, CT value, iodine concentration (IC), and fat fraction were measured on early- and late-phase contrast-enhanced dual-energy CT images and compared between pathologically confirmed metastatic and non-metastatic LNs. Results In total, 51 LNs (34 metastatic and 17 non-metastatic) were included. In the early phase, IC and fat fraction were significantly lower in the metastatic than in the non-metastatic LNs (IC = 1.6 mg/mL vs. 2.2 mg/mL; fat fraction = 20.3% vs. 32.5%; both P < 0.05). Furthermore, in the late phase, IC and fat fraction were significantly lower in the metastatic than in the non-metastatic LNs (IC = 2.0 mg/mL vs. 3.0 mg/mL; fat fraction = 20.4% vs. 33.0%; both P < 0.05). Fat fraction exhibited accuracies of 82.4% and 78.4% on early- and late-phase images, respectively. Conversely, short-axis diameter and CT value on both early- and late-phase images were not significantly different between the metastatic and non-metastatic LNs ( P > 0.05). Conclusion Using dual-energy CT images, IC and fat fraction are useful for diagnosing LN metastasis in patients with esophageal cancer.

Spectral CT - a new supplementary method for preoperative assessment of pathological grades of esophageal squamous cell carcinoma

“…The distribution of iodine in the tissue is strongly correlated with local blood volume and vascular density [16]. Several studies have shown that IC correlates well with higher blood ow and vascularization [14,[17][18][19][20][21][22]. In our study, IC in the AP and VP was signi cantly different among the three groups, as tumor grade increased, it also increased.…”

Diagnostic accuracy of contrast-enhanced dual-energy computed tomography for detecting metastatic lymph nodes in patients with malignant tumors: a systematic review and meta-analysis

“…The mean age of patients in the 16 included studies varied from 34.0±7.8 to 59.5±8.7 years, while the percentage of males ranged from around 0.0% to 70.9%. Moreover, 7 of the 16 studies included patients with thyroid cancer ( 16 , 23 , 24 , 29 , 30 , 33 , 36 ), 4 studies included patients with colorectal cancer ( 25 , 28 , 35 , 37 ), and the remaining 5 studies included patients with esophageal cancer, liver cancer, breast cancer, squamous cell carcinoma of the oropharynx, or lung cancer ( 26 , 27 , 31 , 32 , 34 ). Table 1 details the patient characteristics of the included studies.…”

“…After a reading of the titles and abstracts of these 257 original studies, 202 papers were excluded. Then, full texts were read in detail, and a rescreening was performed based on the inclusion and exclusion criteria, resulting in a final sample of 16 eligible studies for inclusion in this meta-analysis (16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The flowchart outlining the screening process is shown in Figure 1.…”

“…This meta-analysis included 16 original investigations, totaling 2,577 lymph nodes from 984 individuals. The papers included were published between 2015 and 2022, with 11 studies having been published in the last 5 years (16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The mean age of patients in the 16 included studies varied from 34.0±7.8 to 59.5±8.7 years, while the percentage of males ranged from around 0.0% to 70.9%.…”