Esophageal cancer characterization with pneumo-64-MDCT

Abstract

Early diagnosis and accurate staging of esophageal cancer are both essential for therapeutic strategy planning. Endoscopic ultrasound, CT, and positron emission tomography have all been used in the preoperative staging of esophageal cancer separately or in various combinations. Each imaging method has its strengths and weaknesses. Depiction of the tumor's anatomic location conditions the surgical strategy. Endoscopic ultrasound and PET have important advantages but neither provides information for surgical planning. CT scans have some limitations for hollow organ assessment in the absence of lumen distension, since the organ wall may be collapsed. Therefore, optimal esophageal distension could be very useful to overcome these limitations. This potential drawback is crucial at the level of the GE junction, a typically difficult region to evaluate. In order to optimize tumor visualization in the esophageal wall and in the GE junction, we developed a technique named pneumo-64-MDCT. We achieve maximum lumen distension, which better highlights the thickened areas in relation to the normal esophageal wall. At the present time, we have performed 200 studies with this technique and it proved useful, safe and accurate to identify esophageal wall thickening and to stage esophageal cancer. The additional stomach distension led to an adequate definition of both the upper and lower borders of the lesion in tumors located in the GE junction, which in turn was helpful to design the surgical approach.

Venous Malformation of the Esophagus

“…A CT scan with distention (pneumo-CT) allows a better characterization of the tumor and its anatomic relationships, which may be invaluable in preoperative planning when indicated by symptoms or diagnostic uncertainty. This technique of distention with carbon dioxide has been previously described [6].…”

Pneumo-PET-CT: Initial Results of This Novel Technique on the Evaluation of Esophageal and Gastric Tumors with Anatomic-Surgical Correlation

“…Despite the importance of pretreatment staging, no single test or combination of tests for staging esophageal cancer has been accepted as the standard of care [8, 9]. Each one has its strengths and weaknesses.…”

“…Its weaknesses are that it is an invasive method and inaccurate for staging or characterizing the lesion. High-grade stenoses are difficult to be overcome by endoscopy [8, 9].…”

“…Examining the biologic function by examining the uptake of glucose, PET has the strength to evaluate both the locoregional and distant spread of tumor. PET weaknesses are its low availability and also lack of information for surgical planning [8]. Conventional CT is a simple, available, and rapid evaluation method.…”

“…Conventional CT is a simple, available, and rapid evaluation method. It has been the first staging method used for staging esophageal and gastric cancer, with high accuracy for the detection of liver metastases but reduced ability to accurately detect T4 disease because of the local invasion or local lymph node spread [8]. Conventional CT weakness for hollow organ assessment is that in the absence of lumen distension, the organ wall may be collapsed.…”