Multidetector CT and virtual endoscopy in the evaluation of the esophagus

Abstract

In this prospective study, we assessed the diagnostic capabilities of multidetector computed tomography (CT) in various esophageal pathologic conditions. Thirty-three patients underwent a multidetector CT study after esophageal distention by means of effervescent powder administered after induction of pharmacologic esophageal hypotonia. All acquired images were post-processed with two- and three-dimensional software tools. The CT data were compared with the results of conventional radiology (33), endoscopy (28), endoscopy ultrasonography (14), or surgery (14). Follow-up ranged between 4 and 15 months. Esophageal distention in the upper and middle thirds was classified as "good" in 32 of 33 cases (97%); in the lower third, esophageal distention was "good" in 21 of 33 cases (64%). Final diagnoses were leiomyoma (six cases), squamous cell carcinoma (six), adenocarcinoma (four), esophageal infiltration by thyroid cancer (two), benign polyposis (two), chronic esophagitis (five), post-sclerotherapy stenosis (one), no abnormalities (seven). When good distention was achieved, the thickness of unaffected esophageal wall was less than 3 mm (range, 1.5-2.4 mm; mean, 1.9 mm). Pathologic wall thickening was observed in 25 of 33 cases (76%), with values ranging between 3.6 and 36 mm (mean, 9.6 mm). Spiral CT demonstrated 21 true positive cases, and seven true negative cases. There were four false negative cases and one false positive case. Sensitivity was 84%, specificity was 87%, diagnostic accuracy was 85%, positive predictive value was 95%, and negative predictive value was 64%. Evaluation of the esophagus with multidetector CT is a promising technique and easy to use, allowing panoramic exploration, virtual endoluminal visualization, accurate longitudinal and axial evaluations, and simultaneous evaluation of T and N parameters.

Correlation of Radiological and Endoscopic Findings in Patients Presenting with Dysphagia

“…Mazzeo et al [5] studied CT findings in esophageal pathologic conditions in thirty-three cases and reported sensitivity of 84% and specificity of 87%. In the present study maximum cases of carcinoma were seen in males over 40 years of age.…”

The Additional Value of Esophageal Wall Evaluation and Secondary Findings in Emergency Patients Undergoing CT Pulmonary Angiography

“…They recommended using a 5 mm threshold and a target sign to differentiate between them, regardless of esophageal distension, because the lumen was mostly collapsed (7). In a well-distended esophagus achieved by hypotonia and ingestion of effervescent powder, the threshold for normal wall thickness can be decreased to 3 mm, because normal values range from 1.5 to 2.4 mm (mean 1.9 mm) (14). Even though there was a negative linear correlation between luminal distension and esophageal wall thickness, we decided to adopt the 5 mm threshold value, which is also the greatest from what has been proposed so far.…”

Esophageal cancer characterization with pneumo-64-MDCT

“…Oral contrast enhancement may generate confusing images, with the same density as the tumor [22,23]. Moreover, when wall thickening is quantified it can be distorted by the degree of lumen distension (Fig.…”

“…It has been the first staging method used for staging esophageal cancer; with high accuracy for the detection of liver metastases but poor ability to accurately detect T4 disease because of local invasion or N1 local lymph node spread [7,14,22]. Conventional CT weakness for hollow organ assessment is that in the absence of lumen distension the organ wall may be collapsed [23].…”