CT prediction of irresectability in esophageal carcinoma: value of additional patient positions and relation to patient outcome.
BACKGROUND
To improve computed tomographic (CT) prediction of local irresectability and to correlate preoperative CT findings with patient outcome.


METHODS
Eighty-five patients with esophageal carcinoma underwent CT in supine, left lateral decubitus, and prone positions. CT signs that were indicative of local irresectability included (1) an angle of contact >45 degrees with the aorta; (2) obliteration of triangular fat pad between the tumor, aorta, and spine; (3) tumor contiguous with the aorta in all three positions; and (4) indentation of the airway in all three positions.


RESULTS
All CT signs indicative for local irresectability concerning the aorta had comparable percentages of false-positive scans (75%) when correlated with surgical findings. When correlated with pathologic findings, >45 degrees angle of contact with the aorta yielded the fewest false-positive cases (9%). Concerning the airway, additional positions changed the staging correctly in 1 of 18 cases. Median survival was 21 and 8 months, respectively, for tumors considered CT resectable or irresectable.


CONCLUSIONS
Additional patient positions do not improve the CT prediction of aortic invasion. Predicted resectability correlates with a significant longer life expectancy.
van den Hoed
R D
RD
Center of Radiology, Utrecht University Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Feldberg
M A
MA
van Leeuwen
M S
MS
van Dalen
T
T
Obertop
H
H
Kooyman
C D
CD
van der Schouw
Y T
YT
de Graaf
P W
PW
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D011187:Posture / Q000502:physiology*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed