title: CT prediction of irresectability in esophageal carcinoma: value of additional patient positions and relation to patient outcome.
abstract: 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.
authors.affiliation: Center of Radiology, Utrecht University Hospital, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: R D
authors.initials: RD
authors.lastname: van den Hoed
authors.forename: M A
authors.initials: MA
authors.lastname: Feldberg
authors.forename: M S
authors.initials: MS
authors.lastname: van Leeuwen
authors.forename: T
authors.initials: T
authors.lastname: van Dalen
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: C D
authors.initials: CD
authors.lastname: Kooyman
authors.forename: Y T
authors.initials: YT
authors.lastname: van der Schouw
authors.forename: P W
authors.initials: PW
authors.lastname: de Graaf
mesh_terms: 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