[MRI-based N-staging in esophageal cancer].
OBJECTIVE
For planning the therapeutic strategies and estimating the prognosis in esophageal cancer, N-staging is very important. To date, MRI still is of minor importance as imaging modality of the mediastinum despite promising developments in the past, like ECG-gating or "averaging" sequences, e. g., LOTA (Long-term averaging), which facilitate mediastinal and thoracic MR-imaging. In a prospective approach, the value of MRI based N-staging was examined with respect to LOTA-sequences.


METHODS
Within four weeks prior to esophagectomy, standardized MRI of the esophagus was performed in 15 patients (10 squamous-cell-carcinomas and 5 adenocarcinomas) using a 1.5 T whole body scanner. Imaging quality was classified based on depiction of aortic wall or tracheal wall layers. Criteria for malignant infiltration were a diameter of more than 15 mm or a round appearance of a lymph node together with GD-DTPA enhancement. All data were blinded and separately read by two radiologists. The data of the study were compared with those from the pathological workup of the resected specimen.


RESULTS
MRI had a sensitivity of 100 % and a specificity of 78 % for lymph node metastases. Due to incomplete depiction of the celiac trunk (M1), nodal metastasis in a non-enlarged node was missed.


CONCLUSIONS
With modern MRI, N-staging is almost as accurate as the gold standard endoscopic ultrasound and should particularly be used in patients not suited for an endoscopic ultrasound examination.
Krupski
G
G
Abteilung für diagnostische und interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf. krupski@uke.uni-hamburg.de
Lorenzen
J
J
Gawad
K
K
Nicolas
V
V
Izbicki
J R
JR
Adam
G
G
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D016477:Artifacts; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D019786:Gadolinium DTPA