Preoperative local staging of esophageal carcinoma using dual-phase contrast-enhanced imaging with multi-detector row computed tomography: value of the arterial phase images.
OBJECTIVE
To evaluate whether the accuracy of local extension (T-staging) of esophageal carcinoma could be improved with addition of arterial phase images by use of multi-detector row computed tomography.


METHODS
The institutional review board approved this study, and all the subjects provided informed consent. Dual-phase (the arterial and venous phases) contrast-enhanced computed tomography was performed in 45 consecutive patients (39 men and 6 women; age range, 47-84 years) with 47 lesions of esophageal carcinoma who underwent surgical intervention. Two radiologists independently evaluated the T-staging of esophageal carcinoma on both phases. The T-staging on both the arterial and venous phase images was compared with the T-staging at histologic evaluation by means of a resected specimen (as the reference standard). Differences in the overall accuracy and sensitivity for the T-staging between the 2 phases were analyzed with the McNemar test.


RESULTS
The analysis of the interobserver agreement for T-staging showed almost perfect agreement (kappa = 0.85 on the arterial phase and kappa = 0.93 on the venous phase). The overall accuracy in the arterial phase was significantly better than that in the venous phase (68% vs 51%, P < 0.01). The sensitivity values of the T-staging in the arterial phase were 0% in T1a, 71.4% in T1b, 12.5% in T2, 89.5% in T3, and 100% in T4. The sensitivity values in the venous phase were 0% in T1a, 14.3% in T1b, 0% in T2, 94.7% in T3, and 100% in T4. Statistical significance was apparent in the sensitivity of the T1b lesions.


CONCLUSIONS
The arterial phase can improve the accuracy of T-staging of esophageal carcinomas, especially early-staged lesions.
Umeoka
Shigeaki
S
Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. umeoka@kuhp.kyoto-u.ac.jp
Koyama
Takashi
T
Watanabe
Go
G
Saga
Tsuneo
T
Kataoka
Masako
M
Togashi
Kaori
K
Hatabu
Hiroto
H
D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*