title: Distance between the esophageal tumor and the aorta measured by using the contrast-enhanced attenuation on computed tomography for predicting this tumor invading aorta.
abstract: OBJECTIVE
  Despite remarkable advances in diagnostic modalities, preoperative assessment of the local tumor extent in esophageal cancer is still very difficult. The aim of this study was to evaluate the predictive value of the computed tomography (CT) attenuation value between the tumor and the aorta for esophageal cancer.
  
  
  METHODS
  Consecutive CT values were determined between the center of the tumor and the center of the aorta. The distance between the intersection of the average CT attenuation value of the tumor using the lower CT attenuation value of the inclusion tissues (T-A distance) was determined. The minimal CT attenuation value and the overall circumference of contact area (Picus' angle) were also determined. This study included 101 patients suspected of having a tumor invading the adventitia and evaluated the capacity of these parameters for predicting the aortic invasion.
  
  
  RESULTS
  The T-A distance in patients who were diagnosed without aortic invasion was significantly longer than patients who were pathologically confirmed to have invasion to the aortic wall [pT4(Ao)] (P < 0.05). The minimal CT attenuation value in patients without aortic invasion was significantly lower than pT4(Ao) patients (P < 0.05), although such a difference was not observed for the Picus' angle. The T-A distance (1.3 mm >) is the most reliable feature for predicting the aortic invasion, according to the results of the area under the receiver operating characteristic curve.
  
  
  CONCLUSIONS
  The assessment of the T-A distance is simple and objective, and it can help prevent unnecessary surgery in patients with inoperable tumors.
authors.affiliation: Department of Surgery, National Defense Medical College, Tokorozawa, Japan. tsujihi@ndmc.ac.jp
authors.forename: Hironori
authors.initials: H
authors.lastname: Tsujimoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Isao
authors.initials: I
authors.lastname: Kumano
authors.forename: Risa
authors.initials: R
authors.lastname: Takahata
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nomura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hase
mesh_terms: D063194:Adventitia / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D001011:Aorta / Q000473:pathology*; D001027:Aortography / Q000379:methods*; D019540:Area Under Curve; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D019564:Unnecessary Procedures
chemical_list: D003287:Contrast Media