title: Clinical implication of PET/MR imaging in preoperative esophageal cancer staging: comparison with PET/CT, endoscopic ultrasonography, and CT.
abstract: This was a study to compare the diagnostic efficacies of endoscopic ultrasonography (EUS), CT, PET/MR imaging, and PET/CT for the preoperative local and regional staging of esophageal cancer, with postoperative pathologic stage used as the reference standard.
  
  
  METHODS
  During 1 y, 19 patients with resectable esophageal cancer were enrolled and underwent preoperative EUS, CT, PET/CT, and PET/MR imaging. A chest radiologist and nuclear medicine physician retrospectively reviewed the images and assigned tumor and lymph node stages according to the seventh version of the TNM system and the American Joint Committee on Cancer staging system. Four patients who were treated nonsurgically were excluded from data analysis. The efficacies of EUS, CT, PET/CT, and PET/MR imaging were compared.
  
  
  RESULTS
  Primary tumors were correctly staged in 13 (86.7%), 10 (66.7%), and 5 (33.3%) patients at EUS, PET/MR imaging, and CT, respectively (P value ranging from 0.021 to 0.375). The accuracy of determining T1 lesions was 86.7%, 80.0%, and 46.7% for EUS, PET/MR imaging, and CT, respectively. For distinguishing T3 lesions, the accuracy was 93.3% for EUS and 86.7% for both PET/MR imaging and CT. For lymph node staging, the accuracy was 83.3%, 75.0%, 66.7%, and 50.0% for PET/MR imaging, EUS, PET/CT, and CT, respectively. In addition, area-under-the-curve values were 0.800, 0.700, 0.629, and 0.543 for PET/MR imaging, EUS, PET/CT, and CT, respectively.
  
  
  CONCLUSIONS
  PET/MR imaging demonstrated acceptable accuracy for T staging compared with EUS and, although not statistically significant, even higher accuracy than EUS and PET/CT for prediction of N staging. With adjustments in protocols, PET/MR imaging may provide an important role in preoperative esophageal cancer staging in the future.
authors.affiliation: Department of Radiology, Pusan National University Hospital, Busan, Korea Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Geewon
authors.initials: G
authors.lastname: Lee
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, Korea.
authors.forename: Hoseok
authors.initials: H
authors.lastname: I
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea growthkim@daum.net.
authors.forename: Seong-Jang
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Pusan National University Hospital, Busan, Korea Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Yeon Joo
authors.initials: YJ
authors.lastname: Jeong
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Korea; and.
authors.forename: In Joo
authors.initials: IJ
authors.lastname: Kim
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea.
authors.forename: Kyoungjune
authors.initials: K
authors.lastname: Pak
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Pathology, Pusan National University Hospital, Busan, Korea.
authors.forename: Do Yun
authors.initials: DY
authors.lastname: Park
authors.affiliation: Biomedical Research Institute, Pusan National University Hospital, Busan, Korea Department of Internal Medicine, Pusan National University Hospital, Busan, Korea; and.
authors.forename: Gwang Ha
authors.initials: GH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003952:Diagnostic Imaging / Q000379:methods*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D057234:Preoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: EUS; PET/CT; PET/MRI; esophageal cancer; staging