title: Prospective comparison of MR with diffusion-weighted imaging, endoscopic ultrasound, MDCT and positron emission tomography-CT in the pre-operative staging of oesophageal cancer: results from a pilot study.
abstract: OBJECTIVE
  To compare the diagnostic performance of MR and diffusion-weighted imaging (DWI), multidetector CT, endoscopic ultrasonography (EUS) and18F-FDG (fluorine-18 fludeoxyglucose) positron emission tomography CT (PET-CT) in the pre-operative locoregional staging of oesophageal cancer.
  
  
  METHODS
  18 patients with oesophageal or Siewert I tumour (9 directly treated with surgery and 9 addressed to chemo-/radiotherapy before) underwent 1.5-T MR and DWI, 64-channel multidetector CT, EUS and PET-CT before (n = 18) and also after neoadjuvant treatment (n = 9). All images were analysed and staged blindly by dedicated operators (seventh TNM edition). Two radiologists calculated independently the apparent diffusion coefficient from the first scan. Results were compared with histopathological findings. After the population had been divided according to local invasion (T1-T2 vs T3-T4) and nodal involvement (N0 vs N+), sensitivity, specificity, accuracy, positive- and negative-predictive values were calculated and compared. Quantitative measurements from DWI and PET-CT were also analysed.
  
  
  RESULTS
  For T staging, EUS showed the best sensitivity (100%), whereas MR showed the highest specificity (92%) and accuracy (83%). For N staging, MR and EUS showed the highest sensitivity (100%), but none of the techniques showed adequate results for specificity. Overall, MR showed the highest accuracy (66%) for N stage, although this was not significantly different to the other modalities. The apparent diffusion coefficient was different between surgery-only and chemo-/radiotherapy groups (1.90 vs 1.30 × 10-3mm2s-1, respectively; p = 0.005)-optimal cut off for local invasion: 1.33 × 10-3mm2s-1(p = 0.05). Difference in standardized uptake value was also very close to conventional levels of statistical significance (8.81 vs 13.97 g cm-3, respectively; p = 0.05)-optimal cut off: 7.97 g cm-3(p = 0.44).
  
  
  CONCLUSIONS
  In this pilot study, we have shown that MR with DWI could enrich the current pre-operative work-up for oesophageal cancer and could be used for T and N staging. However, larger studies will need to be carried out before introducing this technique in the standard diagnostic pathway, in order to understand if MR with DWI could change its management and replace more costly or invasive tests such as PET-CT or EUS. Advances in knowledge: This pilot study represents the first effort where the four techniques have been prospectively compared together for oesophageal cancer staging. The combination of MR and DWI could provide important, additional information for staging and initial treatment decision-making.
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.|2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Francesco
authors: http://orcid.org/0000-0001-5218-6431
authors: F
authors: Giganti
authors: 2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Alessandro
authors: A
authors: Ambrosi
authors: 3 Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Maria C
authors: MC
authors: Petrone
authors: 4 Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors: Carla
authors: C
authors: Canevari
authors: 2 Vita-Salute San Raffaele University, Milan, Italy.|5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Damiano
authors: D
authors: Chiari
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.|2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Annalaura
authors: A
authors: Salerno
authors: 3 Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Paolo G
authors: PG
authors: Arcidiacono
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.
authors: Roberto
authors: R
authors: Nicoletti
authors: 6 Pathology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors: Luca
authors: L
authors: Albarello
authors: 7 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
authors: Elena
authors: E
authors: Mazza
authors: 8 Institute of Molecular Bioimaging and Physiology, National Research Council, IBFM-CNR, Milan, Italy.
authors: Francesca
authors: F
authors: Gallivanone
authors: 4 Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy.
authors: Luigi
authors: L
authors: Gianolli
authors: 5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Elena
authors: E
authors: Orsenigo
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.|2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Antonio
authors: A
authors: Esposito
authors: 2 Vita-Salute San Raffaele University, Milan, Italy.|5 Department of Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
authors: Carlo
authors: C
authors: Staudacher
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.|2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Alessandro
authors: A
authors: Del Maschio
authors: 1 Department of Radiology and Centre for Experimental Imaging, San Raffaele Scientific Institute, Milan, Italy.|2 Vita-Salute San Raffaele University, Milan, Italy.
authors: Francesco
authors: F
authors: De Cobelli
mesh_terms: D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results