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Preoperative T Staging of Potentially Resectable Esophageal Cancer: 3T MRI based on T2-TSE-BLADE and contrast-enhanced free-breathing radial VIBE (StarVIBE) vs endoscopic ultrasound
Jinrong Qu1, Hongkai Zhang1, Hui Liu2, Xu Yan2, Zhaoqi Wang1, Hailiang Li1, Kiefer Berthold3, Nickel Marcel Dominik3, and Ihab R. Kamel4

1Radiology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, People's Republic of China, 2MR Collaboration, Siemens Healthcare, 3MR Pre-development, Siemens Healthcare, 4Radiology, Johns Hopkins University School of Medicine

Synopsis

This study compared MRI based on the combination of T2-TSE-BLADE and contrast-enhanced T1 radial VIBE (StarVIBE) against endoscopic ultrasound (EUS) for T staging of potentially resectable esophageal cancer (EC). The histology confirmation of the T stage was used as reference. The results showed that the combination of T2-TSE-BLADE and StarVIBE is comparable to EUS in T staging of potentially resectable EC with lesions of T1/T2 stage, and is superior to EUS with lesions of T3/T4 stage.

Purpose: To compare MRI based on the combination of T2-TSE-BLADE and T1 radial VIBE (StarVIBE) against endoscopic ultrasound (EUS) for the T staging of potentially resectable esophageal cancer (EC), with histologic confirmation of the T stage. Materials and Methods: Seventy-two patients with endoscopically proven EC and indeterminate T1/T2/T3/T4a stage by CT and EUS were imaged on a 3T MR scanner (MAGNETOM Skyra, Siemens, Erlangen, Germany). The TSE-BLADE sequence was used for T2-weighted imaging, and a prototype T1 radial VIBE sequence (StarVIBE) was used for the contrast-enhanced scan under free-breathing condition. T stage was scored on MR and EUS by two independent radiologists and one endoscopist, and compared with post-operative histologic findings. Inter-reader agreement was also calculated. Results: The results of the histologic staging were: T1: 26 cases; T2: 16 cases; T3: 25 cases; T4a: 5 cases. The inter-reader agreement of T staging was good for the MRI based on combination of and T1Star-VIBE method (Kappa=0.917, P<0.0001). EUS and histologic T staging showed a correlation coefficient of 0.721 (P<0.0001). The correlation coefficient of T stage score based on MR and histologic T staging was: 0.828 (P<0.0001) and 0.804 (P<0.0001) for readers 1 and 2, respectively. High accuracy for T1/T2 staging was obtained for both readers for MRI (95.2 % and 97.6% for reader 1 and reader 2, respectively) and EUS (100.0% for both readers). For T3/T4 staging, MRI showed an accuracy of 96.7% for both readers, while the EUS accuracy was only 63.3%. Conclusion: The combination of TSE-BLADE and contrast-enhanced free-breathing Star-VIBE is comparable to EUS in T staging of potentially resectable EC for lesions with T1/T2 stages, and is superior to EUS for lesions with T3/T4 stages.

Acknowledgements

No acknowledgement found.

References

No reference found.

Figures

Figure 1: A 53-year-old female with esophageal squamous cell carcinoma. (A) Transverse TSE BLADE (B) Transverse contrast-enhanced StarVIBE (C) sagittal reconstructed TSE-BLADE show tumor is limited in mucosa (thin arrow), and mucosa is intact with MRI: T1 staging. (D,E) EUS shows tumor invading mucosa with intact muscularis mucosa, consistent with T1 staging. (F) Hematoxylin & Eosin (H&E) stained section at ×40 microscopy confirms that the tumor is located in the mucosa and with T1 stage.

Figure 2: A 57-year-old male with esophageal squamous cell carcinoma. (A) Transverse TSE-BLADE (B) Transverse contrast-enhanced StarVIBE images (C) sagittal reconstructed T2-TSE-BLADE show tumor invades adjacent fat (thin arrow) with MRI, and normal muscularis propria with low signal was noted (thick arrow): T4a staging. (D,E) EUS shows tumor invading adventitia resulting in blurred margin and consistent with T4 staging. (E) H&E stained section at ×40 microscopy confirms that the tumor invades adventitia with T4A stage

Proc. Intl. Soc. Mag. Reson. Med. 25 (2017)
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