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Manning MA, Shafa S, Mehrotra AK, Grenier RE, Levy AD. Role of Multimodality Imaging in Gastroesophageal Reflux Disease and Its Complications, with Clinical and Pathologic Correlation. Radiographics 2021; 40:44-71. [PMID: 31917657 DOI: 10.1148/rg.2020190029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common condition and impairs the quality of life for millions of patients, accounts for considerable health care spending, and is a primary risk factor for esophageal adenocarcinoma. There have been substantial advances in understanding the pathogenesis of GERD and its complications and much progress in diagnosis and management of GERD; however, these have not been comprehensively discussed in the recent radiology literature. Understanding the role of imaging in GERD and its complications is important to aid in multidisciplinary treatment of GERD. GERD results from prolonged or recurrent reflux of gastric contents into the esophagus. Common symptoms include heartburn or regurgitation. Prolonged reflux of gastric contents into the esophagus can cause erosive esophagitis. Over time, the inflammatory response related to esophagitis can lead to deposition of fibrous tissue and development of strictures. Alternatively, the esophageal mucosa can undergo metaplasia (Barrett esophagus), a precursor to dysplasia (which can lead to adenocarcinoma). Conventional barium esophagography has long been considered the primary imaging modality for the esophagus, and the fluoroscopic findings for diagnosis of GERD have been well established. Multimodality imaging has a clear role in detection and assessment of the complications of GERD, specifically reflux esophagitis and Barrett esophagus; differentiation of benign and malignant strictures; and detection, staging, and posttreatment surveillance of esophageal adenocarcinoma. Given the dramatic changes in utilization of abdominal imaging during the past 2 decades, with significantly declining volume of fluoroscopic procedures and concomitant increase in CT and MRI studies, it is crucial that modern radiologists appreciate the value of barium esophagography in the workup of GERD and recognize the key imaging features of GERD and its complications at CT and MRI.
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Affiliation(s)
- Maria A Manning
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (M.A.M.); Department of Radiology (M.A.M., A.D.L.) and Division of Gastroenterology and Hepatology (S.S.), MedStar Georgetown University Hospital, Washington, DC; the Joint Pathology Center, Silver Spring, Md (A.K.M.); and Georgetown University School of Medicine, Washington, DC (R.E.G.)
| | - Shervin Shafa
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (M.A.M.); Department of Radiology (M.A.M., A.D.L.) and Division of Gastroenterology and Hepatology (S.S.), MedStar Georgetown University Hospital, Washington, DC; the Joint Pathology Center, Silver Spring, Md (A.K.M.); and Georgetown University School of Medicine, Washington, DC (R.E.G.)
| | - Anupamjit K Mehrotra
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (M.A.M.); Department of Radiology (M.A.M., A.D.L.) and Division of Gastroenterology and Hepatology (S.S.), MedStar Georgetown University Hospital, Washington, DC; the Joint Pathology Center, Silver Spring, Md (A.K.M.); and Georgetown University School of Medicine, Washington, DC (R.E.G.)
| | - Rachel E Grenier
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (M.A.M.); Department of Radiology (M.A.M., A.D.L.) and Division of Gastroenterology and Hepatology (S.S.), MedStar Georgetown University Hospital, Washington, DC; the Joint Pathology Center, Silver Spring, Md (A.K.M.); and Georgetown University School of Medicine, Washington, DC (R.E.G.)
| | - Angela D Levy
- From the American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (M.A.M.); Department of Radiology (M.A.M., A.D.L.) and Division of Gastroenterology and Hepatology (S.S.), MedStar Georgetown University Hospital, Washington, DC; the Joint Pathology Center, Silver Spring, Md (A.K.M.); and Georgetown University School of Medicine, Washington, DC (R.E.G.)
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Elsherif SB, Andreou S, Virarkar M, Soule E, Gopireddy DR, Bhosale PR, Lall C. Role of precision imaging in esophageal cancer. J Thorac Dis 2020; 12:5159-5176. [PMID: 33145093 PMCID: PMC7578477 DOI: 10.21037/jtd.2019.08.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Esophageal cancer is a major cause of morbidity and mortality worldwide. Recent advancements in the management of esophageal cancer have allowed for earlier detection, improved ability to monitor progression, and superior treatment options. These innovations allow treatment teams to formulate more customized management plans and have led to an increase in patient survival rates. For example, in order for the most effective management plan to be constructed, accurate staging must be performed to determine tumor resectability. This article reviews the multimodality imaging approach involved in making a diagnosis, staging, evaluating treatment response and detecting recurrence in esophageal cancer.
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Affiliation(s)
- Sherif B Elsherif
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA.,Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sonia Andreou
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mayur Virarkar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik Soule
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - Priya R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
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Lee JE, Kim YH, Shin HH, Jeong WG, Na KJ. The Diagnostic Utility of Prone Position Chest CT for the Evaluation of Esophageal Cancer. Chonnam Med J 2020; 56:68-74. [PMID: 32021845 PMCID: PMC6976766 DOI: 10.4068/cmj.2020.56.1.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to assess the potential of a prone chest CT for the evaluation of esophageal cancer, as compared with a routine supine chest CT. 69 patients (67±18 years old) with pathologically confirmed esophageal cancers underwent MDCT in the supine and prone positions. The supine CT was performed first, followed by the prone position. Localization and staging of individual esophageal lesions on both the prone and supine CTs were assessed by two thoracic radiologists, using a scoring system that consisted of three confidence scales, and the results were correlated with the endoscopic and surgical findings. The mean confidence score for the detection of esophageal cancer was higher in the prone position (2.58±0.74) than that in the supine position (2.42±0.83) with statistical significance (p=0.002). The mean confidence score for predicting local invasion in the selected patients (n=18) who underwent esophagectomy was also higher in the prone position (2.39±0.85) than that in the supine position (2.06±0.73) with statistical significance (p=0.01). In 10 of 11 cases that showed definitive determination for periesophageal infiltration or adjacent organ invasion on the prone CT (score 3), the corresponding findings were also observed in the post-operative evaluations. In conclusion, prone chest CT for evaluating esophageal cancer could have advantages in regards to the localization of esophageal cancer and predicting local invasion compared to that of routine supine CT and can improve the diagnostic accuracy of chest CTs.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.,Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Hyun Shin
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kook Ju Na
- Department of Cardiothoracic Surgery, Chonnam National University Medical School, Gwangju, Korea
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Cai H, Wang R, Li Y, Yang X, Cui Y. Role of 3D reconstruction in the evaluation of patients with lower segment oesophageal cancer. J Thorac Dis 2018; 10:3940-3947. [PMID: 30174835 DOI: 10.21037/jtd.2018.06.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional (3D) reconstruction has been used in evaluating the lungs and liver, but there is only little research on the application of 3D reconstruction for the oesophagus. This research aims to study the application of 3D reconstruction in patients with lower segment oesophageal tumours to improve the diagnosis and treatment of oesophageal cancer and to provide a better method of preoperative assessment. Methods All the patients were treated at the First Hospital of Jilin University between January 2014 and August 2015 for oesophageal cancer. We collected the patients' imaging data and used surface reconstruction technology to reconstruct their oesophageal tumours and adjacent structures. Tumour shape and other specific parameters were analysed and calculated, and comparisons of the results from different conditions of 3D reconstruction were made. IBM SPSS 19.0 was used to analyse all the data. All the data were averaged over three measurements. The t-test was used to compare the mean of the two groups, and variance analysis was used among the groups, where P<0.05 indicated a significant difference. Results Of the 72 patients, there were 48 cases in which a gastroscope was able to pass through the oesophageal lesion and 24 cases where this was not possible. The location of the lesion ranged from 30 to 42 cm among those 48 cases. The endoscopic measurement length and the 3D length were both longer than the pathological length (P<0.05), but there was no significant difference between the endoscopic measurement length and the 3D length. In the reconstructed data of positive lymph nodes, the length, diameter, volume, CT value and reconstruction of the lymph nodes in the negative group were significantly different compared with the positive group. Conclusions The application of 3D reconstruction in oesophageal cancer is safe and effective. 3D reconstruction plays an important role in preoperative evaluation of tumours and the surrounding lymph nodes and may be useful for evaluation of the long-term efficacy of radiotherapy and chemotherapy for oesophageal cancer.
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Affiliation(s)
- Hongfei Cai
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun 130021, China
| | - Rui Wang
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun 130021, China
| | - Yang Li
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun 130021, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun 130021, China
| | - Youbin Cui
- Department of Thoracic Surgery, the First Hospital of Jilin University, Changchun 130021, China
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Loco-regional staging accuracy in oesophageal cancer—How good are we in the modern era? Eur J Radiol 2017; 97:71-75. [DOI: 10.1016/j.ejrad.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 12/25/2022]
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Abstract
The value of 18F-FDG PET/CT in the initial diagnosis and in the locoregional staging of esophagogastric junction adenocarcinoma is not fully established. However, 18F-FDG PET/CT is widely accepted as the best modality for identification of suspected metastases in staging of the disease. Results published in the literature suggest that 18F-FDG PET/CT may provide useful information for response assessment to neoadjuvancy and to differentiate responding and nonresponding tumors. We review the potential role of 18F-FDG PET/CT imaging in staging, restaging, and prognostic value after chemoradiation therapy in esophagogastric junction adenocarcinoma.
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Ringe KI, Meyer S, Ringe BP, Winkler M, Wacker F, Raatschen HJ. Value of oral effervescent powder administration for multidetector CT evaluation of esophageal cancer. Eur J Radiol 2014; 84:215-20. [PMID: 25497235 DOI: 10.1016/j.ejrad.2014.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/20/2014] [Accepted: 11/09/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the value of oral effervescent powder (EP) for evaluation of esophageal distension, and for detection and staging of esophageal cancer with contrast-enhanced CT. MATERIALS AND METHODS 84 patients without esophageal pathology and 52 patients with histological confirmed diagnosis of esophageal cancer were included in this prospective IRB-approved study. Half of the patients in both groups received EP prior to CT. Esophageal distension was assessed by planimetry of the inner (IA) and outer area (OA). Two blinded readers evaluated the datasets separately with regard to diagnosis of esophageal cancer (yes/no) and staging (T0-T4), if applicable. Distension results were compared (t-Test). In patients with cancer sensitivity, specificity, NPV and PPV were calculated. CT staging results were compared to histopathology (Cohen-k). RESULTS IA and IA/OA were significantly larger after EP as compared to the group without EP (p<0.05). Sensitivity, specificity, NPV and PPV for cancer detection cancer were as follows: 78%/78%, 98%/98%, 95%/95%, 87%/87% with EP; 60%/68%, 98%/98%, 94%/94%, 80%/83% without EP. Staging with EP was good (k=0.84/0.67) and moderate without EP (k=0.58/0.59). CONCLUSIONS Administration of EP prior to CT results in good distension of the esophagus, and improves detection and staging of esophageal cancer, as compared to control studies without EP.
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Affiliation(s)
- Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Simone Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Bastian P Ringe
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Michael Winkler
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
| | - Hans-Juergen Raatschen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
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Rodríguez Carnero P, Herrasti Gallego A, García Villafañe C, Méndez Fernández R, Rodríguez González R. Multislice computed tomography for the study of complications of gastric fundoplication. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shin KE, Lee KS, Choi JY, Kim HK, Shim YM. Esophageal malignancy and staging. Semin Roentgenol 2014; 48:344-53. [PMID: 24034266 DOI: 10.1053/j.ro.2013.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Kyung Eun Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Khil EK, Lee H, Her K. Spontaneous intramural full-length dissection of esophagus treated with surgical intervention: multidetector CT diagnosis with multiplanar reformations and virtual endoscopic display. Korean J Radiol 2014; 15:173-7. [PMID: 24497810 PMCID: PMC3909853 DOI: 10.3348/kjr.2014.15.1.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/21/2013] [Indexed: 12/02/2022] Open
Abstract
Intramural esophageal dissection (IED) is an uncommon disorder characterized by separation of the mucosal and submucosal layers of the esophagus. Iatrogenic intervention is the most common cause of IED, but spontaneous dissection is rare. We report an unusually complicated case of spontaneous IED that involved the full-length of the esophagus that necessitated surgical intervention due to infection of the false lumen. In this case, chest computed tomography successfully established the diagnosis and aided in pre-operative evaluation with the use of various image post-processing techniques.
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Affiliation(s)
- Eun Kyung Khil
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Hospital Bucheon, Bucheon 420-767, Korea
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Multislice computed tomography for the study of complications of gastric fundoplication. RADIOLOGIA 2012; 56:435-9. [PMID: 23141300 DOI: 10.1016/j.rx.2012.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 06/04/2012] [Accepted: 06/24/2012] [Indexed: 11/23/2022]
Abstract
The traditional approach to the imaging evaluation of patients after gastric fundoplication is an upper gastrointestinal series obtained by fluoroscopy. In this article, we describe a new technique using multislice computed tomography that we think can be useful to evaluate patients with suspected complications or late failure after gastric fundoplication.
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Park HA, Kim JW, Park HM. Characteristics of esophageal diverticula using computed tomography and three-dimensional reconstruction in a Maltese dog. J Vet Med Sci 2012; 74:1233-6. [PMID: 22673702 DOI: 10.1292/jvms.11-0546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 7-year-old intact female Maltese dog was referred with ptyalism and intermittent vomiting but no regurgitation for over 1 month. Survey radiographs including a contrast study revealed a large circular dilated cavity from the carina to the diaphragm. Additionally, multi-detector computed tomography and three-dimensional reconstruction were performed. These images revealed large idiopathic distal esophageal diverticula. This case report represents the first report using multi-detector computed tomography and three-dimensional reconstruction for evaluation of esophageal diverticula in a dog.
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Affiliation(s)
- Hyun-Ah Park
- BK 21 Basic & Diagnostic Veterinary Specialist Program for Animal Diseases and Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 143-701, South Korea
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Meijerink MR, van Waesberghe JHTM, Golding RP, van der Weide L, van den Tol P, Meijer S, van Kuijk C. Subtraction-multiphase-CT unbeneficial for early detection of colorectal liver metastases. Eur J Radiol 2009; 74:e132-7. [PMID: 19515521 DOI: 10.1016/j.ejrad.2009.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 03/30/2009] [Accepted: 05/07/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of multiphase-subtraction-CT for early detection of colorectal-liver-metastases (CRLM). METHODS AND MATERIALS In 50 patients suspected of CRLM a routine pre-operative 4-phase-CT-scan of the upper abdomen was obtained. All 12 possible image subtractions between two different phases were constructed applying 3D-image-registration to decrease distortion artefacts induced by differences in inspiration volume. Two experienced radiologists initially reviewed the conventional 4-phase-CT for malignant and/or benign appearing lesions and at least 1-month hereafter the same 4-phase-CT now including the subtracted images. The results were compared to histology reports or to a combination of surgical exploration and intraoperative ultrasound together with results from pre-operative PET and follow-up examinations. RESULTS Although an additional number of 31 malignant appearing lesions were detected on the subtraction images, none proved to represent a true CRLM. Interobserver agreement (kappa) decreased from 0.627 (good) to 0.418 (fair). CONCLUSION Adding linearly co-registered subtraction-CT images to a conventional 4-phase-CT protocol does not improve detection of CRLM.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands.
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Ba-Ssalamah A, Zacherl J, Noebauer-Huhmann IM, Uffmann M, Matzek WK, Pinker K, Herold C, Schima W. Dedicated multi-detector CT of the esophagus: spectrum of diseases. ACTA ACUST UNITED AC 2009; 34:3-18. [PMID: 17653787 DOI: 10.1007/s00261-007-9290-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Multi-detector computed tomography (CT) offers new opportunities in the imaging of the gastrointestinal tract. Its ability to cover a large volume in a very short scan time, and in a single breath hold with thin collimation and isotropic voxels, allows the imaging of the entire esophagus with high-quality multiplanar reformation and 3D reconstruction. Proper distention of the esophagus and stomach (by oral administration of effervescent granules and water) and optimally timed administration of intravenous contrast material are required to detect and characterize disease. In contrast to endoscopy and double-contrast studies of the upper GI tract, CT provides information about both the esophageal wall and the extramural extent of disease. Preoperative staging of esophageal carcinoma appears to be the main indication for MDCT. In addition, MDCT allows detection of other esophageal malignancies, such as lymphoma and benign esophageal tumors, such as leiomyma. A diagnosis of rupture or fistula of the esophagus can be firmly established using MDCT. Furthermore, miscellaneous esophageal conditions, such as achalasia, esophagitis, diverticula, and varices, are incidental findings and can also be visualized with hydro-multi-detector CT. Multi-detector CT is a valuable tool for the evaluation of esophageal wall disease and serves as an adjunct to endoscopy.
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Affiliation(s)
- Ahmed Ba-Ssalamah
- Department of Radiology, Medical University of Vienna, Waehringer Guertel, Vienna, Austria.
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Esophageal stenosis: three-dimensional multidetector CT and virtual endoscopy. ACTA ACUST UNITED AC 2008; 34:19-25. [DOI: 10.1007/s00261-008-9435-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Restrepo CS, Lemos DF, Ocazionez D, Moncada R, Gimenez CR. Intramural hematoma of the esophagus: a pictorial essay. Emerg Radiol 2007; 15:13-22. [PMID: 17952475 DOI: 10.1007/s10140-007-0675-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 09/20/2007] [Indexed: 12/22/2022]
Abstract
Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Computed tomography (CT) is the imaging modality of choice and characteristically reveals a concentric or eccentric thickening of the esophageal wall with well-defined borders and variable degree of obliteration of the lumen. Measurement of the attenuation values within the lesion will reveal blood density which varies according to the age of the hematoma. CT should be considered the preferred diagnostic technique, thereby facilitating proper clinical management. Early diagnosis is crucial as most patients may be treated conservatively with good outcome.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Holzapfel K, Rummeny EJ, Hannig C, Beer AJ. [MSCT for staging and response evaluation of esophageal cancer]. Radiologe 2007; 47:101-9. [PMID: 17225186 DOI: 10.1007/s00117-006-1455-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Squamous cell carcinomas and adenocarcinomas account for the majority of cases of esophageal cancer. Esophageal cancer often is diagnosed in advanced stages as clinical symptoms are lacking in early stages. The major aims of imaging in esophageal cancer are to determine local tumor extension (T and N staging), to rule out systemic disease (M staging), and to assess response to neoadjuvant therapy (response evaluation). CT is still inferior to endoscopic ultrasound in differentiating T stages and detecting regional lymph node metastases. However, it plays a central role in determining infiltration into adjacent organs (T4 stage) and in ruling out distant metastases. Multislice-CT (MSCT) offers the possibility of reconstructions, which often help to assess the relationship between tumor and anatomic landmarks like the tracheobronchial tree or the diaphragm. First results of CT volumetry for response evaluation are promising; however, PET and PET/CT with the glucose analogue FDG are the standard methods to evaluate response to neoadjuvant therapy.
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Affiliation(s)
- K Holzapfel
- Institut für Röntgendiagnostik, Klinikum rechts der Isar, TU München.
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