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Qu J, Wang Z, Zhang H, Lu Y, Jia Z, Lu S, Zhao K, Chu F, Bai B, Zheng Y, Xia Q, Li X, Wang S, Kamel IR. How to update esophageal masses imaging using literature review (MRI and CT features). Insights Imaging 2024; 15:169. [PMID: 38971944 DOI: 10.1186/s13244-024-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 06/16/2024] [Indexed: 07/08/2024] Open
Abstract
MRI offers new opportunities for detailed visualization of the different layers of the esophageal wall, as well as early detection and accurate characterization of esophageal lesions. Staging of esophageal tumors including extramural extent of disease, and status of the adjacent organ can also be performed by MRI with higher accuracy compared to other imaging modalities including CT and esophageal endoscopy. Although MDCT appears to be the primary imaging modality that is indicated for preoperative staging of esophageal cancer to assess tumor resectability, MDCT is considered less accurate in T staging. This review aims to update radiologists about emerging imaging techniques and the imaging features of various esophageal masses, emphasizing the imaging features that differentiate between esophageal masses, demonstrating the critical role of MRI in esophageal masses. CRITICAL RELEVANCE STATEMENT: MRI features may help differentiate mucosal high-grade neoplasia from early invasive squamous cell cancer of the esophagus, also esophageal GISTs from leiomyomas, and esophageal malignant melanoma has typical MR features. KEY POINTS: MRI can accurately visualize different layers of the esophagus potentially has a role in T staging. MR may accurately delineate esophageal fistulae, especially small mediastinal fistulae. MRI features of various esophageal masses are helpful in the differentiation.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China.
| | - Zhaoqi Wang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Hongkai Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Yanan Lu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Zhengyan Jia
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Shuang Lu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Keke Zhao
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Funing Chu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Bingmei Bai
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Yan Zheng
- Department of Thoracic surgery, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Qingxin Xia
- Department of Pathology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Xu Li
- Department of Pathology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, 450008, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
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Bai B, Cui L, Chu F, Wang Z, Zhao K, Wang S, Wang S, Yan X, Wang M, Kamel IR, Yang G, Qu J. Multiple diffusion models for predicting pathologic response of esophageal squamous cell carcinoma to neoadjuvant chemotherapy. Abdom Radiol (NY) 2024:10.1007/s00261-024-04474-7. [PMID: 38954001 DOI: 10.1007/s00261-024-04474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND To assess the feasibility and diagnostic performance of the fractional order calculus (FROC), continuous-time random-walk (CTRW), diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), mono-exponential (MEM) and stretched exponential models (SEM) for predicting response to neoadjuvant chemotherapy (NACT) in patients with esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS This study prospectively included consecutive ESCC patients with baseline and follow up MR imaging and pathologically confirmed cT1-4aN + M0 or T3-4aN0M0 and underwent radical resection after neoadjuvant chemotherapy (NACT) between July 2019 and January 2023. Patients were divided into pCR (TRG 0) and non-pCR (TRG1 + 2 + 3) groups according to tumor regression grading (TRG). The Pre-, Post- and Delta-treatment models were built. 18 predictive models were generated according to different feature categories, based on six models by five-fold cross-validation. Areas under the curve (AUCs) of the models were compared by using DeLong method. RESULTS Overall, 90 patients (71 men, 19 women; mean age, 64 years ± 6 [SD]) received NACT and underwent baseline and Post-NACT esophageal MRI, with 29 patients in the pCR group and 61 patients in the non-pCR group. Among 18 predictive models, The Pre-, Post-, and Delta-CTRW model showed good predictive efficacy (AUC = 0.722, 0.833 and 0.790). Additionally, the Post-FROC model (AUC = 0.907) also exhibited good diagnostic performance. CONCLUSIONS Our study indicates that the CTRW model, along with the Post-FROC model, holds significant promise for the future of NACT efficacy prediction in ESCC patients.
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Affiliation(s)
- Bingmei Bai
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Long Cui
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Funing Chu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Zhaoqi Wang
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Keke Zhao
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shuting Wang
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Mengzhu Wang
- MR Research Collaboration, Siemens Healthineers Ltd, Beijing, 100000, China
| | - Ihab R Kamel
- Department of Radiology, Anschutz Medical Campus, University of Colorado Denver, 12401 East 17Th Avenue, Aurora, CO, 80045, USA
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Jinrong Qu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China.
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Ruby L, Jayaprakasam VS, Fernandes MC, Paroder V. Advances in the Imaging of Esophageal and Gastroesophageal Junction Malignancies. Hematol Oncol Clin North Am 2024; 38:711-730. [PMID: 38575457 DOI: 10.1016/j.hoc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Accurate imaging is key for the diagnosis and treatment of esophageal and gastroesophageal junction cancers . Current imaging modalities, such as computed tomography (CT) and 18F-FDG (2-deoxy-2-[18F]fluoro-D-glucose) positron emission tomography (PET)/CT, have limitations in accurately staging these cancers. MRI shows promise for T staging and residual disease assessment. Novel PET tracers, like FAPI, FLT, and hypoxia markers, offer potential improvements in diagnostic accuracy. 18F-FDG PET/MRI combines metabolic and anatomic information, enhancing disease evaluation. Radiomics and artificial intelligence hold promise for early detection, treatment planning, and response assessment. Theranostic nanoparticles and personalized medicine approaches offer new avenues for cancer therapy.
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Affiliation(s)
- Lisa Ruby
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Xu YH, Lu P, Gao MC, Wang R, Li YY, Guo RQ, Zhang WS, Song JX. Nomogram based on multimodal magnetic resonance combined with B7-H3mRNA for preoperative lymph node prediction in esophagus cancer. World J Clin Oncol 2024; 15:419-433. [PMID: 38576593 PMCID: PMC10989267 DOI: 10.5306/wjco.v15.i3.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Accurate preoperative prediction of lymph node metastasis (LNM) in esophageal cancer (EC) patients is of crucial clinical significance for treatment planning and prognosis. AIM To develop a clinical radiomics nomogram that can predict the preoperative lymph node (LN) status in EC patients. METHODS A total of 32 EC patients confirmed by clinical pathology (who underwent surgical treatment) were included. Real-time fluorescent quantitative reverse transcription-polymerase chain reaction was used to detect the expression of B7-H3 mRNA in EC tissue obtained during preoperative gastroscopy, and its correlation with LNM was analyzed. Radiomics features were extracted from multi-modal magnetic resonance imaging of EC using Pyradiomics in Python. Feature extraction, data dimensionality reduction, and feature selection were performed using XGBoost model and leave-one-out cross-validation. Multivariable logistic regression analysis was used to establish the prediction model, which included radiomics features, LN status from computed tomography (CT) reports, and B7-H3 mRNA expression, represented by a radiomics nomogram. Receiver operating characteristic area under the curve (AUC) and decision curve analysis (DCA) were used to evaluate the predictive performance and clinical application value of the model. RESULTS The relative expression of B7-H3 mRNA in EC patients with LNM was higher than in those without metastasis, and the difference was statistically significant (P < 0.05). The AUC value in the receiver operating characteristic (ROC) curve was 0.718 (95%CI: 0.528-0.907), with a sensitivity of 0.733 and specificity of 0.706, indicating good diagnostic performance. The individualized clinical prediction nomogram included radiomics features, LN status from CT reports, and B7-H3 mRNA expression. The ROC curve demonstrated good diagnostic value, with an AUC value of 0.765 (95%CI: 0.598-0.931), sensitivity of 0.800, and specificity of 0.706. DCA indicated the practical value of the radiomics nomogram in clinical practice. CONCLUSION This study developed a radiomics nomogram that includes radiomics features, LN status from CT reports, and B7-H3 mRNA expression, enabling convenient preoperative individualized prediction of LNM in EC patients.
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Affiliation(s)
- Yan-Han Xu
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Peng Lu
- Department of Imaging, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Ming-Cheng Gao
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Rui Wang
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Yang-Yang Li
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Rong-Qi Guo
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Wei-Song Zhang
- School of Clinical Sciences, Graduate School of Nantong University, Yancheng 226019, Jiangsu Province, China
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Jian-Xiang Song
- Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
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Wang Z, Chu F, Bai B, Lu S, Zhang H, Jia Z, Zhao K, Zhang Y, Zheng Y, Xia Q, Li X, Kamel IR, Li H, Qu J. MR imaging characteristics of different pathologic subtypes of esophageal carcinoma. Eur Radiol 2023; 33:9233-9243. [PMID: 37482548 DOI: 10.1007/s00330-023-09941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To describe the specific MRI characteristics of different pathologic subtypes of esophageal carcinoma (EC) METHODS: This prospective study included EC patients who underwent esophageal MRI and esophagectomy between April 2015 and October 2021. Pathomorphological characteristics of EC such as localized type (LT), ulcerative type (UT), protruding type (PT), and infiltrative type (IT) were assessed by two radiologists relying on the imaging characteristics of tumor, especially the specific imaging findings on the continuity of the mucosa overlying the tumor, the opposing mucosa, mucosa linear thickening, and transmural growth pattern. Intraclass correlation coefficients (ICC) were calculated for the consistency between two readers. The associations of imaging characteristics with different pathologic subtypes were assessed using multilogistic regression model (MLR). RESULTS A total of 201 patients were identified on histopathology with a high inter-reader agreement (ICC = 0.991). LT showed intact mucosa overlying the tumor. IT showed transmural growth pattern extending from the mucosa to the adventitia and a "sandwich" appearance. The remaining normal mucosa on the opposing side was linear and nodular in UT. PT showed correlation with T1 staging and grade 1; IT showed correlation with T3 staging and grades 2-3. Four MLR models showed high predictive performance on the test set with AUCs of 0.94 (LT), 0.87 (PT), 0.96 (IT), and 0.97 (UT), respectively, and the predictors that contributed most to the models matched the four specific characteristics. CONCLUSIONS Different pathologic subtypes of EC displayed specific MR imaging characteristics, which could help predict T staging and the degree of pathological differentiation. CLINICAL RELEVANCE STATEMENT Different pathologic subtypes of esophageal carcinoma displayed specific MR imaging characteristics, which correspond to differences in the degree of differentiation, T staging, and sensitivity to radiotherapy, and could also be one of the predictive factors of cause-specific survival and local progression-free rates. KEY POINTS Different types of EC had different characteristics on MR images. A total of 91/95 (96%) LTEC showed intact mucosa over the tumor, while masses or nodules are specific to PTEC; 21/27 (78%) ITEC showed a "sandwich" sign; and 33/35 (60%) UTEC showed linear and nodular opposing mucosa. In the association of tumor type with degree of differentiation and T staging, PTEC was predominantly associated with T1 and grade 1, and ITEC was associated with T3 and grades 2-3, while LTEC and UECT were likewise primarily linked with T2-3 and grades 2-3.
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Affiliation(s)
- Zhaoqi Wang
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Funing Chu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Bingmei Bai
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shuang Lu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Hongkai Zhang
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Zhengyan Jia
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Keke Zhao
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yudong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China
| | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Qingxin Xia
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xu Li
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205-2196, USA
| | - Hailiang Li
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Jinrong Qu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No.127 Dongming Road, Zhengzhou, 450008, Henan, China.
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Xu YH, Lu P, Gao MC, Wang R, Li YY, Song JX. Progress of magnetic resonance imaging radiomics in preoperative lymph node diagnosis of esophageal cancer. World J Radiol 2023; 15:216-225. [PMID: 37545645 PMCID: PMC10401402 DOI: 10.4329/wjr.v15.i7.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/11/2023] [Accepted: 06/30/2023] [Indexed: 07/24/2023] Open
Abstract
Esophageal cancer, also referred to as esophagus cancer, is a prevalent disease in the cardiothoracic field and is a leading cause of cancer-related mortality in China. Accurately determining the status of lymph nodes is crucial for developing treatment plans, defining the scope of intraoperative lymph node dissection, and ascertaining the prognosis of patients with esophageal cancer. Recent advances in diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging (MRI) have improved the effectiveness of MRI for assessing lymph node involvement, making it a beneficial tool for guiding personalized treatment plans for patients with esophageal cancer in a clinical setting. Radiomics is a recently developed imaging technique that transforms radiological image data from regions of interest into high-dimensional feature data that can be analyzed. The features, such as shape, texture, and waveform, are associated with the cancer phenotype and tumor microenvironment. When these features correlate with the clinical disease outcomes, they form the basis for specific and reliable clinical evidence. This study aimed to review the potential clinical applications of MRI-based radiomics in studying the lymph nodes affected by esophageal cancer. The combination of MRI and radiomics is a powerful tool for diagnosing and treating esophageal cancer, enabling a more personalized and effectual approach.
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Affiliation(s)
- Yan-Han Xu
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Peng Lu
- Department of Imaging, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Ming-Cheng Gao
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Rui Wang
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Yang-Yang Li
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
| | - Jian-Xiang Song
- Department of Thoracic Surgery, Yancheng Third People's Hospital, Affiliated Hospital 6 of Nantong University, Yancheng 224000, Jiangsu Province, China
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Raptis CA, Goldstein A, Henry TS, Porter KK, Catenacci D, Kelly AM, Kuzniewski CT, Lai AR, Lee E, Long JM, Martin MD, Morris MF, Sandler KL, Sirajuddin A, Surasi DS, Wallace GW, Kamel IR, Donnelly EF. ACR Appropriateness Criteria® Staging and Follow-Up of Esophageal Cancer. J Am Coll Radiol 2022; 19:S462-S472. [PMID: 36436970 DOI: 10.1016/j.jacr.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document provides recommendations regarding the role of imaging in the staging and follow-up of esophageal cancer. For initial clinical staging, locoregional extent and nodal disease are typically assessed with esophagogastroduodenoscopy and esophageal ultrasound. FDG-PET/CT or CT of the chest and abdomen is usually appropriate for use in initial clinical staging as they provide additional information regarding distant nodal and metastatic disease. The detection of metastatic disease is critical in the initial evaluation of patients with esophageal cancer because it will direct patients to a treatment pathway centered on palliative radiation rather than surgery. For imaging during treatment, particularly neoadjuvant chemotherapy, FDG-PET/CT is usually appropriate, because some studies have found that it can provide information regarding primary lesion response, but more importantly it can be used to detect metastases that have developed since the induction of treatment. For patients who have completed treatment, FDG-PET/CT or CT of the chest and abdomen is usually appropriate for evaluating the presence and extent of metastases in patients with no suspected or known recurrence and in those with a suspected or known recurrence. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Alan Goldstein
- Division Chief, Abdominal Imaging, Director of CT Colonography, UMass Medical School, Worcester, Massachusetts
| | - Travis S Henry
- Panel Chair; Division Chief of Cardiothoracic Imaging, Duke University, Durham, North Carolina; Co-Director, ACR Education Center HRCT Course
| | - Kristin K Porter
- Panel Chair, University of Alabama Medical Center, Birmingham, Alabama; ACR Council Steering Committee
| | - Daniel Catenacci
- The University of Chicago, Chicago, Illinois; American Society of Clinical Oncology
| | - Aine Marie Kelly
- Assistant Program Director Radiology Residency, Emory University Hospital, Atlanta, Georgia
| | | | - Andrew R Lai
- Hospitalist; University of California San Francisco (UCSF), San Francisco, California; Former Director of the UCSF Hospitalist Procedure Service; Former Director of the UCSF Division of Hospital Medicine's Case Review Committee; Former Director of Procedures/Quality Improvement Rotation for the UCSF Internal Medicine Residency
| | - Elizabeth Lee
- Director, M1 Radiology Education, University of Michigan Medical School; Associate Program Director, Diagnostic Radiology, Michigan Medicine; Director of Residency Education Cardiothoracic Division, Michigan Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Jason M Long
- Director of Robotic Thoracic Surgery, Director of Lung Cancer Screening, University of North Carolina Hospital, Chapel Hill, North Carolina; The Society of Thoracic Surgeons
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Michael F Morris
- Director of Cardiac CT and MRI, University of Arizona College of Medicine, Phoenix, Arizona
| | - Kim L Sandler
- Co-Director Vanderbilt Lung Screening Program, Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair, Thoracic Committee, ECOG-ACRIN; Co-Chair, Lung Screening 2.0 Steering Committee
| | | | - Devaki Shilpa Surasi
- Patient Safety and Quality Officer, Department of Nuclear Medicine, Chair-Elect, Junior Faculty Committee, The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Ihab R Kamel
- Specialty Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edwin F Donnelly
- Specialty Chair; Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio
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Chen H, Wang X, Shao S, Zhang J, Tan X, Chen W. Value of EUS in determining infiltration depth of early carcinoma and associated precancerous lesions in the upper gastrointestinal tract. Endosc Ultrasound 2022; 11:503-510. [PMID: 36537388 PMCID: PMC9921983 DOI: 10.4103/eus-d-21-00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Objective The objective is to evaluate the value of EUS in the determination of infiltration depth of early carcinoma and precancerous lesions in the upper gastrointestinal tract and to analyze the various factors affecting the accuracy of EUS. Methods One hundred and sixty-three patients diagnosed with early gastric cancer or early esophageal cancer, and associated precancerous lesions, who were seen in our hospital in the recent 10 years were selected. These patients received EUS before endoscopic submucosal dissection or surgery. With a pathological diagnosis as the gold standard, the accuracy, sensitivity, specificity, and misjudgment rate of EUS in determining the invasion depth were evaluated using the pathological stratification (mucosa, M1/2; muscularis mucosa, M3; submucosa, [SM]; and muscularis propria) or TN stratification (mucosa, T1a; SM, T1b), and the possible causes of miscalculation were analyzed. Results Based on the pathological stratification, the overall accuracy of EUS was 78.5%, and the overestimation and underestimation rates were 17.8% and 3.7%, respectively. Based on the TN stratification, the overall accuracy of EUS was 81%, and the overestimation and underestimation rates were 16.6% and 2.5%, respectively. There was a significant difference between the groups in terms of overestimation and underestimation rates (P < 0.05), indicating that EUS was more likely to overestimate the depth. Univariate analysis showed that the factors affecting accuracy included lesion size, macroscopic features, sunken mucosa, mucosa with granular and nodular changes, and ulceration. Multivariate logistic regression analysis revealed that larger lesions, mucosa with granular and nodular changes, and ulceration were independent risk factors for the overestimation of infiltration depth by EUS. Conclusion EUS is highly accurate in determining the infiltration depth of early cancer and precancerous lesions in the upper gastrointestinal tract. It also has a good reference value for treatment selection and prognostication. However, attention should be paid to its overestimation, especially accompanied by the aforementioned factors.
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Affiliation(s)
- Huizhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Xueping Wang
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Shenghui Shao
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Jian Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Xuejiao Tan
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Weigang Chen
- Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang Uygur Autonomous Region, China,Address for correspondence Dr. Weigang Chen, Department of Gastroenterology, The First Affiliated Hospital, Shihezi University School of Medicine, 107 North Second Road, Shihezi 832000, Xinjiang Uygur Autonomous Region, China. E-mail:
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Dynamic contrast-enhanced and diffusion-weighted MR imaging in early prediction of pathologic response to neoadjuvant chemotherapy in locally advanced gastric cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3394-3405. [PMID: 35916943 DOI: 10.1007/s00261-022-03623-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the efficacy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the early prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC). METHODS Fifty patients with LAGC who were treated with NAC followed by radical gastrectomy were enrolled. Uncontrasted and DCE-MRI were performed within 1 week before NAC. According to tumor regression grading (TRG), patients were labeled as responders (TRG = 0 + 1) and non-responders (TRG = 2 + 3). Apparent diffusion coefficients (ADC) and DCE-MRI kinetics (Ktrans, Ve, and Kep) were compared between the two groups. Logistic regression analysis was performed to screen independent factors to predict the NAC efficacy. The relationship between MRI parameters and TRG was studied by Spearman's correlation analysis. Receiver-operating characteristic curve analyses were applied to evaluate the efficacy. RESULTS ADC, Ktrans, and Kep values were higher in responders than in non-responders (p < 0.05) and correlated with TRG (p < 0.05). The ADC and Kep values were independent markers for predicting TRG. The area under the curve, sensitivities, specificities of ADC, Ktrans, Kep, and ADC + Kep were 0.813, 0.699, 0.709, 0.886;73.64%, 65.54%, 63.21%, 70.37%; 86.47%, 54.97%, 79.47%, 95.65%; respectively. ADC + Kep demonstrated a higher efficacy than Ktrans and Kep (p = 0.012, 0.011), but without improvement compared with ADC (p > 0.05). CONCLUSION Both DWI and DCE-MRI can effectively predict the pathologic response to NAC in LAGC. A combination of ADC and Kep increased the efficacy, and ADC is the most valuable imaging parameter.
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Withey SJ, Goh V, Foley KG. State-of-the-art imaging in oesophago-gastric cancer. Br J Radiol 2022; 95:20220410. [PMID: 35671095 PMCID: PMC10996959 DOI: 10.1259/bjr.20220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
Radiological investigations are essential in the management of oesophageal and gastro-oesophageal junction cancers. The current multimodal combination of CT, 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET/CT) and endoscopic ultrasound (EUS) has limitations, which hinders the prognostic and predictive information that can be used to guide optimum treatment decisions. Therefore, the development of improved imaging techniques is vital to improve patient management. This review describes the current evidence for state-of-the-art imaging techniques in oesophago-gastric cancer including high resolution MRI, diffusion-weighted MRI, dynamic contrast-enhanced MRI, whole-body MRI, perfusion CT, novel PET tracers, and integrated PET/MRI. These novel imaging techniques may help clinicians improve the diagnosis, staging, treatment planning, and response assessment of oesophago-gastric cancer.
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Affiliation(s)
- Samuel J Withey
- Department of Radiology, The Royal Marsden NHS Foundation
Trust, London,
UK
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering & Imaging
Sciences, King’s College London,
London, UK
- Department of Radiology, Guy’s and St Thomas’ NHS
Foundation Trust, London,
UK
| | - Kieran G Foley
- Division of Cancer & Genetics, School of Medicine, Cardiff
University, Wales,
UK
- Department of Radiology, Velindre Cancer Centre,
Cardiff, UK
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11
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Quantitative RECIST derived from multiparametric MRI in evaluating response of esophageal squamous cell carcinoma to neoadjuvant therapy. Eur Radiol 2022; 32:7295-7306. [PMID: 36048205 DOI: 10.1007/s00330-022-09111-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a quantitative Response Evaluation Criteria in Solid Tumors (qRECIST) for evaluating response to neoadjuvant therapy (nT) in ESCCs relying on multiparametric (mp) MRI. METHODS Patients with cT2-T4a/N0-N3/M0 ESCC undergoing pre-nT and post-nT esophageal mpMRI before radical resection were prospectively included. Images were reviewed by two experienced radiologists. qRECIST was redefined using four methods including conventional criterion (cRECIST) and three model-dependent RECIST relying on quantitative MRI measurements at pre-nT, post-nT, and delta pre-post nT, respectively. Pathological tumor regression grades (TRGs) were used as a reference standard. The rates of agreement between four qRECIST methods and TRGs were determined with a Cronbach's alpha test, area under the curve (AUC), and a diagnostic odds ratio meta-analysis. RESULTS Ninety-one patients were enrolled. All four methods revealed high inter-reader agreements between the two radiologists, with a Kappa coefficient of 0.96, 0.87, 0.88, and 0.97 for cRECIST, pre-nT RECIST, post-nT RECIST, and delta RECIST, respectively. Among them, delta RECIST achieved the highest overall agreement rate (67.0% [61/91]) with TRGs, followed by post-nT RECIST (63.8% [58/91]), cRECIST (61.5% [56/91]), and pre-nT RECIST (36.3% [33/91]). Especially, delta RECIST achieved the highest accuracy (97.8% [89/91]) in distinguishing responders from non-responders, with 97.3% (34/35) for responders and 98.2% (55/56) for non-responders. Post-nT RECIST achieved the highest accuracy (93.4% [85/91]) in distinguishing complete responders from non-pCRs, with 77.8% (11/18) for pCRs and 94.5% (69/73) for non-pCRs. CONCLUSION The qRECIST with mpMRI can assess treatment-induced changes and may be used for early prediction of response to nT in ESCC patients. KEY POINTS • Quantitative mpMRI can reliably assess tumor response, and delta RECIST model had the best performance in evaluating response to nT in ESCCs, with an AUC of 0.98, 0.95, 0.80, and 0.82 for predicting TRG0, TRG1, TRG2, and TRG3, respectively. • In distinguishing responders from non-responders, the rate of agreement between delta RECIST and pathology was 97.3% (34/35) for responders and 98.2% (55/56) for non-responders, resulting in an overall agreement rate of 97.8% (89/91). • In distinguishing pCRs from non-pCR, the rate of agreement between MRI and pathology was 77.8% (11/18) for pCRs and 94.5% (69/73) for non- pCRs, resulting in an overall agreement rate of 91.2% (83/91).
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12
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Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, van Hooft JE, Deprez PH, Dinis-Ribeiro M. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54:591-622. [PMID: 35523224 DOI: 10.1055/a-1811-7025] [Citation(s) in RCA: 187] [Impact Index Per Article: 93.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett's esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.
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Affiliation(s)
- Pedro Pimentel-Nunes
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Surgery and Physiology, Porto Faculty of Medicine, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, The Netherlands
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia and Western Clinical School, University of Sydney, Sydney, Australia
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Chu F, Liu Y, Liu Q, Li W, Jia Z, Wang C, Wang Z, Lu S, Li P, Zhang Y, Liao Y, Xu M, Yao X, Wang S, Liu C, Zhang H, Wang S, Yan X, Kamel IR, Sun H, Yang G, Zhang Y, Qu J. Development and validation of MRI-based radiomics signatures models for prediction of disease-free survival and overall survival in patients with esophageal squamous cell carcinoma. Eur Radiol 2022; 32:5930-5942. [PMID: 35384460 DOI: 10.1007/s00330-022-08776-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/21/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To develop and validate an optimal model based on the 1-mm-isotropic-3D contrast-enhanced StarVIBE MRI sequence combined with clinical risk factors for predicting survival in patients with esophageal squamous cell carcinoma (ESCC). METHODS Patients with ESCC at our institution from 2015 to 2017 participated in this retrospective study based on prospectively acquired data, and were randomly assigned to training and validation groups at a ratio of 7:3. Random survival forest (RSF) and variable hunting methods were used to screen for radiomics features and LASSO-Cox regression analysis was used to build three models, including clinical only, radiomics only and combined clinical and radiomics models, which were evaluated by concordance index (CI) and calibration curve. Nomograms and decision curve analysis (DCA) were used to display intuitive prediction information. RESULTS Seven radiomics features were selected from 434 patients, combined with clinical features that were statistically significant to construct the predictive models of disease-free survival (DFS) and overall survival (OS). The combined model showed the highest performance in both training and validation groups for predicting DFS ([CI], 0.714, 0.729) and OS ([CI], 0.730, 0.712). DCA showed that the net benefit of the combined model and of the clinical model is significantly greater than that of the radiomics model alone at different threshold probabilities. CONCLUSIONS We demonstrated that a combined predictive model based on MR Rad-S and clinical risk factors had better predictive efficacy than the radiomics models alone for patients with ESCC. KEY POINTS • Magnetic resonance-based radiomics features combined with clinical risk factors can predict survival in patients with ESCC. • The radiomics nomogram can be used clinically to predict patient recurrence, DFS, and OS. • Magnetic resonance imaging is highly reproducible in visualizing lesions and contouring the whole tumor.
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Affiliation(s)
- Funing Chu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yun Liu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Qiuping Liu
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Weijia Li
- Henan Province Institute for Medical Equipment Testing, Zhengzhou, Henan, 450000, People's Republic of China
| | - Zhengyan Jia
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Chenglong Wang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Zhaoqi Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shuang Lu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Ping Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yuanli Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yubo Liao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Mingzhe Xu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Xiaoqiang Yao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shuting Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Cuicui Liu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Xi'an, 710065, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
| | - Haibo Sun
- Department of Thoracic surgery, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Yudong Zhang
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu Province, 210029, China
| | - Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China.
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Shimada H, Fukagawa T, Haga Y, Okazumi S, Oba K. Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature. Ann Gastroenterol Surg 2021; 5:404-418. [PMID: 34337289 PMCID: PMC8316742 DOI: 10.1002/ags3.12444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Clinical staging is vital for selecting appropriate candidates and designing neoadjuvant treatment strategies for advanced tumors. The aim of this review was to evaluate diagnostic abilities of clinical TNM staging for gastrointestinal, gastrointestinal cancers. METHODS We conducted a systematic review of recent publications to evaluate the accuracy of diagnostic modalities on gastrointestinal cancers. A systematic literature search was performed in PubMed/MEDLINE using the keywords "TNM staging," "T4 staging," "distant metastases," "esophageal cancer," "gastric cancer," and "colorectal cancer," and the search terms used in Cochrane Reviews between January 2005 to July 2020. Articles focusing on preoperative diagnosis of: (a) depth of invasion; (b) lymph node metastases; and (c) distant metastases were selected. RESULTS After a full-text search, a final set of 55 studies (17 esophageal cancer studies, 26 gastric cancer studies, and 12 colorectal cancer studies) were used to evaluate the accuracy of clinical TNM staging. Positron emission tomography-computed tomography (PET-CT) and/or magnetic resonance imaging (MRI) were the best modalities to assess distant metastases. Fat and fiber mode of CT may be useful for T4 staging of esophageal cancer, CT was a partially reliable modality for lymph node staging in gastric cancer, and CT combined with MRI was the most reliable modality for liver metastases from colorectal cancer. CONCLUSION The most reliable diagnostic modality differed among gastrointestinal cancers depending on the type of cancer. Therefore, we propose diagnostic algorithms for clinical staging for each type of cancer.
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Affiliation(s)
- Hideaki Shimada
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
| | - Takeo Fukagawa
- Department of SurgeryTeikyo University School of MedicineTokyoJapan
| | - Yoshio Haga
- Department of SurgeryJapan Community Healthcare Organization Amakusa Central General HospitalAmakusaJapan
| | - Shin‐ichi Okazumi
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Sakura Medical CenterSakuraJapan
| | - Koji Oba
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
- Interfaculty Initiative in Information StudiesGraduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
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Lee SL, Yadav P, Starekova J, Christensen L, Chandereng T, Chappell R, Reeder SB, Bassetti MF. Diagnostic Performance of MRI for Esophageal Carcinoma: A Systematic Review and Meta-Analysis. Radiology 2021; 299:583-594. [PMID: 33787334 DOI: 10.1148/radiol.2021202857] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Although CT, endoscopic US, and PET are critical in determining the appropriate management of esophageal carcinoma (squamous cell carcinoma and adenocarcinoma), previous reports show that staging accuracy remains low, particularly for nodal involvement sensitivity. Purpose To perform a systematic review and meta-analysis to determine the diagnostic performance of MRI for multiple staging thresholds in patients with biopsy-proven esophageal carcinoma (differentiation of stage T0 disease from stage T1 or higher disease, differentiation of stage T2 or lower disease from stage T3 or higher disease, and differentiation of stage N0 disease from stage N1 or higher disease [where T refers to tumor stage and N refers to nodal stage]). Materials and Methods Studies of the diagnostic performance of MRI in determining the stage of esophageal carcinoma in patients before esophagectomy and pathologic staging between 2000 and 2019 were searched in PubMed, Scopus, Web of Science, and Cochrane Library by a librarian and radiation oncologist. Pooled diagnostic performance of MRI was calculated with a bivariate random effects model. Bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2) tool. Results Twenty studies with a total of 984 patients were included in the analysis. Pooled accuracy for stage T0 versus stage T1 or higher had a sensitivity of 92% (95% CI: 82, 96) and a specificity of 67% (95% CI: 51, 81). Pooled accuracy for stage T2 or lower versus stage T3 or higher had a sensitivity of 86% (95% CI: 76, 92) and a specificity of 86% (95% CI: 75, 93). Pooled accuracy for stage N0 versus stage N1 or higher had a sensitivity of 71% (95% CI: 60, 80) and a specificity of 72% (95% CI: 64, 79). The concern for applicability was low for the patient selection, index test, and reference test domains, except for 10% of studies (two of 20) that had unclear concern for patient selection applicability. Conclusion MRI has high sensitivity but low specificity for the detection of esophageal carcinoma, which shows promise for determining neoadjuvant therapy response and for detecting locally advanced disease for potential trimodality therapy. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Leeflang in this issue.
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Affiliation(s)
- Sangjune Laurence Lee
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Poonam Yadav
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Jitka Starekova
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Leslie Christensen
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Thevaa Chandereng
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Richard Chappell
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Scott B Reeder
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
| | - Michael F Bassetti
- From the Department of Oncology, Division of Radiation Oncology, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2 (S.L.L.); Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.L.L., P.Y., M.F.B.); Department of Radiology, University of Wisconsin-Madison, Madison, Wis (J.S., S.B.R.); Departments of Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin-Madison, Madison, Wis (S.B.R); University of Wisconsin School of Medicine and Public Health, Madison, Wis (L.C.); Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wis (T.C., R.C.)
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Choi JY, Bae SE, Ahn JY, Lee JH, Park YS, Kim DH, Choi KD, Chang HS, Song HJ, Lee GH, Choe J, Jang SJ, Jung HY. Novel Endoscopic Criteria for Predicting Tumor Invasion Depth in Superficial Esophageal Squamous Carcinoma. J Korean Med Sci 2020; 35:e336. [PMID: 33107226 PMCID: PMC7590655 DOI: 10.3346/jkms.2020.35.e336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Accurate prediction of tumor invasion depth in superficial esophageal squamous carcinoma (SESC) is essential for deciding the appropriate treatment strategy. We proposed novel endoscopic criteria to differentiate between mucosal and submucosal esophageal cancers and to evaluate the diagnostic accuracy and usefulness of the criteria. METHODS A total of 352 patients who underwent endoscopic or surgical resection for SESC between 1991 and 2010 were included. First, the novel endoscopic criteria were created based on the endoscopic features of 60 randomly selected patients as follows: for T1m cancers, I. flat or slightly elevated or depressed lesion with smooth/even surface of any size, II. slightly elevated lesion of ≤ 1 cm with granular or uneven surface, III. hyperemic flat lesion of ≤ 3 cm with granular or uneven surface, IV. slightly depressed lesion of ≤ 2 cm with uneven surface and for T1sm cancers, I. irregularly (unevenly) nodular or protruded lesion of any size, II. slightly elevated lesion of > 1 cm with granular or uneven surface, III. hyperemic flat lesion of > 3 cm with granular or uneven surface, IV. irregularly (unevenly) depressed lesion of > 2 cm, and V. ulcerative lesion of any size. Next, the endoscopic findings of the remaining 292 patients were reviewed according to the criteria. RESULTS The accuracy of novel endoscopic criteria was 79.5% (232/292). The sensitivity and specificity of mucosal cancers were 78.4% and 81.0%, respectively, whereas those for submucosal cancers were 81.0% and 78.4%, respectively. The accuracy for mucosal cancers was high (97.3%, 72/74) when the lesions were flat or slightly elevated/depressed with smooth/even surface regardless of size, whereas that for submucosal cancers was high (85.7%, 18/21) when the lesions were irregular/nodular protrusions regardless of size. In multivariate analysis, macroscopic type IIb lesion was identified as an independent factor affecting accuracy (P < 0.05). The difference in recurrence-free survival rates between endoscopically mucosal and submucosal cancers was significant (P = 0.026). CONCLUSION The novel endoscopic criteria appear to be accurate and useful in predicting invasion depth in SESC. Our criteria might help not only to decide the treatment strategy between surgery and endoscopic resection but also to predict the outcomes of SESC.
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Affiliation(s)
- Ji Young Choi
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suh Eun Bae
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Sook Chang
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- Health Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Maffazzioli L, Zilio MB, Klamt AL, Duarte JA, Mazzini GS, Campos VJ, Chedid MF, Gurski RR. ADC as a predictor of pathologic response to neoadjuvant therapy in esophageal cancer: a systematic review and meta-analysis. Eur Radiol 2020; 30:3934-3942. [PMID: 32157409 DOI: 10.1007/s00330-020-06723-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Diffusion-weighted magnetic resonance imaging (DWI) is part of clinical practice. The aim of this study was to evaluate the role of apparent diffusion coefficient (ADC) as a predictor of pathologic response to neoadjuvant therapy (nCRT) in patients with esophageal cancer (EC). METHODS The MEDLINE, Embase, and Google Scholar databases were systematically searched for studies using ADC to evaluate response to neoadjuvant therapy in patients with EC. Methodological quality of the studies was evaluated with the QUADAS tool. Data from eligible studies were extracted and evaluated by two independent reviewers. Meta-analyses were performed comparing mean ADC values between responders and non-responders to nCRT in three different scenarios: baseline (BL) absolute values; percent change between intermediate (IM) values and BL; and percent change between final follow-up (FU) value and baseline BL. RESULTS Seven studies (n = 158 patients) were included. Responders exhibited a statistically significant percent increase in ADC during nCRT (mean difference [MD] 21.06%, 95%CI = 13.04-29.09; I2 = 49%; p = 0.12). A similar increase was identified in the complete pathologic response (pCR) versus non-complete pathologic response (npCR) subgroup (MD = 25.68%, 95%CI = 18.87-32.48; I2 = 0%; p = 0.60). At the end of treatment, responders also exhibited a statistically significant percent increase in ADC (MD = 22.49%, 95%CI = 9.94-35.05; I2 = 0%; p = 0.46). BL ADC was not associated with any definition of pathologic response (MD = 0.11%, 95%CI = - 0.21-0.42; I2 = 85%; p < 0.01). CONCLUSION These results suggest that ADC can be used as a predictor of pathologic response, with a statistically significant association between percent ADC increase during and after treatment and pCR. ADC may serve as a tool to help in guiding clinical decisions. KEY POINTS • DWI is routinely included in MRI oncological protocols. • ADC can be used as a predictor of pathologic response, with a statistically significant association between percent ADC increase during and after treatment and pCR.
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Affiliation(s)
- Leticia Maffazzioli
- Division of Radiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2350, 2nd Floor, Porto Alegre, 90035-903, Brazil. .,Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil.
| | - Mariana B Zilio
- Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil.,Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Medical School of UFRGS, Porto Alegre, Brazil
| | - Alexandre L Klamt
- Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil.,Division of Gastroenterology, Hospital de Clínicas de Porto Alegre (HCPA), Medical School of UFRGS, Porto Alegre, Brazil
| | - Juliana A Duarte
- Division of Radiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos 2350, 2nd Floor, Porto Alegre, 90035-903, Brazil
| | - Guilherme S Mazzini
- Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Medical School of UFRGS, Porto Alegre, Brazil
| | - Vinicius J Campos
- Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil
| | - Marcio F Chedid
- Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil.,Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Medical School of UFRGS, Porto Alegre, Brazil
| | - Richard R Gurski
- Post-Graduation Program in Medicine: Surgical Sciences, Medical School of UFRGS, Porto Alegre, Brazil.,Division of Gastrointestinal Surgery, Hospital de Clínicas de Porto Alegre (HCPA), Medical School of UFRGS, Porto Alegre, Brazil
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Qu J, Wang Z, Qin J, Zhang H, Zhao Y, Lu Y, Yan X, Zhang S, Wang S, Kamel IR, Li H. MRI features in differentiating mucosal high-grade neoplasia from early invasive squamous cell cancer of the esophagus. Eur Radiol 2020; 30:3455-3461. [PMID: 32086576 DOI: 10.1007/s00330-020-06716-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/01/2020] [Accepted: 02/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of unenhanced and contrast-enhanced MRI in the differentiation of mucosal high-grade neoplasia (MHN) from early invasive squamous cell cancer (EISCC) of the esophagus. METHODS Between March 2015 and January 2019, 72 study participants with MHN (n = 46) and EISCC (n = 26) of the esophagus were enrolled in this prospective study. Postoperative histopathologic analysis was the reference standard. All participants underwent MRI (T2-multi-shot turbo spin-echo sequence (msTSE), diffusion-weighted imaging (DWI), and 3D gradient-echo-based sequence (3D-GRE)). Two radiologists, blinded to participants' data, independently evaluated MRI and assigned MR features including shape (mucosal thickening or focal mass), signal on T2-msTSE and DWI, enhancement degree (intense or slight), and enhancement pattern (homogeneous, heterogeneous, or heart-shaped). Diagnostic performance of the 5 features was compared using the chi-square test; kappa values were assessed for reader performance. RESULTS Surgery was performed within 3.6 + 3.5 days after MR imaging. Inter-reader agreement on MR features was excellent (kappa value = 0.854, p < 0.001). All 8 mass-like MHN were "heart-shaped" in appearance. The degree of enhancement showed the best diagnosis performance in differentiating between MHN and EISCC of the esophagus. The combination of all 5 features had only borderline improved sensitivity, specificity, and AUC of 100%, 96.2%, and 0.999, respectively, which was not statistically significant compared with the degree of enhancement alone. CONCLUSIONS MRI can differentiate MHN from EISCC in esophagus; the presence of "heart-shaped" appearance favors the diagnosis of MHN. KEY POINTS • All 8 mass-like MHN showed a "heart-shaped" enhancement pattern which may help differentiating MHN from EISCC. • Degree of enhancement had the best diagnostic performance in differentiating between MHN and EISCC in esophagus. • The combined 5 features (shape, signal in T2-msTSE and DWI, enhancement degree, and enhancement pattern) provided sensitivity, specificity, and AUC of 100%, 96.2%, and 0.999, respectively, which was not statistically significant than tumor enhancement alone in distinguishing MHN from EISCC.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Zhaoqi Wang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Jianjun Qin
- Department of Thoracic Surgery, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.,Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongkai Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yan Zhao
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Yanan Lu
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Xu Yan
- MR Scientific Marketing, Siemens Healthineers, Shanghai, 201318, China
| | - Shouning Zhang
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China
| | - Shaoyu Wang
- MR Scientific Marketing, Siemens Healthineers, Xi'an, 710065, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
| | - Hailiang Li
- Department of Radiology, the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 127 Dongming Road, Zhengzhou, 450008, Henan, China.
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Performing clinical 18F-FDG-PET/MRI of the mediastinum optimising a dedicated, patient-friendly protocol. Nucl Med Commun 2019; 40:815-826. [PMID: 31169592 DOI: 10.1097/mnm.0000000000001035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To construct a mediastinal-specific fluorine-18-fluorodeoxyglucose (F-FDG)-PET/MR protocol with high-quality MRI of minimal acquisition-time and comparable diagnostic value to F-FDG-PET/computed tomography (CT). MATERIALS AND METHODS Fifteen healthy participants received PET/MRI and 10 patients with mediastinal tumours (eight non-small-cell lung, two oesophageal cancer) received F-FDG-PET/MRI immediately after F-FDG-PET/CT. Sequences volume interpolated breath-hold examination (T1-VIBE) and Half-Fourier acquisition single-shot turbo spin echo (T2-HASTE) were optimised by varying the parameters: breath-hold (BH, end-expiration), fat suppression (spectral adiabatic inversion recovery), and ECG-triggering (ECG, end-diastole). Image quality (IQ) of each sequence-variation was qualitatively scored by medical experts and quantitatively assessed by calculating signal-to-noise ratios, contrast relative to muscle, standardized-uptake-value, and tumour-to-blood ratios. Patient comfort was evaluated on patients' experience. Diagnostic accuracy of F-FDG-PET/MRI was compared to F-FDG-PET/CT, in reference to histopathology/cytopathology. RESULTS ECG-triggered T1-VIBE images showed the highest signal-to-noise ratio (P < 0.01) and the largest contrast between mediastinal soft-tissues, regardless of BH or free-breathing acquisition. IQ of ECG-triggered T1-VIBE scans in BH were scored qualitatively highest with good reader agreement (κ = 0.62). IQ of T2-HASTE was not significantly affected by BH acquisition (P > 0.9). Qualitative IQ of T1-VIBE and T2-HASTE declined after spectral adiabatic inversion recovery fat-suppression. All patients could maintain BH at end-expiration and reported no discomfort. Diagnostic performance of F-FDG-PET/MR was not significantly different from F-FDG-PET/CT with comparable staging, standardized-uptake-values, and tumour-to-blood ratios. However, T-status was more often over-staged on F-FDG-PET/CT, while N-status was more frequently under-staged on F-FDG-PET/MR. CONCLUSION ECG-triggered T1-VIBE sequences acquired during short, multiple BHs are recommended for mediastinal imaging using F-FDG-PET/MR. With dedicated protocols, F-FDG-PET/MRI will be useful in thoracic oncology and aid in diagnostic evaluation and tailored treatment decision-making.
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Yuan Y, Chen L, Ren S, Wang Z, Chen Y, Jin A, Li S, Fang X, Wang T, Bian Y, Yang Q, Bai C, Hao Q, Lu J. Diagnostic performance in T staging for patients with esophagogastric junction cancer using high-resolution MRI: a comparison with conventional MRI at 3 tesla. Cancer Imaging 2019; 19:83. [PMID: 31801587 PMCID: PMC6894201 DOI: 10.1186/s40644-019-0269-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To investigate and compare the diagnostic performance in T staging for patients with esophagogastric junction cancer using high-resolution magnetic resonance imaging (HR MRI), as compared with conventional MRI at 3 Tesla. METHODS A total of 118 patients with pathologically confirmed esophagogastric junction cancer were included and underwent multiparameter HR MRI (Cohort 1, 62 patients) or conventional MRI (Cohort 2, 56 patients). T2-weighted, T1-weighted, diffusion-weighted and contrast-enhanced T1-weighted images of each patient were evaluated by two radiologists who determined the preoperative T staging by consensus. Using pathologic staging as the gold standard, the consistency between HR MRI and pathology and between conventional MRI and pathology in T staging was calculated and compared. The overall accuracy, overstatement and understatement of HR MRI and conventional MRI in T staging of patients with esophagogastric junction cancer were computed and compared. Moreover, the diagnostic performance of HR MRI and conventional MRI in T staging (≤ T1 and ≥ T4) of patients with esophagogastric junction cancer were evaluated. RESULTS There were no significant differences in age (p = 0.465) and sex (p = 0.175) between Cohorts 1 and 2. Excellent agreement was observed in the T staging of patients with esophagogastric junction cancer between pathology and HR MRI (kappa = 0.813), while moderate agreement was observed between pathology and conventional MRI (kappa = 0.486). Significant differences were observed in overall accuracy (88.7% vs 64.3%, p = 0.002) and understatement (1.6% vs 26.8%, p < 0.001) but not for overstatement (9.7% vs 8.9%, p = 0.889) in T staging between HR MRI and conventional MRI techniques. For differentiating the T stages of ≤ T1 from ≥ T2 and the T stages of ≤ T3 from ≥ T4, no significant differences were observed between the imaging techniques. CONCLUSIONS HR MRI has good diagnostic performance and may serve as an alternative technique in the T staging of patients with esophagogastric junction cancer in clinical practice.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Shengnan Ren
- Department of Nuclear medicine, Changhai Hospital of Shanghai, Shanghai, China
| | - Zhen Wang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Yukun Chen
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Aiguo Jin
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Shuai Li
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Xu Fang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Tiegong Wang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Yun Bian
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Chenguang Bai
- Department of Pathology, Changhai Hospital of Shanghai, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Second Military Medical University, No.168 Changhai Road, Shanghai, 200433 China
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Accuracy of 3-T MRI for Preoperative T Staging of Esophageal Cancer After Neoadjuvant Chemotherapy, With Histopathologic Correlation. AJR Am J Roentgenol 2019; 212:788-795. [PMID: 30673335 DOI: 10.2214/ajr.18.20204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Whole-tumour histogram analysis of pharmacokinetic parameters from dynamic contrast-enhanced MRI in resectable oesophageal squamous cell carcinoma can predict T-stage and regional lymph node metastasis. Eur J Radiol 2019; 112:112-120. [PMID: 30777199 DOI: 10.1016/j.ejrad.2019.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/06/2019] [Accepted: 01/13/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify whether whole-tumour histogram analysis of pharmacokinetic parameters from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could predict T-stage and regional lymph node metastasis (LNM) of resectable oesophageal squamous cell carcinoma (SCC). MATERIALS AND METHODS Forty-two consecutive patients with confirmed oesophageal SCC underwent thoracic DCE-MRI. Histogram metrics (median, mean, standard deviation [SD], skewness, kurtosis and entropy) of whole-tumour pharmacokinetic parameters including endothelial transfer constant (Ktrans), reflux rate (Kep) and fractional extravascular extracellular space volume (Ve) were generated by the Omni-Kinetics software. Histogram datasets were interpreted using the Mann-Whitney U test and receiver operating characteristic (ROC) statistical analyses. RESULTS The Mann-Whitney U tests revealed that the median, mean and SD of Ktrans, the SD and entropy of Kep, and the median, mean and entropy of Ve of T1-2 stage oesophageal SCC were lower when compared with T3 stage (all Ps < 0.05); and the ROC analysis showed that the entropy of Ve could reliably distinguish T1-2 stage from T3 stage with an area under ROC (AUC) of 0.773. The Mann-Whitney U tests illustrated that the entropy of Ktrans, and the median, mean, SD and entropy of Kep were higher while the skewness of Kep was lower in tumours with LNM than without LNM (all Ps < 0.05); and the ROC analysis demonstrated that the SD of Kep could best identify tumours with LNM with an AUC of 0.702. CONCLUSION Whole-tumour histogram analysis of pharmacokinetic parameters of oesophageal SCC on DCE-MRI could be used to predict T-stage and regional LNM.
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Novel imaging techniques in staging oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:17-25. [PMID: 30551852 DOI: 10.1016/j.bpg.2018.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
The survival of oesophageal cancer is poor as most patients present with advanced disease. Radiological staging of oesophageal cancer is complex but is fundamental to clinical management. Accurate staging investigations are vitally important to guide treatment decisions and optimise patient outcomes. A combination of baseline computed tomography (CT), endoscopic ultrasound (EUS) and positron emission tomography (PET) are currently used for initial treatment decisions. The potential value of these imaging modalities to re-stage disease, monitor response and alter treatment is currently being investigated. This review presents an essential update on the accuracy of oesophageal cancer staging investigations, their use in re-staging after neo-adjuvant therapy and introduces evolving imaging techniques, including novel biomarkers that have clinical potential in oesophageal cancer.
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Qu J, Shen C, Qin J, Wang Z, Liu Z, Guo J, Zhang H, Gao P, Bei T, Wang Y, Liu H, Kamel IR, Tian J, Li H. The MR radiomic signature can predict preoperative lymph node metastasis in patients with esophageal cancer. Eur Radiol 2018; 29:906-914. [PMID: 30039220 DOI: 10.1007/s00330-018-5583-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the role of the MR radiomic signature in preoperative prediction of lymph node (LN) metastasis in patients with esophageal cancer (EC). PATIENTS AND METHODS A total of 181 EC patients were enrolled in this study between April 2015 and September 2017. Their LN metastases were pathologically confirmed. The first half of this cohort (90 patients) was set as the training cohort, and the second half (91 patients) was set as the validation cohort. A total of 1578 radiomic features were extracted from MR images (T2-TSE-BLADE and contrast-enhanced StarVIBE). The lasso and elastic net regression model was exploited for dimension reduction and selection of the feature space. The multivariable logistic regression analysis was adopted to identify the radiomic signature of pathologically involved LNs. The discriminating performance was assessed with the area under receiver-operating characteristic curve (AUC). The Mann-Whitney U test was adopted for testing the potential correlation of the radiomic signature and the LN status in both training and validation cohorts. RESULTS Nine radiomic features were selected to create the radiomic signature significantly associated with LN metastasis (p < 0.001). AUC of radiomic signature performance in the training cohort was 0.821 (95% CI: 0.7042-0.9376) and in the validation cohort was 0.762 (95% CI: 0.7127-0.812). This model showed good discrimination between metastatic and non-metastatic lymph nodes. CONCLUSION The present study showed MRI radiomic features that could potentially predict metastatic LN involvement in the preoperative evaluation of EC patients. KEY POINTS • The role of MRI in preoperative staging of esophageal cancer patients is increasing. • MRI radiomic features showed the ability to predict LN metastasis in EC patients. • ICCs showed excellent interreader agreement of the extracted MR features.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China.,School of Life Science and Technology, XIDIAN University, Xi'an, 710126, Shaanxi, China
| | - Chen Shen
- School of Life Science and Technology, XIDIAN University, Xi'an, 710126, Shaanxi, China.,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jianjun Qin
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Zhaoqi Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Zhenyu Liu
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jia Guo
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Pengrui Gao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Tianxia Bei
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Yingshu Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Hui Liu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
| | - Jie Tian
- School of Life Science and Technology, XIDIAN University, Xi'an, 710126, Shaanxi, China. .,Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Hailiang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, Henan, China.
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Huang TC, Hsu CH. On predicting clinical response to chemoradiotherapy in esophageal squamous cell carcinoma: additional evaluation by magnetic resonance imaging may help. ANNALS OF TRANSLATIONAL MEDICINE 2018; 5:487. [PMID: 29299449 DOI: 10.21037/atm.2017.09.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ta-Chen Huang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
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