Improving the quality of pretreatment staging in patients with esophageal carcinoma - a fast track study

Diffusion-weighted whole-body imaging with background body signal suppression/T2-weighted image fusion of gastrointestinal cancers

Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) yields positive results for cancer against the surrounding tissues. The combination of DWIBS and T2-weighted images (DWIBS/T2) in the diagnosis of gastrointestinal tract cancers was retrospectively analyzed in the present study. Patients were subjected to magnetic resonance imaging after cancer was diagnosed through specimens obtained via biopsy or endoscopic mucosal resection. Sixteen patients were assessed between July, 2012 and June, 2013 and the correlation between detection with DWIBS/T2 and T staging was analyzed. Regarding patients who underwent surgery, the correlation between detection with DWIBS/T2 and the diameter or depth of invasion was analyzed. All cancers that had advanced to >T2 stage were detectable by DWIBS/T2, whereas all cancers staged as <T1 were not (P<0.0001). Tumors that were undetected by DWIBS/T2 had a mean diameter of 1.53±0.25 cm, whereas those detected had a mean diameter of 3.63±1.88 cm; however, the difference was not statistically significant (P=0.1053). Cancers invading beyond the muscularis propria were detectable by DWIBS/T2, while those which had not invaded the mucosa were not (P=0.0476). In conclusion, DWIBS/T2 was able to positively identify gastrointestinal tract cancers at an advanced stage (>T2) or invading beyond the muscularis propria.

Diffusion-weighted imaging and diffusion-weighted whole-body imaging with background body signal suppression for characterizing esophageal cancer: a case report

Purpose

Information on the extent or structure of esophageal cancer (ESC) is necessary for identifying whether the carcinoma is localized or resectable. Diffusion-weighted imaging (DWI) and diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) are useful for this purpose.

Patients and methods

One case of ESC with dysphagia presented at our hospital. Endoscopic examination revealed an elevated lesion with an ulcer, and stenosis was detected. DWI showed a high-intensity signal extending from the proximal to the distal ends of the carcinoma and extending to the tunica adventitia. A strong signal was also observed using ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). DWIBS clearly revealed ESC, and these findings, along with those from DWI, suggested that our case had stage-T3 ESC. FDG-PET did not reveal the detailed structure of the ESC. DWIBS, on the other hand, showed that the signal extended to the tunica adventitia and the lumen of the esophagus.

Conclusion

These findings suggest that DWI and DWIBS are useful for the detection and assessment of ESC.