Preoperative Local Staging of Esophageal Carcinoma Using Dual-Phase Contrast-Enhanced Imaging With Multi-Detector Row Computed Tomography: Value of the Arterial Phase Images

摘要

Purpose: To evaluate whether the accuracy of local extension (T-staging) of esophageal carcinoma could be improved with addition of arterial phase images by use of multi-detector row computed tomography. Materials and Methods: The institutional review board approved this study, and all the subjects provided informed consent. Dual-phase (the arterial and venous phases) contrast-enhanced computed tomography was performed in 45 consecutive patients (39 men and 6 women; age range, 47-84 years) with 47 lesions of esophageal carcinoma who underwent surgical intervention. Two radiologists independently evaluated the T-staging of esophageal carcinoma on both phases. The T-staging on both the arterial and venous phase images was compared with the T-staging at histologic evaluation by means of a resected specimen (as the reference standard). Differences in the overall accuracy and sensitivity for the T-staging between the 2 phases were analyzed with the McNemar test.Results: The analysis of the interobserver agreement for T-staging showed almost perfect agreement (k = 0.85 on the arterial phase and k = 0.93 on the venous phase). The overall accuracy in the arterial phase was significantly better than that in the venous phase (68% vs 51%, P < 0.01). The sensitivity values of the T-staging in the arterial phase were 0% in Tia, 71.4% in Tib, 12.5% in T2, 89.5% in T3, and 100% in T4. The sensitivity values in the venous phase were 0% in Tla, 14.3% in Tib, 0% in T2, 94.7% in T3, and 100% in T4. Statistical significance was apparent in the sensitivity of the Tib lesions.Conclusion: The arterial phase can improve the accuracy of T-staging of esophageal carcinomas, especially early-staged lesions.