Potential use of high-resolution T2-weighted MRI with histopathologic findings in staging esophageal cancer

Xiaohong Xing; Xiaochun Kuang; Xiaobing Li; Yingsheng Cheng; Fengjun Liu

doi:10.21037/qims-22-376

Potential use of high-resolution T2-weighted MRI with histopathologic findings in staging esophageal cancer

Quant Imaging Med Surg. 2023 Jan 1;13(1):249-258. doi: 10.21037/qims-22-376. Epub 2022 Oct 22.

Authors

Xiaohong Xing¹, Xiaochun Kuang¹, Xiaobing Li¹, Yingsheng Cheng^{1

2}, Fengjun Liu³

Affiliations

¹ Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China.
² Department of Radiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
³ Department of Radiology, Shanghai Public Health Clinical Center, Shanghai Fudan University, Shanghai, China.

Abstract

Background: Magnetic resonance imaging (MRI) has shown promising capabilities in diagnosing local esophageal carcinoma. This study investigated the clinical value of high resolution (HR; small field of view and continuous thin section) axial T2-weighted MRI (HR-T2WI) as a noninvasive method for esophageal carcinoma tumor staging (T staging).

Methods: Forty-two patients with biopsy-proven esophageal cancer were investigated using HR-T2WI. The discrepancies between the esophageal wall layers and tumor tissue were assessed for MRI T staging using a visual MRI signal intensity scale (low, intermediate, and high intensities). The computed tomography (CT) and MRI T staging was compared with whole-mount histopathological sections in all patients who underwent resection.

Results: HR-T2WI provided a thorough view of the esophageal wall and the tumor's anatomic layers. Of the 42 patients with histological tumors (HTs), there were 6 cases with tumors classified as HT-1a, 5 cases with HT-1b, 14 cases with HT-2, and 17 cases with HT-3/4, and their MRI T stages were 5 MRI-T1a, 6 MRI-T1b, 14 MRI-T2, and 17 MRI-T3/4, respectively. After analyzing the imaging presentation at different HT staginess, we found that HR-T2WI enabled a more accurate classification than was possible with CT. The difference in accuracy between CT and T2WI was statistically significant (P<0.05) in the entire sample and in HT_1-2 tumors and HT_3-4 tumors.

Conclusions: HR-T2WI clearly identified normal esophageal wall layers; it had high diagnostic accuracy when evaluating tumor invasion and in MRI-T staging for esophageal carcinoma. This study established staging criteria of esophageal carcinoma using HR-T2WI and indicated that this approach could be used as a supplemental noninvasive method for the local T staging of esophageal carcinoma.

Keywords: Esophageal cancer (EC); T staging; high-resolution magnetic resonance imaging (MRI).