TY - JOUR
T1 - MRI features in differentiating mucosal high-grade neoplasia from early invasive squamous cell cancer of the esophagus
AU - Qu, Jinrong
AU - Wang, Zhaoqi
AU - Qin, Jianjun
AU - Zhang, Hongkai
AU - Zhao, Yan
AU - Lu, Yanan
AU - Yan, Xu
AU - Zhang, Shouning
AU - Wang, Shaoyu
AU - Kamel, Ihab R.
AU - Li, Hailiang
N1 - Funding Information:
This study has received funding by the General Programs of the National Natural Science Foundation of China (No. 81972802), the Henan Health Science and Technology Innovation Talent Project (No. 201004057), and the National Nature Science Foundation of Henan Province (No. 182300410355).
Publisher Copyright:
© 2020, European Society of Radiology.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - 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.
AB - 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.
KW - Differential diagnosis
KW - Esophageal cancer
KW - Magnetic resonance imaging
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U2 - 10.1007/s00330-020-06716-w
DO - 10.1007/s00330-020-06716-w
M3 - Article
C2 - 32086576
AN - SCOPUS:85079757717
SN - 0938-7994
VL - 30
SP - 3455
EP - 3461
JO - European radiology
JF - European radiology
IS - 6
ER -