MRI features in differentiating mucosal high-grade neoplasia from early invasive squamous cell cancer of the esophagus

Jinrong Qu, Zhaoqi Wang, Jianjun Qin, Hongkai Zhang, Yan Zhao, Yanan Lu, Xu Yan, Shouning Zhang, Shaoyu Wang, Ihab R. Kamel, Hailiang Li

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3455-3461
Number of pages7
JournalEuropean radiology
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2020

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Keywords

  • Differential diagnosis
  • Esophageal cancer
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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