Value of spectral detector CT for pretherapeutic, locoregional assessment of esophageal cancer

David Zopfs; Nils Große Hokamp; Robert Reimer; Grischa Bratke; David Maintz; Christiane Bruns; Christoph Mallmann; Thorsten Persigehl; Stefan Haneder; Simon Lennartz

doi:10.1016/j.ejrad.2020.109423

Value of spectral detector CT for pretherapeutic, locoregional assessment of esophageal cancer

Eur J Radiol. 2021 Jan:134:109423. doi: 10.1016/j.ejrad.2020.109423. Epub 2020 Nov 21.

Affiliations

¹ University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany.
² Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Str. 32, 50937, Cologne, Germany.
³ University Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany; Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA. Electronic address: simon.lennartz@uk-koeln.de.

PMID: 33302024
DOI: 10.1016/j.ejrad.2020.109423

Abstract

Purpose: To investigate the diagnostic value of spectral detector dual-energy CT-derived low-keV virtual monoenergetic images (VMI) and iodine overlays (IO) for locoregional, pretherapeutic assessment of esophageal cancer.

Method: 74 patients with biopsy-proven esophageal cancer who underwent pre-therapeutic, portal-venous-phase staging examinations of the chest and abdomen were retrospectively included. Quantitative image analysis was performed ROI-based within the tumor, healthy esophageal wall, peri-esophageal lymph nodes, azygos vein, aorta, liver, diaphragm, and mediastinal fat. Two radiologists evaluated delineation of the primary tumor and locoregional lymph nodes, assessment of the celiac trunk and diagnostic certainty regarding tumor infiltration in conventional images (CI), VMI from 40 to 70 keV and IO. Moreover, presence/absence of advanced tumor infiltration (T3/T4) was determined binary using all available images.

Results: VMI_40-60keV showed significantly higher attenuation and signal-to-noise ratio compared to CI for all assessed ROIs, peaking at VMI_40keV (p < 0.05). Contrast-to-noise ratio of tumor/esophagus (VMI_40keV/CI: 7.7 ± 4.7 vs. 2.3 ± 1.5), tumor/diaphragm (VMI_40keV/CI: 9.0 ± 5.5 vs. 2.2 ± 1.7) and tumor/liver (4.3 ± 5.5 vs. 1.9 ± 2.1) were all significantly higher compared to CI (p < 0.05). Qualitatively, lymph node delineation and diagnostic certainty regarding tumor infiltration received highest ratings both in IO and VMI_40keV, whereas vascular assessment was rated highest in VMI_40keV and primary tumor delineation in IO. Sensitivity/Specificity/Accuracy for detecting advanced tumor infiltration using the combination of CI, VMI_40-70keV and IO was 42.4 %/82.0 %/56.3 %.

Conclusions: IO and VMI_40-60keV improve qualitative assessment of the primary tumor and depiction of lymph nodes and vessels at pretherapeutic SDCT of esophageal cancer patients yet do not mitigate the limitations of CT in determining tumor infiltration.

Keywords: Esophageal neoplasms; Medical oncology; Neoplasm staging; Tomography; X-Ray computed.

MeSH terms

Esophageal Neoplasms* / diagnostic imaging
Humans
Portal Vein
Retrospective Studies
Signal-To-Noise Ratio
Tomography, X-Ray Computed*