Kiyohiko Shuto MD, PhD, Presenter: Nothing to Disclose

Tomoyoshi Aoyagi MD, Abstract Co-Author: Nothing to Disclose

Kazuo Narushima, Abstract Co-Author: Nothing to Disclose

Asami Sato, Abstract Co-Author: Nothing to Disclose

Hiroshige Saito, Abstract Co-Author: Nothing to Disclose

Shinichi Okazumi MD, PhD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic ability of metastatic lymph node (LN) of esophageal cancer using diffusion-weighted magnetic resonance imaging (DWI) in comparison with F18-DG PET.

Twenty-seven consecutive patients of esophageal cancer were enrolled in this study. All of the patients underwent radical esophagectomy with cervico-thoraco-abdominal lymphadenectomy. Prior to surgery, DWI and FDG PET imaging were performed. DW images were acquired using a 1.5T whole body scanner equipped with a phased-array body coil. A single shot spin-echo type of echo planar sequence that provided diffusion weighting in the direction of slice selection was used. The corresponding b-value to the diffusion sensitizing gradients were b=1000 s/mm2. PET imaging was performed one hour after intravenous injection of 370 MBq of F18-FDG tracer. Preoperatively Images were analyzed measuring apparent diffusion coefficient (ADC) value and SUV of the detected LN in each image independently. Dissected LNs were divided regional LN groups. We compared both imaging with histological results and evaluated the correlation between ADC value and SUV of metastatic node.

284 regional LN groups were evaluated. 41 groups (14%) were positive for metastasis. The sensitivity, specificity and accuracy rate of DWI were 73%, 85% and 94%, respectively. The sensitivity, specificity and accuracy rate of PET were 54%, 97%, 91%, respectively. There was a significant difference between DWI and PET in sensitivity (P<0.001), but there was no statistical difference in accuracy rate between them. The ADC value of metastatic node was 1.693 +/- 1.873 x 10-3mm2/s, and SUV was 9.34 +/- 5.94. Concerning metastatic node, there was a statistical correlation between ADC value and SUV (R=0.597, P=0.0113).

DWI may have an acceptable diagnostic ability and this noninvasive imaging may become a clinical valid modality by no means inferior to PET.

Noninvasive DWI may yields better predictive power than PET and is recommended in initial evaluation of suspected nodal metastasis of esophageal cancer.

Shuto, K, Aoyagi, T, Narushima, K, Sato, A, Saito, H, Okazumi, S, Preoperative N-staging of Esophageal Squamous Cell Cancer: Diffusion-weighted Magnetic Resonance Imaging versus PET.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013208.html