Early diagnosis and accurate staging of esophageal cancer are both essential for therapeutic strategy planning. Since its emergence, computed tomography (CT) has been a key imaging examination for staging; it offers valuable information for therapeutic strategy and resectability assessment. However, conventional CT scans have some limitations for hollow organ assessment in the absence of lumen distension, since the organ wall may be collapsed. Indeed, it is sometimes difficult to define wall thickening or to guarantee the presence of esophageal tumors with endoluminal growth. For these reasons, optimal esophageal distension could be very useful to overcome these limitations. Esophageal and gastric lumen distension may be performed with oral contrast agents, but it is often suboptimal due to contrast rapid transit. Moreover, oral contrast enhancement may generate confusing images, with the same density as the tumor. This potential drawback is crucial at the level of the GE junction, a typically difficult region to evaluate, where depiction of the tumor anatomic location conditions the surgical strategy. In order to optimize tumor visualization in the esophageal wall and in the GE junction, we developed a technique named pneumo-64-MDCT (Pn64MDCT). It consists in the transorally or tranasally introduction of a Foley catheter under local spray anesthesia. We settled it right below the cricopharyngeal muscles and continuous CO2 is supplied and sustained during the acquisition with a pressure between 10-0mmHG. We achieve maximum lumen distension, which would better highlight the thickened areas in relation to the normal esophageal wall. At the present time we had performed approximately 200 studies with this technique and it proved to be useful, safe and accurate to identify esophageal wall thickening and to stage esophageal cancer. The additional stomach distension led to an adequate definition of both the upper and lower borders of the lesion in tumors located in the GE junction, which in turn was helpful to design the surgical approach.
Ulla, M,
Virtual MDCT Pneumoesophagoscopy. Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL.
http://archive.rsna.org/2010/9016468.html
