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High-Resolution MRI in Evaluation of the Surgical Anatomy of the Esophagus and Posterior Mediastinum

¹ Department of Diagnostic Radiology, Royal Marsden Hospital Foundation Trust, Downs Rd., Sutton, Surrey, SM2 5PT, United Kingdom.
² Department of Anatomy, St. George's Hospital Medical School, London SW17 0RE, United Kingdom.

OBJECTIVE. The purpose of this study was to use high-resolution MRI to evaluate the surgical anatomy of the posterior mediastinum, in particular the esophagus and its relation to the surrounding structures. The aim was to familiarize radiologists with the appearance of structures considered important in planning surgical resection of the esophagus.

MATERIALS AND METHODS. The thoraces of two cadavers were imaged with a 1.5-T magnet using a high-resolution T2-weighted sequence. Axial cadaveric sections of the posterior mediastinum were cut with a band saw at levels determined from the MR images, and histologic whole-mount sections of the esophagus and surrounding tissue were prepared from the cadaveric sections. The appearance of structures identified on the MR images was compared with the findings on corresponding gross anatomic and histologic whole-mount sections.

RESULTS. The MR images depicted the esophagus and structures in close anatomic relation: the pleural reflections and pericardium. The technique enabled visualization of structures to our knowledge not previously described on cross-sectional imaging: the individual layers of the esophageal wall, the thoracic duct, a connective tissue layer attaching the esophagus to the anterior wall of the aorta, and a fascial plane passing between layers of the right and left parietal pleura posterior to the esophagus.

CONCLUSION. High-resolution MRI of the posterior mediastinum provides detailed anatomic information, delineating structures not visible on other forms of cross-sectional imaging. It can provide important information for planning surgical intervention.

Keywords: anatomy • esophageal disease • MRI

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