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Potential of Surface-Coil MRI for Staging of Esophageal Cancer

¹ Department of Diagnostic Radiology, The Royal Marsden Hospital, Downs Road, Sutton, Surrey, London, United Kingdom, SM2 5PT.
² Department of Radiology, The Chelsea and Westminster Hospital, London, United Kingdom.
³ Department of Histopathology, The Royal Marsden Hospital, London, United Kingdom.
⁴ Department of Surgery, The Royal Marsden Hospital, London, United Kingdom.
⁵ Department of Medical Oncology, The Royal Marsden Hospital, London, United Kingdom.

View larger version (178K): [in a new window]   Fig. 1A —61-year-old man with squamous cell carcinoma of esophagus. High-resolution axial images show normal esophagus (arrow). Esophageal wall layers cannot be defined on T1-weighted image (A), whereas corresponding T2-weighted image (B) clearly shows individual layers.

View larger version (173K): [in a new window]   Fig. 1B —61-year-old man with squamous cell carcinoma of esophagus. High-resolution axial images show normal esophagus (arrow). Esophageal wall layers cannot be defined on T1-weighted image (A), whereas corresponding T2-weighted image (B) clearly shows individual layers.

View larger version (150K): [in a new window]   Fig. 2A —47-year-old woman with adenocarcinoma of lower esophagus. Axial T2-weighted image (A) shows normal esophageal wall layers. Low-signal-intensity mucosa (white arrow) is surrounded by higher-signal submucosa (arrowhead) and low-signal-intensity muscularis propria (black arrow).

View larger version (97K): [in a new window]   Fig. 2B —47-year-old woman with adenocarcinoma of lower esophagus. Histology slide matching image in A is shown, with corresponding layers marked with same indicators as A.

View larger version (138K): [in a new window]   Fig. 3A —59-year-old man with adenocarcinoma of lower esophagus. T2-weighted image shows intermediate-signal-intensity tumor involving right side of esophageal wall (arrow). Tumor replaces high-signal-intensity submucosa and infiltrates into muscularis propria. Involved lymph node is seen just anterior to aorta (arrowhead). Normal esophageal wall layers are preserved on left side.

View larger version (54K): [in a new window]   Fig. 3B —59-year-old man with adenocarcinoma of lower esophagus. Histology slide matching image in A confirms tumor involving submucosa and muscularis on right side (arrow) and replacing periesophageal lymph node (arrowhead).

View larger version (10K): [in a new window]   Fig. 4A —Bland-Altman scatterplots show mean difference between MRI and histology for esophageal wall and tumor thickness. The mean difference for interpreter 1 (A) was 0.54 mm (2 SDs ± 8.37 mm); for interpreter 2 (B) was 0.86 mm (2 SDs ± 7.06 mm); and for interpreter 3 (C) was 1.01 mm (2 SDs ± 8.22 mm). Value for 2 SDs provides 95% CI in each case, which determines limits of agreement for scatterplots. Path = histology.

View larger version (9K): [in a new window]   Fig. 4B —Bland-Altman scatterplots show mean difference between MRI and histology for esophageal wall and tumor thickness. The mean difference for interpreter 1 (A) was 0.54 mm (2 SDs ± 8.37 mm); for interpreter 2 (B) was 0.86 mm (2 SDs ± 7.06 mm); and for interpreter 3 (C) was 1.01 mm (2 SDs ± 8.22 mm). Value for 2 SDs provides 95% CI in each case, which determines limits of agreement for scatterplots. Path = histology.

View larger version (9K): [in a new window]   Fig. 4C —Bland-Altman scatterplots show mean difference between MRI and histology for esophageal wall and tumor thickness. The mean difference for interpreter 1 (A) was 0.54 mm (2 SDs ± 8.37 mm); for interpreter 2 (B) was 0.86 mm (2 SDs ± 7.06 mm); and for interpreter 3 (C) was 1.01 mm (2 SDs ± 8.22 mm). Value for 2 SDs provides 95% CI in each case, which determines limits of agreement for scatterplots. Path = histology.

View larger version (10K): [in a new window]   Fig. 5A —Bland-Altman scatterplots show good correlation between interpreters, particularly for measurements less than 5 mm. Mean difference between interpreters 1 and 2 (A) was 0.30 mm (2 SDs ± 5.63 mm). For interpreters 2 and 3 (B), mean difference was 0.20 mm (2 SDs ± 6.3 mm). For interpreters 1 and 3 (C), mean difference was 0.47 mm (2 SDs ± 7.19 mm). Value for 2 SDs from mean represents coefficient of repeatability.

View larger version (10K): [in a new window]   Fig. 5B —Bland-Altman scatterplots show good correlation between interpreters, particularly for measurements less than 5 mm. Mean difference between interpreters 1 and 2 (A) was 0.30 mm (2 SDs ± 5.63 mm). For interpreters 2 and 3 (B), mean difference was 0.20 mm (2 SDs ± 6.3 mm). For interpreters 1 and 3 (C), mean difference was 0.47 mm (2 SDs ± 7.19 mm). Value for 2 SDs from mean represents coefficient of repeatability.

View larger version (10K): [in a new window]   Fig. 5C —Bland-Altman scatterplots show good correlation between interpreters, particularly for measurements less than 5 mm. Mean difference between interpreters 1 and 2 (A) was 0.30 mm (2 SDs ± 5.63 mm). For interpreters 2 and 3 (B), mean difference was 0.20 mm (2 SDs ± 6.3 mm). For interpreters 1 and 3 (C), mean difference was 0.47 mm (2 SDs ± 7.19 mm). Value for 2 SDs from mean represents coefficient of repeatability.

View larger version (149K): [in a new window]   Fig. 6A —78-year-old man with mucinous gastroesophageal junction tumor. High-resolution T2-weighted image (A) shows high-signal-intensity submucosa (arrowhead), interpreted as submucosal edema by all three interpreters; however, corresponding histology (B) reveals mucinous adenocarcinoma. On MRI, muscularis propria appears thinned on right side because of invasion of tumor (arrow). This misinterpretation accounted for four of seven images where MRI measurement underestimated tumor thickness.

View larger version (124K): [in a new window]   Fig. 6B —78-year-old man with mucinous gastroesophageal junction tumor. High-resolution T2-weighted image (A) shows high-signal-intensity submucosa (arrowhead), interpreted as submucosal edema by all three interpreters; however, corresponding histology (B) reveals mucinous adenocarcinoma. On MRI, muscularis propria appears thinned on right side because of invasion of tumor (arrow). This misinterpretation accounted for four of seven images where MRI measurement underestimated tumor thickness.

View larger version (160K): [in a new window]   Fig. 7A —78-year-old woman with bulky tumor. Tumor-narrowing lumen (arrow) makes accurate measurement of single wall thickness difficult on MRI (A). Tumor, however, does not invade muscularis (arrowhead). Corresponding histology (B) confirms extensive intraluminal tumor-narrowing lumen (arrow) and normal surrounding muscularis propria (arrowhead). Five of 20 overestimations of tumor thickness were because of this difficulty.

View larger version (107K): [in a new window]   Fig. 7B —78-year-old woman with bulky tumor. Tumor-narrowing lumen (arrow) makes accurate measurement of single wall thickness difficult on MRI (A). Tumor, however, does not invade muscularis (arrowhead). Corresponding histology (B) confirms extensive intraluminal tumor-narrowing lumen (arrow) and normal surrounding muscularis propria (arrowhead). Five of 20 overestimations of tumor thickness were because of this difficulty.

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