Preoperative T Staging of Potentially Resectable Esophageal Cancer: A Comparison between Free-Breathing Radial VIBE and Breath-Hold Cartesian VIBE, with Histopathological Correlation

Fengguang Zhang, Jinrong Qu, Hongkai Zhang, Hui Liu, Jianjun Qin, Zhidan Ding, Yin Li, Jie Ma, Zhongxian Zhang, Zhaoqi Wang, Jianwei Zhang, Shouning Zhang, Yafeng Dong, Robert Grimm, Ihab R Kamel, Hailiang Li, Fengguang Zhang, Jinrong Qu, Hongkai Zhang, Hui Liu, Jianjun Qin, Zhidan Ding, Yin Li, Jie Ma, Zhongxian Zhang, Zhaoqi Wang, Jianwei Zhang, Shouning Zhang, Yafeng Dong, Robert Grimm, Ihab R Kamel, Hailiang Li

Abstract

Purpose: To compare the T staging of potentially resectable esophageal cancer using free-breathing radial VIBE (r-VIBE) and breath-hold Cartesian VIBE (C-VIBE), with pathologic confirmation of the T stage.

Materials and methods: Fifty patients with endoscopically proven esophageal cancer and indeterminate T1/T2/T3 stage by CT scan were examined on a 3-T scanner. The MRI protocol included C-VIBE at 150 seconds post-IV contrast, immediately followed by a work-in-progress r-VIBE with identical spatial resolution (1.1 mm × 1.1 mm × 3.0 mm). Two independent readers assigned a T stage on MRI according to the 7th edition of UICC-AJCC TNM Classification, and postoperative pathologic confirmation was considered the gold standard. Interreader agreement was also calculated.

Results: The T staging agreement between both VIBE techniques and postoperative pathologic T staging was 52% (26/50) for C-VIBE, 80% (40/50) for r-VIBE for reader 1, and 50% (25/50), 82% (41/50) for reader 2, respectively. For the esophageal cancer with invading lamina propria, muscularis mucosae, or submucosa (T1 stage), r-VIBE achieved 86% (12/14) agreement for both readers 1 and 2. For invasion of muscularis propria (T2 stage), r-VIBE achieved 83% (25/30) for both readers 1 and 2, whereas for the invasion of adventitia (T3 stage), r-VIBE could only achieve agreement in 50% (3/6) and 67% (4/6) for readers 1 and 2, respectively.

Conclusion: Contrast-enhanced free-breathing r-VIBE is superior to breath-hold CVIBE in T staging of potentially resectable esophageal cancer, especially for T1 and T2.

Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Examples of image quality (1 = poor, 2 = acceptable, 3 = average, 4 = good, 5 = excellent) for both C-VIBE (E-G: score 2-4) and r-VIBE (A-D: score 2-5). = tumor, mucosa (black arrow), muscularis propria (white arrow), and interrupted muscularis propria (thick black arrow).
Figure 2
Figure 2
T staging criteria of contrast-enhanced radial VIBE for esophageal cancer. 1, mucosa; 2, muscularis propria; 3, adventitia.
Figure 3
Figure 3
Scatter diagram of image quality for C-VIBE and r-VIBE (n = 50).
Figure 4
Figure 4
(A and B) Axial radial VIBE and reformatted sagittal images in a 65-year-old female esophageal cancer patient, = tumor. (A) Image obtained with contrast-enhanced radial VIBE shows mucous layer remains ring-like intact (black arrow), and MRI staging is T1. (D and E) Axial conventional VIBE and reformatted sagittal images; both tumor and mucous layer are blurred. (C) On a photograph of EC, tumor is seen as a yellowish solid mass, mucous layer (thin black arrow) is not interrupted completely, and muscularis propria is intact (thick black arrow). (F) Tumor invades submucosa (white arrow), and muscularis propria is intact (black arrow) via a hematoxylin and eosin (H&E)–stained section at ×100.
Figure 5
Figure 5
(A-C) Axial radial VIBE, reformatted sagittal and coronal images in a 63-year-old male esophageal cancer patient, = tumor, thin white arrow = mucous layer, and thick white arrow means muscularis propria. (A-C) Images obtained with contrast-enhanced radial VIBE show that tumor invades muscularis propria (arrowhead), and MRI staging is T2. (D-F) Axial conventional VIBE, reformatted sagittal and coronal images, tumor, mucous layer, and muscularis propria are blurred. (G) On a photograph of EC, tumor is seen as a white solid mass, mucous layer (thin white arrow) is interrupted, and muscularis propria (thick white arrow) is invaded. (H) Tumor invades muscularis propria (white arrow) via an H&E-stained section at ×100.
Figure 6
Figure 6
(A-C) Axial radial VIBE, reformatted sagittal and coronal images in 47-year-old male esophageal cancer patients, = tumor, thick arrow = muscularis propria. (A-C) Images obtained with contrast-enhanced radial VIBE show that tumor invades adventitia (thin arrow), and MRI staging is T3. (D-F) Axial conventional VIBE, reformatted sagittal and coronal images, tumor, mucous layer, and muscularis propria are blurred. (G) On a photograph of EC, tumor is seen as a solid mass, mucous layer is interrupted, and muscularis propria and adventitia are invaded. (H) Tumor invades adventitia (black arrow) via an H&E-stained section at ×100.

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