Ulla Marina, Gentile Ernestina María José, Cavadas Demetrio, Yeyati Ezequiel Levy, Frank Laura, Argerich Javier Ithurralde, Garcia Mónaco Ricardo
Department of Radiology, Hospital Italiano, Universidad de Buenos Aires, Argentina.
Abdom Imaging. 2012 Aug;37(4):501-11. doi: 10.1007/s00261-011-9784-z.
Early diagnosis and accurate staging of esophageal cancer are both essential for therapeutic strategy planning. Endoscopic ultrasound, CT, and positron emission tomography have all been used in the preoperative staging of esophageal cancer separately or in various combinations. Each imaging method has its strengths and weaknesses. Depiction of the tumor's anatomic location conditions the surgical strategy. Endoscopic ultrasound and PET have important advantages but neither provides information for surgical planning. CT scans have some limitations for hollow organ assessment in the absence of lumen distension, since the organ wall may be collapsed. Therefore, optimal esophageal distension could be very useful to overcome these limitations. This potential drawback is crucial at the level of the GE junction, a typically difficult region to evaluate. In order to optimize tumor visualization in the esophageal wall and in the GE junction, we developed a technique named pneumo-64-MDCT. We achieve maximum lumen distension, which better highlights the thickened areas in relation to the normal esophageal wall. At the present time, we have performed 200 studies with this technique and it proved 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.
食管癌的早期诊断和准确分期对于治疗策略的规划都至关重要。超声内镜、CT和正电子发射断层扫描都已分别或多种组合用于食管癌的术前分期。每种成像方法都有其优缺点。肿瘤解剖位置的描绘决定了手术策略。超声内镜和PET有重要优势，但两者都不能为手术规划提供信息。在没有管腔扩张的情况下，CT扫描在评估中空器官时有一些局限性，因为器官壁可能会塌陷。因此，最佳的食管扩张对于克服这些局限性可能非常有用。这一潜在缺点在胃食管交界部这一典型的难以评估的区域尤为关键。为了优化食管壁和胃食管交界部肿瘤的可视化，我们开发了一种名为充气64排多层螺旋CT的技术。我们实现了最大管腔扩张，这能更好地突出相对于正常食管壁增厚的区域。目前，我们已用该技术进行了200例研究，结果证明它在识别食管壁增厚和食管癌分期方面是有用、安全且准确的。额外的胃扩张使得位于胃食管交界部的肿瘤病变的上下边界都能得到充分界定，这反过来有助于设计手术入路。
