Levy Vincent, Jreige Mario, Haefliger Laura, Du Pasquier Celine, Noirot Camille, Dorothea Wagner Anna, Mantziari Styliani, Schäfer Markus, Vietti-Violi Naik, Dromain Clarisse
Department of Radiodiagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Nuclear Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Eur Radiol. 2025 May 16. doi: 10.1007/s00330-025-11549-6.
To compare the diagnostic accuracy of MRI and PET/CT combined versus standard staging methods (CT, endoscopic ultrasound [EUS], and PET/CT) for initial staging of esophageal cancer (EC).
This study included patients newly diagnosed with histologically proven EC between 2017 and 2021. Patients underwent a 3-T esophageal MRI alongside standard staging (CT, EUS, PET/CT) prior to treatment. TNM-stages were assessed by two independent reviewers for MRI, CT, and PET/CT, with EUS evaluated by one operator. Discrepancies were resolved by a third reviewer. Patients were categorized based on treatment management: surgery (T1-T2N0M0), neoadjuvant (radio)chemotherapy (T3-T4a and/or N1-N2-N3M0), and palliative chemotherapy (T4b and/or M1). The reference standard was histopathology from surgical specimens or TNM staging from tumor board discussions. The area under the curve (AUC) was calculated for each imaging combination.
60 patients newly diagnosed with EC (50M/10F; mean age 66.5 years) were prospectively enrolled. MRI + PET/CT combination exhibited the highest AUC (0.92, 95% CI: 0.79-1) for differentiating curative versus palliative patients, without statistically significant difference compared to CT + EUS (0.80, 95% CI: 0.56-1, p = 0.34), CT + PET/CT (0.77, 95% CI: 0.53-1, p = 0.42), and CT + EUS + PET/CT (0.78, 95% CI: 0.58-0.97, p = 0.26). In term of differentiating patients eligible for upfront surgery from those with indication for neoadjuvant (radio)chemotherapy, the combination of CT + EUS + PET/CT demonstrated the highest AUC (0.90, 95% CI: 0.75-1) without statistically significant difference compared to CT + EUS (0.82, 95% CI: 0.56-1, p = 0.49), CT + PET/CT (0.79, 95% CI: 0.46-1, p = 0.36), and MRI + PET/CT (0.83, 95% CI: 0.65-1, p = 0.59).
MRI + PET/CT combination is highly accurate for initial EC staging and non-inferior to standard methods, offering less invasiveness and reduced radiation exposure.
Question Can MRI help improve the TNM staging of esophageal cancer? Findings MRI + PET/CT showed no statistically significant difference compared to endoscopic ultrasound (EUS) + CT + PET/CT in identifying curative vs palliative patients but with a tendency for improved staging. Clinical relevance Thoraco-abdominal MRI can provide added value (as a replacement of CT and EUS) in initial staging of esophagus cancer, particularly in cases of stenotic or advanced tumors.
比较MRI与PET/CT联合检查及标准分期方法（CT、内镜超声[EUS]和PET/CT）对食管癌（EC）初始分期的诊断准确性。
本研究纳入了2017年至2021年间新诊断为经组织学证实的EC患者。患者在治疗前接受了3-T食管MRI检查以及标准分期检查（CT、EUS、PET/CT）。由两名独立的评估人员对MRI、CT和PET/CT的TNM分期进行评估，EUS由一名操作人员评估。分歧由第三位评估人员解决。根据治疗管理方式对患者进行分类：手术（T1-T2N0M0）、新辅助（放）化疗（T3-T4a和/或N1-N2-N3M0）和姑息化疗（T4b和/或M1）。参考标准为手术标本的组织病理学检查结果或肿瘤多学科讨论得出的TNM分期。计算每种成像组合的曲线下面积（AUC）。
前瞻性纳入了60例新诊断为EC的患者（50例男性/10例女性；平均年龄66.5岁）。在区分可治愈与姑息患者方面，MRI+PET/CT组合的AUC最高（0.92，95%CI：0.79-1），与CT+EUS（0.80，95%CI：0.56-1，p=0.34）、CT+PET/CT（0.77，95%CI：0.53-1，p=0.42）和CT+EUS+PET/CT（0.78，95%CI：0.58-0.97，p=0.26）相比，差异无统计学意义。在区分适合直接手术的患者与有新辅助（放）化疗指征的患者方面，CT+EUS+PET/CT组合的AUC最高（0.90，95%CI：0.75-1），与CT+EUS（0.82，95%CI：0.56-1，p=0.49）、CT+PET/CT（0.79，95%CI：0.46-1，p=0.36）和MRI+PET/CT（0.83，95%CI：0.65-1，p=0.59）相比，差异无统计学意义。
MRI+PET/CT组合对EC初始分期具有高度准确性，且不劣于标准方法，具有侵入性较小和辐射暴露减少的优点。
问题MRI能否有助于改善食管癌的TNM分期？研究结果在识别可治愈与姑息患者方面，MRI+PET/CT与内镜超声（EUS）+CT+PET/CT相比，差异无统计学意义，但有分期改善的趋势。临床意义胸腹部MRI在食管癌初始分期中可提供附加价值（作为CT和EUS的替代方法），尤其是在狭窄或晚期肿瘤的病例中。
