Published online before print November 26, 2003, 10.1148/radiol.2301021047
Esophageal Cancer Staging with Endoscopic MR Imaging: Pilot Study1
Umakant R. Dave, MD,
Andreanna D. Williams, MD,
Jason A. Wilson, MD,
Zahir Amin, MD,
David J. Gilderdale, MD,
David J. Larkman, MD,
Mark R. Thursz, MD,
Simon D. Taylor-Robinson, MD and
Nandita M. deSouza, MD
1 From the Robert Steiner MRI Unit (U.R.D., A.D.W., D.J.G., D.J.L., S.D.T.R., N.M.d.S.), Departments of Gastroenterology (U.R.D., S.D.T.R., N.M.d.S.) and Anesthesia (J.A.W.), Hammersmith Hospitals Trust, DuCane Rd, London W12 0HS, England; Division of Medicine, Imperial College, London, England (M.R.T.); and Department of Radiology, Chelsea & Westminster Hospital, London, England (Z.A.). Received September 15, 2002; revision requested November 6; final revision received May 15, 2003; accepted May 19. MEDLINK funding enabled the design and production of the MR-compatible endoscope and the coil. Marconi Medical Systems provided further financial support and technical assistance. Address correspondence to N.M.d.S. (e-mail: ndesouza@hhnt.org).
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Figure 1. Photograph shows distal end of MR-compatible endoscope with integral coil system. The outer saddle geometry receive coil is detachable and is inductively coupled to the pick-up coil embedded within the endoscope tip.
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Figure 2. Porcine esophagus in vitro. Transverse T1-weighted (355/20) (A) and T2-weighted (2,500/80) (B) MR images show four distinct wall layers that correspond to histopathologic examination of the transverse pathologic section in C. From inner to outer layers, these are high-signal-intensity (SI) mucus and epithelium (black arrowhead), low-SI muscularis mucosa (black arrow), high-SI submucosa (long white arrow), and low-SI muscularis propria (short white arrow). In addition, an outer layer with high SI (white arrowhead) is seen in A that corresponds to the fibrofatty adventitia in C (gray arrowhead).
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Figure 3. Transverse T1-weighted (840/20) MR image obtained through the midesophagus in a patient with normal esophageal wall anatomy. The innermost low-SI layer represents muscularis mucosa (long arrow). Around this layer is the thicker high-SI submucosa (short arrow), and the muscularis propria is the outermost low-SI band (arrowhead). E = endoscopic coil, L = lung, A = aorta, V = vertebral body. Note that the larger diameter of the esophagus compared with that of the coil results in collapsed "outpouching" of the esophageal wall on the left.
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Figure 4a. (a) Transverse T1-weighted (840/20) MR image obtained in a patient with esophageal cancer and (b) corresponding histopathologic section. (Hematoxylin-eosin stain; original magnification, x40.) The tumor (T) is seen anteriorly in a, with a rim of intact muscularis propria (arrows) surrounding it. E = endoscopic coil, L = lung, A = aorta, V = vertebral body. In b, the tumor (T) has invaded the submucosa, while the muscularis propria (MP) is intact. There was good agreement between endoscopic MR imaging staging and pathologic staging of this tumor.
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Figure 4b. (a) Transverse T1-weighted (840/20) MR image obtained in a patient with esophageal cancer and (b) corresponding histopathologic section. (Hematoxylin-eosin stain; original magnification, x40.) The tumor (T) is seen anteriorly in a, with a rim of intact muscularis propria (arrows) surrounding it. E = endoscopic coil, L = lung, A = aorta, V = vertebral body. In b, the tumor (T) has invaded the submucosa, while the muscularis propria (MP) is intact. There was good agreement between endoscopic MR imaging staging and pathologic staging of this tumor.
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Copyright © 2004 by the Radiological Society of North America.
