This study aimed to evaluate both the short- and long-term efficacies of chemoradiotherapy in relation to the treatment of esophageal cancer . This was achieved through the use of dynamic contrast-enhanced magnetic resonance imaging-derived volume transfer constant and diffusion weighted imaging-derived apparent diffusion coefficient . Patients with esophageal cancer were assigned into the sensitive and resistant groups based on respective efficacies in chemoradiotherapy. Dynamic contrast-enhanced magnetic resonance imaging and diffusion weighted imaging were used to measure volume transfer constant and apparent diffusion coefficient, while computed tomography was used to calculate tumor size reduction rate. Pearson correlation analyses were conducted to analyze correlation between volume transfer constant, apparent diffusion coefficient, and the tumor size reduction rate. Receiver operating characteristic curve was constructed to analyze the short-term efficacy of volume transfer constant and apparent diffusion coefficient, while Kaplan-Meier curve was employed for survival rate analysis. Cox proportional hazard model was used for the risk factors for prognosis of patients with esophageal cancer. Our results indicated reduced levels of volume transfer constant, while increased levels were observed in ADCmin, ADCmean, and ADCmax following chemoradiotherapy. A negative correlation was determined between ADCmin, ADCmean, and ADCmax, as well as in the tumor size reduction rate prior to chemoradiotherapy, whereas a positive correlation was uncovered postchemoradiotherapy. Volume transfer constant was positively correlated with tumor size reduction rate both before and after chemoradiotherapy. The 5-year survival rate of patients with esophageal cancer having high ADCmin, ADCmean, and ADCmax and volume transfer constant before chemoradiotherapy was greater than those with respectively lower values. According to the Cox proportional hazard model, ADCmean, clinical stage, degree of differentiation, and tumor stage were all confirmed as being independent risk factors in regard to the prognosis of patients with EC. The findings of this study provide evidence suggesting that volume transfer constant and apparent diffusion coefficient as being tools allowing for the evaluation of both the short- and long-term efficacies of chemoradiotherapy esophageal cancer treatment.

https://journals.sagepub.com/doi/pdf/10.1177/1533034618765254

DCE-MRI-Derived Volume Transfer Constant (Ktrans) and DWI Apparent Diffusion Coefficient as Predictive Markers of Short- and Long-Term Efficacy of Chemoradiotherapy in Patients With Esophageal Cancer.

Currently, the use of magnetic resonance imaging (MRI) in patients with esophageal carcinoma is limited. However, the quality of MRI for esophageal carcinoma continues to improve and the importance of MRI in patients with esophageal carcinoma has been gradually recognized. Compared with endoscopic ultrasound and computed tomography applied in T and N staging, MRI has now achieved excellent results after the imaging technique has been optimized. We review the literature on MRI and discuss the future of MRI in esophageal carcinoma. While the role of MRI in staging, tumor volume target delineation and evaluation for preoperative chemoradiotherapy, prognosis and recurrence is still evolving. The application of MRI in esophageal carcinoma has a bright future and potential to improve precision of T and N staging as well as treatment delivery.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajco.13112

The value of magnetic resonance imaging in esophageal carcinoma: Tool or toy?

Simple Summary Esophageal cancer (EC) is the eighth most frequent cancer worldwide, with a poor prognosis. Current imaging modalities for staging and follow-up mainly include computed tomography (CT), positron emission tomography (PET)/CT, and endoscopic ultrasound. Magnetic resonance imaging (MRI), which is a non-irradiating and non-invasive modality, can provide identification of the esophageal wall and esophagogastric junction. MRI has shown encouraging capabilities in regional and local staging of EC as well as in the assessment of treatment response to therapy. Technical refinements in MRI technique and sequences overtime have contributed to its increasing diagnostic performance as well as its generalizability. MRI could become a routine imaging technique for EC management in the future, alone or in combination with other modalities. Abstract Esophageal cancer (EC) is the eighth more frequent cancer worldwide, with a poor prognosis. Initial staging is critical to decide on the best individual treatment approach. Current modalities for the assessment of EC are irradiating techniques, such as computed tomography (CT) and positron emission tomography/CT, or invasive techniques, such as digestive endoscopy and endoscopic ultrasound. Magnetic resonance imaging (MRI) is a non-invasive and non-irradiating imaging technique that provides high degrees of soft tissue contrast, with good depiction of the esophageal wall and the esophagogastric junction. Various sequences of MRI have shown good performance in initial tumor and lymph node staging in EC. Diffusion-weighted MRI has also demonstrated capabilities in the evaluation of tumor response to chemoradiotherapy. To date, there is not enough data to consider whole body MRI as a routine investigation for the detection of initial metastases or for prediction of distant recurrence. This narrative review summarizes the current knowledge on MRI for the management of EC.

/pdf/the-role-of-magnetic-resonance-imaging-in-the-management-of-qvthapdt.pdf

The Role of Magnetic Resonance Imaging in the Management of Esophageal Cancer

Contribution of magnetic resonance imaging to the management of esophageal diseases: A systematic review.

Purpose The purpose of this study was to investigate the association between the radiomics features (RFs) extracted from a whole-tumor ADC map during the early treatment course and response to concurrent chemoradiotherapy (cCRT) in patients with esophageal squamous cell carcinoma (ESCC). Methods Patients with ESCC who received concurrent chemoradiotherapy were enrolled in two hospitals. Whole-tumor ADC values and RFs were extracted from sequential ADC maps before treatment, after the 5th radiation, and after the 10th radiation, and the changes of ADC values and RFs were calculated as the relative difference between different time points. RFs were selected and further imported to a support vector machine classifier for building a radiomics signature. Radiomics signatures were obtained from both RFs extracted from pretreatment images and three sets of delta-RFs. Prediction models for different responders based on clinical characteristics and radiomics signatures were built up with logistic regression. Results Patients (n=76) from hospital 1 were randomly assigned to training (n=53) and internal testing set (n=23) in a ratio of 7 to 3. In addition, to further test the performance of the model, data from another institute (n=17) were assigned to the external testing set. Neither ADC values nor delta-ADC values were correlated with treatment response in the three sets. It showed a predictive effect to treatment response that the AUC values of the radiomics signature built from delta-RFs over the first 2 weeks were 0.824, 0.744, and 0.742 in the training, the internal testing, and the external testing set, respectively. Compared with the evaluated response, the performance of response prediction in the internal testing set was acceptable (p = 0.048). Conclusions The ADC map-based delta-RFs during the early course of treatment were effective to predict the response to cCRT in patients with ESCC.

/pdf/response-prediction-to-concurrent-chemoradiotherapy-in-1uvr0p6b.pdf

Response Prediction to Concurrent Chemoradiotherapy in Esophageal Squamous Cell Carcinoma Using Delta-Radiomics Based on Sequential Whole-Tumor ADC Map

High-resolution magnetic resonance (MR) images clearly depict the normal oesophageal wall as consisting of eight layers, which correlates well with histopathological findings. In 56 (91.8%) of 61 lesions, the depth of oesophageal wall invasion determined through MR imaging was consistent with histopathological staging (r = 0.975, P < 0.001). The sensitivity, specificity and accuracy for the mucosa were 71.4%, 98.1%, and 95.1%, respectively, and the corresponding values for the submucosa were 82.4%, 95.5%, and 91.8%; for the muscularis propria, the sensitivity, specificity and accuracy were 100%, 95.7%, and 96.7%, respectively, and for the adventitia, these values were 100%, 100%, and 100%. The Cohen k values for interobserver agreement were excellent: K = 0.839, P < 0.001 (observer 1 vs. observer 2); K = 0.908, P < 0.001 (observer 1 vs. observer 3); and K = 0.885, P < 0.01 (observer 2 vs. observer 3). High-resolution ex vivo MR images obtained with a 3.0 T scanner can be used to precisely evaluate oesophageal carcinoma invasion and provide good diagnostic sensitivity, specificity and accuracy.

/pdf/oesophageal-carcinoma-comparison-of-ex-vivo-high-resolution-4cj3l2txfp.pdf

Oesophageal carcinoma: comparison of ex vivo high-resolution 3.0 T MR imaging with histopathological findings.

Purpose
To prospectively determine the feasibility of T2-mapping magnetic resonance imaging (MRI) to quantitatively describe the signal characteristics of the normal esophageal wall and assess the depth of esophageal wall invasion by carcinoma at 3.0T.

Materials and Methods
Thirty-two patient specimens, each having foci of carcinoma, were studied using 3.0T MR. Freehand regions of interest were placed to measure the T2 value of the normal esophageal layers and were compared with the regions of carcinoma. Three independent readers reviewed the MR images to evaluate the depth of carcinoma invasion; when the three radiologists could not fully agree with each other, the final stage was determined by consensus. The Games-Howell test was used to compare the difference between the normal esophageal layers and carcinoma. Spearman correlation coefficient analysis was used to compare the stage at MRI with that at histopathological analysis. The interobserver agreement was compared with Cohen's kappa. The sensitivity, specificity, and accuracy for detecting carcinoma invasion were calculated.

Results
The T2 values between the carcinoma and normal esophageal layers were different (all P < 0.01), except for the inner circular muscle (P = 0.511). The T2 value of each layer of the normal esophageal wall was also different from that of the adjacent layer (all P < 0.01). In 29 of 32 lesions, the depth of the esophageal wall invasion determined by MR was consistent with the histopathological stage (r = 0.969, P < 0.001). The sensitivity, specificity, and accuracy were 80%, 96.3%, and 93.8%, respectively, for invasion into the mucosa; 77.8%, 95.7%, and 90.6%, respectively, for invasion into submucosa; 100%, 95.8%, and 96.9%, respectively, for invasion into muscularis propria; and 100%, 100%, and 100%, respectively, for invasion into the adventitia.

Conclusion
T2-mapping MR images obtained using a 3.0T MR scanner can be used to depict the precise histopathological layers of the esophageal wall clearly and provide excellent diagnostic accuracy for assessing esophageal carcinoma invasion.

Level of Evidence: 1

J. Magn. Reson. Imaging 2016.

Esophageal carcinoma: Ex vivo evaluation by high‐spatial‐resolution T2‐mapping MRI compared with histopathological findings at 3.0T

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Oesophageal carcinoma: comparison of ex vivo high-resolution 3.0 T MR imaging with histopathological findings.

Esophageal carcinoma: Ex vivo evaluation by high‐spatial‐resolution T2‐mapping MRI compared with histopathological findings at 3.0T