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Analyzing the post-contrast attenuation of the esophageal wall on routine contrast-enhanced MDCT examination can improve the diagnostic accuracy in response evaluation of the squamous cell esophageal carcinoma to neoadjuvant chemoradiotherapy in comparison with the esophageal wall thickness

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Abstract

Purpose

To evaluate the accuracy of the multidetector computed tomography (MDCT) in the response evaluation of the esophageal squamous cell carcinoma (ESCC) to neoadjuvant chemoradiotherapy (nCRT) by analyzing the thickness and post-contrast attenuation of the esophageal wall after the nCRT.

Methods

Contrast-enhanced (CE)-MDCT examinations in portal venous phase of one hundred patients with locally advanced ESCC who received nCRT and underwent esophageal resection and histopathology assessment of tumor regression grade (TRG) were retrospectively analyzed by measuring the maximal thickness and mean density of the esophageal wall in the segment involved by tumor and visually searching for hyperdense foci within it. Diagnostic performance was evaluated using the ROC analysis.

Results

Average attenuation of the esophageal wall had stronger diagnostic performance for predicting pathologic complete regression (pCR) (AUC = 0.994; p < 0.001) in relation to maximal esophageal wall thickness (AUC = 0.731; p < 0.001). Maximal esophageal wall thickness ≤ 9 mm and average attenuation of the esophageal wall ≤ 64 HU predicted pCR with the sensitivity, specificity, and overall accuracy of 62.5%, 77.9%, and 73%, and 96.9%, 98.5%, and 98%, respectively. Combination of both cutoff values enabled correct assessment of pCR with the 100% accuracy. Visual detection of the hyperdense focus within the esophageal wall predicted pCR with the sensitivity, specificity, and overall accuracy values of 100%, 94.1%, and 96%, respectively.

Conclusion

Visual analysis and measurement of post-contrast attenuation of the esophageal wall after the nCRT can improve diagnostic accuracy of MDCT in the response evaluation of the ESCC to nCRT in comparison with measuring the esophageal wall thickness.

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Abbreviations

nCRT:

Neoadjuvant chemoradiotherapy

TRG:

Tumor regression grade

pCR:

Pathologic complete regression

pPR:

Pathologic partial regression

CR:

Complete response

PR:

Partial response

EC:

Esophageal carcinoma

ESCC:

Esophageal squamous cell carcinoma

MDCT:

Multidetector computed tomography

CE-MDCT:

Contrast-enhanced MDCT

ROC:

Receiving operation characteristics

AUC:

Area under the curve

CI:

Confidence interval

Pre-nCRT MDCT examination:

A MDCT examination before the nCRT

Post-nCRT MDCT examination:

A MDCT examination after the nCRT

PPV:

Positive predictive value

NPV:

Negative predictive value

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Authors and Affiliations

  1. Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MR, Clinical Center of Serbia, Koste Todorovica 6, 11000, Belgrade, Serbia

    Aleksandra Djuric-Stefanovic, Aleksandra Jankovic & Dusan Saponjski

  2. Department of Pathology, First Surgery University Clinic, Clinical Center of Serbia, Belgrade, Serbia

    Marjan Micev & Milena Cosic-Micev

  3. Clinic for Radiation Oncology and Diagnostics, Department of Radiation Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

    Suzana Stojanovic-Rundic

  4. First Surgery University Clinic, Clinical Center of Serbia, Belgrade, Serbia

    Predrag Pesko

  5. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Aleksandra Djuric-Stefanovic, Marjan Micev, Suzana Stojanovic-Rundic & Predrag Pesko

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  1. Aleksandra Djuric-Stefanovic
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  2. Aleksandra Jankovic
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Correspondence to Aleksandra Djuric-Stefanovic.

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Djuric-Stefanovic, A., Jankovic, A., Saponjski, D. et al. Analyzing the post-contrast attenuation of the esophageal wall on routine contrast-enhanced MDCT examination can improve the diagnostic accuracy in response evaluation of the squamous cell esophageal carcinoma to neoadjuvant chemoradiotherapy in comparison with the esophageal wall thickness. Abdom Radiol 44, 1722–1733 (2019). https://doi.org/10.1007/s00261-019-01911-w

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