Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2018; 24(36): 4197-4207
Published online Sep 28, 2018. doi: 10.3748/wjg.v24.i36.4197
Low-dose spectral insufflation computed tomography protocol preoperatively optimized for T stage esophageal cancer - preliminary research experience
Yue Zhou, Dan Liu, Ping Hou, Kai-Ji Zha, Feng Wang, Kun Zhou, Wei He, Jian-Bo Gao
Yue Zhou, Ping Hou, Kai-Ji Zha, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Dan Liu, Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Feng Wang, Wei He, Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Kun Zhou, Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Gao JB and Zhou Y designed the research; Zhou Y, Hou P, Zha KJ, Liu D, Zhou K and He W performed the research and data analysis; Zhou Y, Hou P and Zha KJ contributed to the statistical analysis; Liu D, Zhou K and He W collected the data and assigned the forms; Zhou Y and Gao JB wrote the paper.
Supported by Scientific and Technological Support Plan Projects of China, No. 2007BAI05B05; and Medical Science and Technology Project of Henan Province, No. 201602012.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of the First Affiliated Hospital of Zhengzhou University.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Bo Gao, MD, PhD, Professor, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou 450052, Henan Province, China. cjr_gaojianbo@163.com
Telephone: +86-371-67966890 Fax: +86-371-66970906
Received: June 25, 2018
Peer-review started: July 2, 2018
First decision: July 17, 2018
Revised: July 28, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 28, 2018
Processing time: 91 Days and 19.4 Hours
Abstract
AIM

To evaluate the T stage of esophageal squamous cell carcinoma (ESCC) using preoperative low-dose esophageal insufflation computed tomography (EICT).

METHODS

One hundred and twenty ESCC patients confirmed by surgery or esophagoscopy were divided into three groups. Groups B and C were injected with 300 mgI/kg contrast medium for automatic spectral imaging assist (GSI assist), while group A underwent a conventional 120 kVp computed tomography (CT) scan with a 450 mgI/kg contrast medium injection. EICT was performed in group C. Group A was reconstructed with filtered back projection, and groups B and C were reconstructed with 50% adaptive statistical iterative reconstruction. The contrast-to-noise ratio of lesion-to-mediastinal adipose tissue and the radiation dose were measured. Specific imaging features were observed, and T stage ESCCs were evaluated.

RESULTS

The sensitivity and accuracy of the T1/2 stage were higher in group C than in groups A and B (sensitivity: 43.75% vs 31.82% and 33.33%; accuracy: 54.29% vs 46.67% and 52.50%, respectively). With regard to the T3 stage, the sensitivity and specificity in group C were higher than those in groups A and B (sensitivity: 56.25% vs 41.17% and 44.44%; specificity: 73.68% vs 67.86% and 63.64%, respectively). The diagnostic sensitivity, specificity and accuracy of the T4 stage were similar among all groups. There were no significant differences in volume CT dose index [(5.91 ± 2.57) mGy vs (3.24 ± 1.20) vs (3.65 ± 1.77) mGy], dose-length product [(167.10 ± 99.08) mGy•cm vs (113.24 ± 54.46) mGy•cm vs (117.98 ± 32.32) mGy•cm] and effective dose [(2.52 ± 1.39) vs (1.63 ± 0.76) vs (1.73 ± 0.44) mSv] among the groups (P > 0.05). However, groups B and C received similar effective doses but lower iodine loads than group A [(300 vs 450) mgI/kg].

CONCLUSION

EICT combined with GSI assist allows differential diagnosis between the T1/2 and T3 stages. The ability to differentially diagnose the T3 and T4 stages of medullary ESCC can be improved by quantitatively and qualitatively analyzing the adipose tissue in front of the vertebral body.

Keywords: Esophageal neoplasms; tomography; tumor staging

Core tip: Esophageal insufflation computed tomography (EICT) is a method of insufflating air into the stomach before computed tomography examination, which fully expands the esophageal lumen. The optimal monochromatic energy level clearly displays esophageal lesions and surrounding adipose infiltration by means of effectively improving the image quality and resolution. Our study demonstrates that EICT combined with GSI assist technology contributes to better performance in the differential diagnosis between the T1/2 vs T3 stages and the T3 vs T4 stages in medullary esophageal cancer.