Multidetector CT in assessment of disease spectrum of oesophageal carcinoma

Objective: To analyse and discuss the role of multidector CT in the assessment of disease spectrum of oesophageal carcinoma. Materials & Methods: Multidetector CT (MDCT) images of 48 cases of histopathologically proven oesophageal carcinoma were retrospectively reviewed. Axial images in soft tissue, lung and bone windows were analysed along with multiplanar reconstructions wherever necessary. Imaging findings of local extension to various structures were analysed and assessed. The extent of involvement and various complications were also evaluated using established criteria. Involvement of regional and distant lymph nodes as well as distant metastases and their imaging appearances were analysed. A scanning protocol for lungs and abdomen with appropriate intravenous contrast delay with bolus tracking was used to allow biphasic study of the liver. Results: Of 48 cases of oesophageal carcinoma studied, 20 hadperilesional fat involvement, 12 had involvement of the tracheobronchial tree, 10 of the aorta, 2 showed pericardial involvement, 3 had pleural involvement, 5 cases showed gastric invasion, 1 showed direct infiltration of lung parenchyma and 1 case had involvement of the bone by the primary tumour. In 14 cases there was regional lymph node involvement and 4 showed non-regional node involvement There were 11 cases which showed metastatic lesions in the lungs, 8 with metastatic deposits in the liver and 3 with bony metastases. Multidetector CT improves spatial resolution, allows volumetric imaging, muliplanar reformats and enhances confidence in image assessment Conclusion: CT is a widely available and useful investigation in the work up of oesophageal carcinoma. It is an excellent tool for noninvasively determining the extent of oesophageal carcinoma and assessing its resectability. Multidetector CT imaging improves spatial resolution and allows greater confidence in image analysis in addition to providing reformats. Biphasic examination of the liver can routinely be achieved when scanning for chest and abdomen. MDCT should be used routinely in the pretreatment staging and follow-up of the majority of these cases