Quantitative Assessment Of Resectable Esophageal Squamous Cell Carcinoma With Dynamic Contrast-enhanced Magnetic Resonance Imaging For The Staging

Part one:Diagnosis and Regional Lymphatic Metastasis Prediction of Resectable Esophageal Squamous Cell Carcinoma:Combination of Quantitative and Semi-quantitative Parameters Derived from Dynamic Contrast-enhanced Magnetic Resonance Imaging at 3.0 TObjective:To determine whether combination of quantitative and semi-quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging?DCE-MRI?can help identify resectable esophageal squamous cell carcinoma?ESCC?and regional lymphatic metastasis.Methods:Thirty-nine patients with ESCC underwent DCE-MRI less than 2 weeks before surgery.Endothelial transfer constant(K^trans),reflux rate(K_ep),fractional extravascular extracellular space volume?V_e?and fractional plasma volume?V_p?of ESCC and normal esophagus were measured for quantitative analysis.Time to peak?TTP?,max concentration?MAX Conc?,Max Slope and area under the concentration-time curve?AUC?were calculated for semi-quantitative analysis.Statistical analysis was performed to determine feasibility of DCE-MRI to identify ESCC and lymphatic metastasis.Results:The Mann-Whitney U test revealed that K^trans and K_ep of esophageal cancer were higher whereas TTP was shorter compared with normal oesophagus(K^trans:0.29±0.23 vs.0.18±0.24 ml/min,K_ep:0.56±0.20 vs.0.22±0.15 ml/min,and TTP:2.36±0.54 vs.3.42±0.99 min;all P<0.05);and receiver operating characteristic?ROC?curve analysis showed that K_ep was better than TTP or K^trans for identifying ESCC?areas under ROC curve:0.903 vs.0.832 or 0.713?.K_ep was higher and TTP was shorter in patients with lymphatic metastasis than without this metastasis?both P<0.05?,and TTP was better than K_ep for predicting lymphatic metastasis?areas under ROC curve:0.696 vs.0.659?.The other parameters showed no differences between ESCC and normal esophagus or between statuses of lymphatic metastasis?all P>0.05?.Conclusions:K_ep and TTP can aid identify ESCC and lymphatic metastasis.Part two: Whole-tumor Histogram Analysis of Pharmacokinetic Parameters from Dynamic Contrast-enhanced MRI in Resectable Esophageal Squamous Cell Carcinoma: A Preliminary Correlation study with Pathologic T stage and Lymphatic MetastasisObjective: To determine if pharmacokinetic parameters histograms of ESCC from DCE-MRI are related to pathologic T stage and lymphatic metastasis.Methods: This institutional review board-approved prospective study included 42 patients with biopsy-confirmed ESCC who underwent DCE-MRI.Histogram metrics?median,mean,standard deviation [SD],skewness,kurtosis and entropy?of whole-tumor pharmacokinetic parameters including endothelial transfer constant(K^trans),reflux rate(K_ep)and fractional extravascular extracellular space volume?V_e?of ESCC were generated from Omni-Kinetics software.Statistic analysis was performed to determine correlations of pharmacokinetic parameters histograms with pathologic T stage and lymphatic metastasis.Results: Mann-Whitney U tests revealed K^trans?median,mean and SD?,K_ep?SD and entropy?and V_e?median,mean and entropy?of stage T1/2 ESCC were lower compared with stage T3 disease?all Ps < 0.05?;and K^trans?entropy?and K_ep?median,mean,SD and entropy?were higher while K_ep?skewness?was lower in tumors with lymphatic metastasis than without this metastasis?all Ps < 0.05?.Receiver operating characteristic?ROC?analysis demonstrated entropy of V_e could best distinguish stage T1/2 from stage T3 with a sensitivity of 0.86 and specificity of 0.62;and SD of K_ep could best identify lymphatic metastasis with a sensitivity of 0.78 and specificity of 0.60.The other histograms of pharmacokinetic parameters showed no differences between T stages and between statuses of lymphatic metastasis?all Ps > 0.05?.Conclusions: Pharmacokinetic parameters histograms of ESCC obtained on DCE-MRI are associated with pathologic T stage and lymphatic metastasis.