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

Diagnostic value of combining ultrafast cine MRI and morphological measurements on gastroesophageal reflux disease

PURPOSE

To evaluate the diagnostic performance of combining ultrafast real-time cine MRI with morphological measurements on gastroesophageal reflux disease (GERD).

METHODS

In the prospective study, 40 healthy volunteers and 30 GERD patients underwent real-time cine MRI using an undersampled low-angle gradient echo sequence (50 ms/frame) with deep-learning reconstruction, to monitor the gastroesophageal junction (GEJ) and observe the reflux of the contrast agent during the Valsalva maneuver. The width of the lower esophagus, the length of the lower esophageal sphincter (LES), the end-expiratory and post Valsalva maneuver His angle were measured.

RESULTS

There were no statistical differences between the two group either in lower esophageal width (14.06 ± 1.50 mm vs. 14.75 ± 1.57 mm, P > 0.05) or LES length (25.20 ± 1.46 mm vs. 24.39 ± 1.68 mm, P > 0.05). The end-expiratory His angle (84.45 ± 18.67°) and post Valsalva maneuver His angle (101.53 ± 19.22°), and the differences between them (17.08 ± 5.65°) in the GERD group were greater than those in the healthy volunteers (71.51 ± 18.01°, 86.09 ± 18.24°, 14.57 ± 3.88° respectively, P < 0.05). Reflux was induced in 8 cases of GERD group including 4 cases with hiatus hernia and not observed in healthy volunteers. The AUC for diagnosing GERD were 0.702, 0.737 and 0.634 for end-expiratory, post Valsalva maneuver His angle and their differences, when combined with real-time MRI was 0.823, with a sensitivity of 86.67% and a specificity of 67.50%.

CONCLUSION

Real-time MRI can display dynamic swallowing and reflux at the GEJ. The His angle can serve as a morphological indicator for diagnosing GERD with MRI.

Esophageal cancer T-staging on MRI: A preliminary study using cine and static MR sequences

OBJECTIVES

To evaluate the added value of cine MR in addition to static MRI for T-Staging assessment of esophageal cancer (EC).

MATERIALS AND METHODS

This prospective monocentric study included 54 patients (mean age 66.3 ± 9.4 years, 46 men) with histologically proven EC. They underwent MRI on a 3 T-scanner in addition to the standard workup. Acquisitions included static and cine sequences (steady-state-free-precession and real-time True-FISP during water ingestion). Three radiologists independently assessed T-staging and diagnosis confidence by reviewing (1) static sequences (S-MRI) and (2) adding cine sequences (SC-MRI). Inter-reader agreement was performed. MRI T-staging was correlated to reference standard T-staging (histopathology or consensus on endoscopic ultrasonography and imaging findings) and to clinical outcome by log-rank test.

RESULTS

Both S-MRI and SC-MRI T-staging showed a significant correlation with reference T-staging (rs = 0.667, P < 0.001). SC-MRI showed a slightly better performance in distinguishing T1-T3 from T4 with a sensitivity, specificity and AUC of 76.5% (95% CI: 50.1-93.2), 83.8% (68-93.8) and 0.801 (0.681-0.921) vs 70.6% (44-89.7), 83% (68-93.8) and 0.772 (0.645-0.899) for S-MRI. Compared to S-MRI, SC-MRI increased inter-reader agreement for T4a and T4b (κ = 0.403 and 0.498) and T-staging confidence.

CONCLUSION

MRI is accurate for T-staging of EC. The addition of cine sequences allows better differentiation between T1-T3 and T4 tumors with increased diagnostic confidence and inter-reader agreement.

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

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.

Giant epiphrenic diverticulum: an unusual case from diagnosis to treatment

Esophageal diverticulum is a rare disease caused by impairment of esophageal motility. The incidence is not known, due to lack of symptoms in many cases. Surgical treatment is reserved to symptomatic patients.

In this case report, we describe a rare case of epiphrenic esophageal diverticulum. A 61-year-old male with silent medical history, suffering severe chest pain had a CT scan showing a large esophageal diverticulum. The patient was referred to our hospital, IRCCS “Casa Sollievo della Sofferenza”, to complete pre-operative assessment with a CT scan and a Barium swallowing radiography, giving morphodimensional details of the diverticulum. Based on these findings, the surgeons have chosen the appropriate operative strategy. The surgeons adopted a laparoscopic access, completed with robotic-assisted laparotomy due to the morphology of the diverticulum.

Radiological evaluation is crucial in the diagnosis and in the treatment planning of symptomatic patients.

Detection and Independent Validation of Model-Based Quantitative Transcriptional Regulation Relationships Altered in Lung Cancers

Differential expressions of genes are widely evaluated for the diagnosis and prognosis correlations with diseases. But limited studies investigate how transcriptional regulations are quantitatively altered in diseases. This study proposes a novel model-based quantitative measurement of transcriptional regulatory relationships between mRNA genes and Transcription Factor (TF) genes (mqTrans features). This study didn't consider the regulatory relationships between TF genes, so the mRNA genes were the protein-coding genes excluding the TF genes. The models are trained in the control samples in a lung cancer dataset and evaluated in two independent datasets and the hold-out testing samples from the third dataset. Twenty-nine mRNA genes are detected with transcriptional regulations quantitatively altered in lung cancers. The transcriptional modification technologies like RNA interference (RNAi) may be utilized to restore the altered transcriptional regulations in lung cancers.