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
ARTICLE HIGHLIGHTS
Research background

Conventional computed tomography (CT) has limitations for esophageal cancer staging or restaging after treatment. Diagnoses of the T1 and T2 stages exhibit low accuracy due to difficulty visualizing the esophageal mucosa. The optimal monochromatic energy level clearly displays esophageal lesions and the surrounding adipose infiltration by effectively improving the image quality and resolution.

Research motivation

Radiation from multiple follow-ups can be potentially harmful to patients who receive multiple radiation or chemotherapy treatments. Low-dose scanning brings benefits to patients with esophageal cancer. GSI combined with ASIR achieved image quality equal to or greater than that of conventional scanning.

Research objectives

We aimed to evaluate the T stage of esophageal cancer using low-dose spectral insufflation CT, and we discuss the accuracy of this technique for preoperatively diagnosing the T stage.

Research methods

One hundred and twenty patients with esophageal cancer were divided into three groups that included 45 patients (group A underwent conventional 120 kVp CT with 450 mgI/kg contrast medium injection), 40 patients (group B underwent GSI assist and 300 mgI/kg contrast medium injection) and 35 patients (group C underwent insufflation CT combined GSI assist and 300 mgI/kg contrast medium injection). Specific imaging features were observed, and the contrast-to-noise ratio of lesion-to-mediastinal adipose tissue was calculated for qualitative and quantitative T stage evaluation. The radiation dose was measured in each group.

Research results

When performed with insufflation CT combined with GSI assist technology, the ability to present layered enhancement was significantly different for the identification of T1/2 and T3 stage medullary esophageal cancer. Combined analyses of the morphological features and normalized iodine concentration during the arterial phase in the triangular area in front of the vertebral body highlighted a significant difference in discriminating T3 and T4 stage medullary esophageal cancer.

Research conclusions

EUS can be clinically used to determine the infiltration of esophageal cancer and the possibility of surgical resection. However, the detection range is limited to centimeters from the center of the ultrasonic probe without interference or severe stenosis. Currently, CT and PET/CT are common methods used to evaluate the T stage before esophageal cancer treatment. Hence, we aimed to evaluate the T stage of esophageal squamous cell carcinoma using low-dose spectral insufflation CT, and we discuss the accuracy of this technique for preoperatively diagnosing the T stage. We propose the new idea that the T stage for esophageal cancer can be assessed quantitatively and qualitatively methods using low-dose spectral CT scanning. We found that insufflation CT combined GSI assist technology allows a differential diagnosis between the T1/2 and T3 stages. The ability to differentially diagnose the T3 and T4 stages in medullary esophageal cancer can be improved by analyzing the adipose tissue in front of the vertebral body.

Research perspectives

Nose or mouth leaks are unavoidable when patients hold their breath for a long period of time. Furthermore, the process of insufflation CT is influenced by the patient’s age and ability to tolerate the procedures. The future direction of our research will focus on local expansion by lumen filling.