Analyzing the post-contrast attenuation of the esophageal wall on routine contrast-enhanced MDCT examination can improve the diagnostic accuracy in response evaluation of the squamous cell esophageal carcinoma to neoadjuvant chemoradiotherapy in comparison with the esophageal wall thickness

  • Aleksandra Djuric-StefanovicEmail author
  • Aleksandra Jankovic
  • Dusan Saponjski
  • Marjan Micev
  • Suzana Stojanovic-Rundic
  • Milena Cosic-Micev
  • Predrag Pesko
Hollow Organ GI



To evaluate the accuracy of the multidetector computed tomography (MDCT) in the response evaluation of the esophageal squamous cell carcinoma (ESCC) to neoadjuvant chemoradiotherapy (nCRT) by analyzing the thickness and post-contrast attenuation of the esophageal wall after the nCRT.


Contrast-enhanced (CE)-MDCT examinations in portal venous phase of one hundred patients with locally advanced ESCC who received nCRT and underwent esophageal resection and histopathology assessment of tumor regression grade (TRG) were retrospectively analyzed by measuring the maximal thickness and mean density of the esophageal wall in the segment involved by tumor and visually searching for hyperdense foci within it. Diagnostic performance was evaluated using the ROC analysis.


Average attenuation of the esophageal wall had stronger diagnostic performance for predicting pathologic complete regression (pCR) (AUC = 0.994; p < 0.001) in relation to maximal esophageal wall thickness (AUC = 0.731; p < 0.001). Maximal esophageal wall thickness ≤ 9 mm and average attenuation of the esophageal wall ≤ 64 HU predicted pCR with the sensitivity, specificity, and overall accuracy of 62.5%, 77.9%, and 73%, and 96.9%, 98.5%, and 98%, respectively. Combination of both cutoff values enabled correct assessment of pCR with the 100% accuracy. Visual detection of the hyperdense focus within the esophageal wall predicted pCR with the sensitivity, specificity, and overall accuracy values of 100%, 94.1%, and 96%, respectively.


Visual analysis and measurement of post-contrast attenuation of the esophageal wall after the nCRT can improve diagnostic accuracy of MDCT in the response evaluation of the ESCC to nCRT in comparison with measuring the esophageal wall thickness.


Esophageal neoplasms Multidetector computed tomography Neoadjuvant therapy Treatment outcome 



Neoadjuvant chemoradiotherapy


Tumor regression grade


Pathologic complete regression


Pathologic partial regression


Complete response


Partial response


Esophageal carcinoma


Esophageal squamous cell carcinoma


Multidetector computed tomography


Contrast-enhanced MDCT


Receiving operation characteristics


Area under the curve


Confidence interval

Pre-nCRT MDCT examination

A MDCT examination before the nCRT

Post-nCRT MDCT examination

A MDCT examination after the nCRT


Positive predictive value


Negative predictive value



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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Digestive Radiology (First Surgery University Clinic), Center of Radiology and MRClinical Center of SerbiaBelgradeSerbia
  2. 2.Department of Pathology, First Surgery University ClinicClinical Center of SerbiaBelgradeSerbia
  3. 3.Clinic for Radiation Oncology and Diagnostics, Department of Radiation OncologyInstitute for Oncology and Radiology of SerbiaBelgradeSerbia
  4. 4.First Surgery University ClinicClinical Center of SerbiaBelgradeSerbia
  5. 5.Faculty of MedicineUniversity of BelgradeBelgradeSerbia

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