Diagnostic Imaging of the Esophageal Cancer

  • Hiroya OjiriEmail author


Diagnostic imaging can play an important role in detecting and staging esophageal cancer. Current diagnostic workup consists of barium esophagography, endoscopy/endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). CT, EUS, MRI, and PET should be considered complementary modalities. In combination, they are crucial to determine the most appropriate treatment for patients with esophageal cancer.

This chapter describes the diagnostic imaging, mainly of CT and MRI, and relevant anatomy of the esophagus for clinical decision-making with regard to esophageal cancers. EUS precisely shows tumor invasion mainly localized in the esophageal wall (defined as T1–3). On the other hand, cross-sectional imaging such as CT and MRI are useful to detect tumor invasion to the adjacent structures beyond the adventitia (defined as T4). Currently, regional lymph node metastases are evaluated using EUS, CT, and/or FDG-PET. Detection of metastatic lymphadenopathies on CT depends primarily on nodal size (size criteria) although size is known to be an insensitive parameter. MRI’s role to assess regional nodal metastasis is limited so far. CT is currently the best diagnostic method to detect metastases.


CT Esophageal cancer Imaging MRI 


  1. 1.
    American Joint Committee on Cancer, Edge SB, et al. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag; 2010.CrossRefGoogle Scholar
  2. 2.
    Mancuso AA. Cervical esophagus. In: Mancuso AA, editor. Head and neck radiology. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer; 2011.Google Scholar
  3. 3.
    Hasegawa N, Niwa Y, Arisawa T, et al. Preoperative staging of superficial esophageal carcinoma: comparison of an ultrasound probe and standard endoesopic ultrasonography. Gastrointest Endosc. 1996;39:388–92.CrossRefGoogle Scholar
  4. 4.
    Postlethwait RW. Carcinoma of the thoracic esophagus. Surg Clin North Am. 1983;63:933–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim TJ, Kim HY, Lee KW, et al. Multimodality assessment of esophageal cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2009;29:403–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237:414–27.PubMedCrossRefGoogle Scholar
  7. 7.
    The Japan Esophageal Society. Japanese classification of esophageal cancer. 10th ed. Tokyo: Kanehara Co. Ltd; 2008.Google Scholar
  8. 8.
    Levine MS, Chu P, Furth EE, et al. Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis. AJR Am J Roentgenol. 1997;168:1423–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Levine MS, Halvorsen RA. Esophageal carcinoma. In: Core RM, Levine MS, Laufer I, editors. Textbook of gastrointestinal radiology. Philadelphia: WB Saunders Co; 1994.Google Scholar
  10. 10.
    Wakelin SJ, Deans C, Crofts TJ, et al. A comparison of computerized tomography, laparoscopic ultrasound and endoscopic ultrasound in the preoperative staging of oesophagogastric carcinoma. Eur J Radiol. 2002;41:161–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Preston ST, Clark GW, Martin IG, et al. Effect of endoscopic ultrasonography on the management of 100 consecutive patients with oesophageal and junctional carcinoma. Br J Surg. 2003;90:1220–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Holsher AH, Dittler HJ, Siewert JR. Staging of squamous esophageal cancer: accuracy and value. World J Surg. 1994;18:312–20.CrossRefGoogle Scholar
  13. 13.
    van den Hoed RD, Feldberg MAM, van Leeuwen MS, et al. CT prediction of irresectability in esophageal carcinoma: value of additional patient positions and relation to patient outcome. Abdom Imaging. 1997;22:132–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Thompson WM, Halvorsen RA, Foster WL Jr, et al. Computed tomography for staging esophageal and gastroesophgaeal cancer: reevaluation. AJR Am J Roentgenol. 1983;141:951–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Halvorsen RA Jr, Thompson WM. Computed tomographic staging of gastrointestinal malignancies. I. Esophagus and stomach. Investig Radiol. 1987;22:2–16.CrossRefGoogle Scholar
  16. 16.
    Umeoka S, Koyama T, Togashi K, et al. Esophageal cancer: evaluation with triple-phase dynamic CT - initial experience. Radiology. 2006;239:777–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Umeoka S, Okada T, Daido S, et al. “Early esophageal rim enhancement”: a new sign of esophageal cancer on dynamic CT. Eur J Radiol. 2013;82:459–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Yoon YC, Lee KS, Shim YM, et al. Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG PET for presurgical detection prospective study. Radiology. 2003;227:764–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Desai RK, Tagliabue JR, Wegryn SA, et al. CT evaluation of wall thickening in the alimentary tract. Radiographics. 1991;11:771–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Xia F, Mao J, Ding J, Yang H. Observation of normal appearance and wall thickness of esophagus on CT images. Eur J Radiol. 2009;72:406–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Liao ZX, Liu H, Komaki R. Target delineation for esophageal cancer. J Women’s Imaging. 2003;5:177–86.CrossRefGoogle Scholar
  22. 22.
    Moss AA, Schnyder P, Thoeni RF, et al. Esophageal carcinoma: pretherapy staging by computed tomography. Am J Roentgenol. 1981;136:1051–6.CrossRefGoogle Scholar
  23. 23.
    Noh HM, Fishman EK, Forastiere AA, et al. CT of the esophagus: spectrum of disease with emphasis on esophageal carcinoma. Radiographics. 1995;15:1113–34.PubMedCrossRefGoogle Scholar
  24. 24.
    Van Rossum PSN, van Hillegersberg R, Lever FM, et al. Imaging strategies in the management of oesophageal cancer: what’s the role of MRI? Eur Radiol. 2013;23:1753–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Picus D, Balfe DM, Koehler RE, et al. Computed tomography in the staging of esophageal carcinoma. Radiology. 1983;46:433–8.CrossRefGoogle Scholar
  26. 26.
    Lehr L, Rupp N, Siewert JR. Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging. Surgery. 1988;103:344–50.PubMedGoogle Scholar
  27. 27.
    Takashima S, Takeuchi N, Shiozaki H, et al. Carcinoma of the esophagus: CT vs MR imaging in determining resectability. AJR Am J Roentgenol. 1991;156:297–302.PubMedCrossRefGoogle Scholar
  28. 28.
    Quint LE, Bogot NR. Staging esophageal cancer. Cancer Imaging. 2008;8:S33–42. Sepec No APubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Lefor AT, Merino MM, Steinberg SM, et al. Computerized tomographic prediction of extraluminal spread and prognostic implications of lesion width in esophageal cancer (abstr). Radiology. 1989;171:290.CrossRefGoogle Scholar
  30. 30.
    Ruf G, Brobmann GF, Grosser G, et al. Wert der Computer-tomographie fur die Beurteiling der lokalen Operabilitat und die chirurgische Verfahrenswahl beim Oesophagus-carcinoom. Langenbecks Arch Chir. 1985;365:157–68.PubMedCrossRefGoogle Scholar
  31. 31.
    Ogawa Y, Nischiyama K, Ikesoe J, et al. Preoperative assessment of tumor invasions of the intrathoracic esophageal carcinoma. In: Siewert JR, Holscher AH, editors. Diseases of the esophagus. 1st ed. New York: Springer; 1987. p. 203–6.Google Scholar
  32. 32.
    Sakurada A, Takahara T, Kwee IC, et al. Diagnostic performance of diffusion-weighted magnetic resonance imaging in esophageal cancer. Eur Radiol. 2009;19:1461–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Iyer RB, Silverman PM, Tamm EP, et al. Imaging in oncology from the University of Texas M.D. Anderson cancer center. Diagnosis, staging, and follow-up of esophageal cancer. AJR Am J Roentgenol. 2003;181:785–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Block MI, Patterson GA, Sundaresan RS, et al. Improvement in staging of esophageal cancer with the addition of positron emission tomography. Ann Thorac Surg. 1997;64:770–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Kato H, Kuwano H, Nakajima M, et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002;94:921–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Van Vliet EP, Heijenbrok-Kal MH, Hunink MG, et al. Staging investigation for oesophageal cancer: a meta-analysis. Br J Cancer. 2008;98:547–57.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Van Westreenen HL, Westerterp M, Bossuyt PM, et al. Systematic review of the staging performance of 18F-fluiorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol. 2004;22:3805–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Quint LE, Hepbum LM, Francis IR, et al. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma. Cancer. 1995;76:1120–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Mandard AM, Chasle J, Marnay J, et al. Autopsy findings in 111 cases of esophageal cancer. Cancer. 1981;48:329–35.PubMedCrossRefGoogle Scholar
  40. 40.
    Flanagan FL, Dehdashti F, Siegel BA, et al. Staging of esophageal cancer with 18F-fluirodeoxyglucose positron emission tomography. AJR Am J Roentgenol. 1997;168:417–24.PubMedCrossRefGoogle Scholar
  41. 41.
    Flamen P, Lerut A, Van Cutsem E, et al. Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol. 2000;18:3202–10.PubMedCrossRefGoogle Scholar
  42. 42.
    Downey RJ, Akhurst T, Ilson D, et al. Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of the prospective trial. J Clin Oncol. 2003;21:428.PubMedCrossRefGoogle Scholar
  43. 43.
    Rice TW. Clinical staging of esophageal carcinoma. CT, EUS, and PET. Chest Surg Clin N Am. 2000;10:471–85.PubMedGoogle Scholar
  44. 44.
    Carlisle JG, Quint LE, Francis IR, et al. Recurrent esophageal carcinoma: CT evaluation after esophagectomy. Radiology. 1993;189:271–5.PubMedCrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of RadiologyThe Jikei University School of MedicineTokyoJapan

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