Chonnam Med J.  2020 Jan;56(1):68-74. 10.4068/cmj.2020.56.1.68.

The Diagnostic Utility of Prone Position Chest CT for the Evaluation of Esophageal Cancer

• Lee JE
• Kim YH
• Shin HH
• Jeong WG
• Na KJ

• KMID: 2468149
• DOI: http://doi.org/10.4068/cmj.2020.56.1.68

Abstract

The aim of this study was to assess the potential of a prone chest CT for the evaluation of esophageal cancer, as compared with a routine supine chest CT. 69 patients (67±18 years old) with pathologically confirmed esophageal cancers underwent MDCT in the supine and prone positions. The supine CT was performed first, followed by the prone position. Localization and staging of individual esophageal lesions on both the prone and supine CTs were assessed by two thoracic radiologists, using a scoring system that consisted of three confidence scales, and the results were correlated with the endoscopic and surgical findings. The mean confidence score for the detection of esophageal cancer was higher in the prone position (2.58±0.74) than that in the supine position (2.42±0.83) with statistical significance (p=0.002). The mean confidence score for predicting local invasion in the selected patients (n=18) who underwent esophagectomy was also higher in the prone position (2.39±0.85) than that in the supine position (2.06±0.73) with statistical significance (p=0.01). In 10 of 11 cases that showed definitive determination for periesophageal infiltration or adjacent organ invasion on the prone CT (score 3), the corresponding findings were also observed in the post-operative evaluations. In conclusion, prone chest CT for evaluating esophageal cancer could have advantages in regards to the localization of esophageal cancer and predicting local invasion compared to that of routine supine CT and can improve the diagnostic accuracy of chest CTs.

Keyword

Esophageal Neoplasms; Diagnostic Imaging; X-rays

MeSH Terms

Diagnostic Imaging
Esophageal Neoplasms*
Esophagectomy
Humans
Prone Position*
Supine Position
Thorax*
Tomography, X-Ray Computed*
Weights and Measures

Figure

• 

  FIG. 1 A 75-year-old man with squamous cell carcinoma in the distal esophagus. (A) The axial contrast-enhanced CT scan with the patient in the supine position shows a collapsed esophageal lumen without any detectable mass-like lesion. (B) The axial contrast-enhanced CT scan with the patient in the prone position demonstrates eccentric nodular wall thickening (arrow) by virtue of the broaden interspace between the heart and vertebra and the distended esophagus.

• 

  FIG. 2 A 61-year-old man with squamous cell carcinoma in the mid esophagus. (A and B) The axial contrast enhanced CT scans (A and B) show a protruding mass (black arrows in A and B) in the esophagus. The axial CT scan with the patient in the supine position (A) demonstrates the esophagus, which abuts against the thoracic aorta (arrowheads), with suspicious invasion. However, the axial CT scan with the patient in the prone position (B) clearly demonstrates a fat plane (arrowheads) between the esophageal tumor and thoracic aorta, without evidence of invasion. Esophagectomy was performed in this patient and the postoperative TNM stage was determined to be T2 N0 M0.

• 

  FIG. 3 A 72-year-old man with mid esophageal cancer. (A) The axial contrast-enhanced CT scan with the patient in the supine position shows a hypo-attenuation lesion (white arrow) in the distal esophagus. (B) The axial contrast-enhanced CT scan with the patient in the prone position clearly shows the presence of hypo-attenuation lesion (white arrow in A) that is a necrotizing metastatic lymph node (arrowheads) rather than an esophageal lesion by virtue of the broaden interspace between the esophagus and the vertebral body.

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