MR Imaging for Predicting Neoplastic Invasion of the Cervical Esophagus
Sudipta Roychowdhurya,
Laurie A. Loevnera,
David M. Yousema,
Ara Chaliana and
Kathleen T. Montonea
a From the Department of Radiology (S.R.), University of Medicine and Dentistry New Jersey (S.R.), Robert Wood Johnson University Hospital, New Brunswick, NJ; Department of Radiology, Neuroradiology Section (D.M.Y.), Johns Hopkins University, Baltimore, MD; Departments of Radiology, Neuroradiology Section (L.A.L), Otolaryngology, Head and Neck Surgery (L.A.L., A.C.), and Pathology and Laboratory Medicine (K.T.M.), Hospital of the University of Pennsylvania, Philadelphia, PA.
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FIG 1. This 68-year-old woman with a benign, left, thyroidal multinodular goiter demonstrates the normal MR imaging appearance of the adjacent esophagus.
A, Axial T1-weighted image (500/16 [TR/TE]) shows an intact fat plane (arrow) between the esophagus and the mass. The thyroid mass is adjacent to the esophagus, and the esophageal lumen is collapsed.
B, Axial T2-weighted image (3500/84) shows normal hypointense signal of the wall musculature of the esophagus (arrow).
C, Axial enhanced 3D FMPSPGR image (220/27; flip angle, 90o) shows mild enhancement of the mucosal lining of the esophageal wall (arrow).
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FIG 2. This 62-year-old man with metastatic laryngeal carcinoma to cervical lymph nodes had surgically proven esophageal invasion.
A, Axial T1-weighted image (700/17) shows obliteration of the fat plane between the mass (arrowheads) and the right lateral esophageal wall. There is focal wall thickening of the esophagus (white arrow). The esophageal lumen is distended with air (black arrow). The mass abuts the esophageal wall for less than 180o.
B, Axial T2-weighted image (4000/80) demonstrates increased esophageal wall signal (arrow) adjacent to the mass.
C, Axial enhanced 3D FMPSPGR image (235/21; flip angle, 90o) shows increased enhancement of the esophageal wall (arrow) as well as diffuse enhancement of the adjacent mass.
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FIG 3. This 66-year-old man had direct EI by laryngeal carcinoma, resulting in a tracheo-esophageal fistula.
A, Axial T1-weighted image (600/17) shows a mass that surrounds the esophagus (arrows) by approximately 270o. The fat plane between the mass and the esophagus is obliterated. The esophageal lumen contains air.
B, Axial T2-weighted image (4000/80) shows focal increased signal (arrow) in the esophageal wall adjacent to the mass.
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FIG 4. This 72-year-old woman had follicular carcinoma of the left lobe of the thyroid. This case represents a false-positive interpretation of esophageal invasion. There was no evidence of esophageal invasion by surgical or pathologic evaluation.
A, Axial T1-weighted image (700/17) shows effacement of the fat plane between the esophagus and the left thyroid (arrow).
B, Axial T2-weighted image (3000/78) shows focal increased signal within the esophageal wall adjacent to the thyroid mass (arrowheads) compared with the normal right lateral wall of the esophagus (arrow).
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