Development of New Imaging Diagnostic Tool for Esophageal Cancer : Virtual Esophagogram and Endoscopy Produced by High-resolution 3D-CT

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Because of stricture of esophagocardiac junction (ECJ), a tumor located in the ECJ could not be well imaged by conventional computed tomography (CT).The purpose of this study was to investigate the utility of the combination of prolonged air infusion as an esophageal dilatation method and virtual esophagogram or endoscopy produced by multi-slice CT for diagnosis of ECJ tumors.The subjects were 15 examples diagnosed by barium study or endoscopic examination including 5 gastric cancers, 4 carcinomas present in ECJ, 4 esophageal cancers, and 2 leiomyomata.Prolonged air infusion CT imaging was performed as follows : First, an endonasal 5-12Fr. tube was placed in the lower esophagus. Subsequently, contrast enhanced CT was performed with 40sec scan delay, 1.25 mm collimation, 3 or 5.5 pitch, and 0.6mm reconstruction while air of 400 mL was injected for persistence in 10mL/sec from the tube in the esophagus beforehand.Compliance was evaluated with three phases. It was "excellent" for the case that lumen was confirmed in esophagus, ECJ, and stomach, each ; The case that lumen was not confirmed only in ECJ was good ; The case that the lumen at esophagus or stomach was not confirmed is poor. Furthermore, visualization ability of a lesion was evaluated in MPR, virtual esophagogram, and endoscopy.Poor was 1 example(7%), excellent 6 (40%), good 8 (53%) regarding compliance of lumen results. Any tumor was identified in MPR, virtual esophagogram, and endoscopy in all 15 cases (including lesions with less than 6mm in diameter). Virtual esophagogram or MPR was able to depict development of the tumor that hang over ECJ in 10 cases except small 2 lesion equal to or less than 2cm in diameter.In conclusion, it was suggested that prolonged air infusion 3D-CT imaging improve visualization ability of ECJ lesions.