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

由于食道心脏交界处狭窄，传统的CT不能很好地显示位于ECJ的肿瘤。本研究的目的是探讨多层螺旋CT仿真食道造影或内窥镜联合应用对ECJ肿瘤的诊断价值。15例患者，其中胃癌5例，ECJ癌4例，食道癌4例，子宫肌瘤2例。置管于下段食道。扫描延迟40s，层厚1.25 mm，螺距3或5.5，重建0.6 mm，注入空气400mL10ml/s，顺应性分为3个阶段。食道、ECJ、胃均证实管腔为“优”，ECJ未确认管腔为好，食道或胃腔未确认为差。此外，在MPR、虚拟食道造影和内窥镜检查中评价病变的可视化能力，管腔结果差1例(7%)，优6例(40%)，良8例(53%)。15例患者(包括直径小于6 mm的病变)均在MPR、仿真食道造影和内窥镜检查中发现肿瘤。除2个直径小于或等于2 cm的小病灶外，虚拟食管图或MPR能显示10例ECJ上方肿瘤的发展情况，提示延长空气灌注期3D-CT成像可提高ECJ病变的显示能力。

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.