In terms of effects on clinical staging, You et al [17] prospectively evaluated 491 patients with esophageal cancer with FDG-PET/CT and reported clinically important stage changes in 188 (24%) patients. In a smaller cohort, Williams et al [18] reported the use of FDG-PET/CT changing initial staging in 10 of 38 (26%) patients with esophageal cancer, with 7 of 38 (18%) patients having a concomitant management change. FDG-PET/MRI Skull Base to Mid-Thigh There are no substantial data supporting the use of FDG-PET/MRI in the staging of esophageal cancer. In a small study evaluating 19 patients with esophageal cancer who underwent esophageal US, CT, FDG-PET/CT, and FDG- PET/MRI, Lee et al [19] reported acceptable T staging compared with esophageal US and statistically nonsignificant but higher accuracy than esophageal US and FDG-PET/CT for N staging. Impact on M staging was not reported. Given available data on the performance of FDG-PET/CT in the evaluation of M disease, it would be expected that FDG-PET/MRI may have similar potential, but data supporting its use are not yet available. Fluoroscopy Upper GI Series There is no relevant literature to support the use of fluoroscopy upper gastrointestinal (GI) series in the staging of esophageal cancer. MRI Chest and Abdomen There is only limited evidence supporting the use of MRI chest and abdomen in the evaluation of patients with esophageal cancer. Giganti et al [20] compared MRI, CT, esophageal US, and FDG-PET/CT in 27 patients with esophageal cancer. In this small study, contrast-enhanced MRI with diffusion-weighted imaging showed higher specificity (92%) and accuracy (82%) for T staging, but esophageal US was the most sensitive modality. MRI showed the highest reported accuracy for N stage (66%) in this study, although this would be in line with values previously determined for other imaging modalities.
Staging and Follow up of Esophageal Cancer. In terms of effects on clinical staging, You et al [17] prospectively evaluated 491 patients with esophageal cancer with FDG-PET/CT and reported clinically important stage changes in 188 (24%) patients. In a smaller cohort, Williams et al [18] reported the use of FDG-PET/CT changing initial staging in 10 of 38 (26%) patients with esophageal cancer, with 7 of 38 (18%) patients having a concomitant management change. FDG-PET/MRI Skull Base to Mid-Thigh There are no substantial data supporting the use of FDG-PET/MRI in the staging of esophageal cancer. In a small study evaluating 19 patients with esophageal cancer who underwent esophageal US, CT, FDG-PET/CT, and FDG- PET/MRI, Lee et al [19] reported acceptable T staging compared with esophageal US and statistically nonsignificant but higher accuracy than esophageal US and FDG-PET/CT for N staging. Impact on M staging was not reported. Given available data on the performance of FDG-PET/CT in the evaluation of M disease, it would be expected that FDG-PET/MRI may have similar potential, but data supporting its use are not yet available. Fluoroscopy Upper GI Series There is no relevant literature to support the use of fluoroscopy upper gastrointestinal (GI) series in the staging of esophageal cancer. MRI Chest and Abdomen There is only limited evidence supporting the use of MRI chest and abdomen in the evaluation of patients with esophageal cancer. Giganti et al [20] compared MRI, CT, esophageal US, and FDG-PET/CT in 27 patients with esophageal cancer. In this small study, contrast-enhanced MRI with diffusion-weighted imaging showed higher specificity (92%) and accuracy (82%) for T staging, but esophageal US was the most sensitive modality. MRI showed the highest reported accuracy for N stage (66%) in this study, although this would be in line with values previously determined for other imaging modalities.