Objectives

Learning objectives

Identify MRI sequences that can be used for clarifying the T-staging of thoracic Oesophagus cancer

Demonstrate how utilising MRI in oesophageal cancer can help better delineate the tissue planes with adjacent organs and thereby aid in clarifying the T-staging

Highlight specific areas where MRI can problem solve in locally invasive thoracic oesophageal cancer

Background

Background:

The standard tool for assessing the local stage of oesophageal cancer is endoscopic ultrasound (EUS). However, approximately 1 in 20 tumours are impassable by EUS even after endoscopic dilatation. An early study showed MRI to have over 80% accuracy for local staging, and therefore may be comparable to EUS. In this exhibit, we describe a case series where MRI has provided improved clarity in the local T-staging compared to CT in patients where EUS was not possible because of luminal compromise.

Imaging findings OR Procedure findings

Imaging findings:

MRI oesophagus confirming Left atrium involvement

MRI clarifying tumour clearance from the aortic arch and descending thoracic aorta

MRI oesophagus showing tracheal involvement

MRI oesophagus clarifying tumour clearance from the left inferior pulmonary vein

MRI oesophagus showing involvement of pericardium only

These MRI features are demonstrated and compared with the related staging CT images.

Conclusion

Conclusion:

MRI of the oesophagus can provide better clarification of the T-staging of thoracic oesophageal cancer compared to CT and can be an invaluable tool particularly in cases where EUS cannot be performed.

Purpose

The national uptake of organ preservation in early rectal cancer in the UK is 17%. Local preservation rates, and potential factors influencing this were reviewed locally for all radiologically staged T1/T2 cancers over a 7 year period.

Material and methods

The medical records of 170 consecutive patients from 2012-2018 with MRI and/or endorectal US staged T1 or T2 rectal cancers were reviewed. Where organ preservation was not performed, the reasons were documented from clinical correspondence. Patients with subsequent benign post-op pathology were included.

Results

Twenty four patients were excluded. The reasons for exclusion were: location higher than 12cm above anal verge (8), unfit/unsuitable for surgery (1), mucinous or adverse histology (3), sphincter involvement (1), MRI node positive (9) or incomplete endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEMS) (2). 82.2% (120/146) patients had organ preservation. Patient choice or clinician preference accounted for 13.0%(19/146). In 4.8% of patients the reason for surgery was not specified. 92.5% of T1s and 80% of T2s had organ preservation. 45.5% (20/44) of all T1s were diagnosed in 2018 following an in-house training programme of 100 validated T1/T2 cases, with 54.5% (24/44) diagnosed over the preceding 6 years.

Conclusion

Surgical acceptance of radiology staging is consistent, with organ preservation directed by the MRI/Endoscopic US staging. An increase in organ preservation rates followed improved case finding and increased yield of T1/T2 on MRI. This post dates the introduction of internal training and validation of early rectal cancer staging, suggesting radiology training, not surgical acceptance, is the limiting step.