"Early esophageal rim enhancement": A new sign of esophageal cancer on dynamic CT

Objective: To retrospectively assess a new CT finding of esophageal cancer, "early esophageal rim enhancement". Materials and methods: Sixty-two patients with pathological proven esophageal squamous cell carcinoma who underwent dual phase CT imaging (arterial and venous phases) were enrolled. Two blinded observes independently evaluated presence of partial or circumferential enhancement of the esophageal periphery on arterial (early esophageal rim enhancement) and venous phase CT images. The radiological assessment was compared with the pathological T-stages. Agreement between the observers was also evaluated with a Cohen' kappa value. Results: Pathologic results found 19, 12, 30 and 1 lesions, respectively for T1, T2, T3 and T4 stages. Agreement between two readers was substantial (kappa = 0.71). Esophageal rim enhancement was observed in 0, 4, 24 and 1 lesions respectively for T1, T2, T3 and T4 stages at the arterial phase, whereas no esophageal rim enhancement could be detected at the venous phase. Early esophageal rim enhancement was more frequently observed in T3/T4 lesions than T1/T2 lesions with statistical significance (p < 0.0001). The sensitivity, specificity and accuracy for the diagnosis of T3 or T4 lesion were 80.6%, 87.1% and 83.9%, respectively. Conclusion: Early esophageal rim enhancement may be helpful for assessing invasion into the adventitia. (C) 2012 Elsevier Ireland Ltd. All rights reserved.