The evaluation of esophageal adenocarcinoma using dynamic contrast-enhanced magnetic resonance imaging

Although neoadjuvant chemoradiation eradicates esophageal adenocarcinoma in a substantial proportion of patients, conventional imaging techniques cannot accurately detect this response. Dynamic contrast-enhanced magnetic resonance imaging is an emerging approach that may be well suited to fill this role. This pilot study evaluates the ability of this method to discriminate adenocarcinoma from normal esophageal tissue. Patients with esophageal adenocarcinoma and control subjects underwent scanning. Patients treated with neoadjuvant therapy underwent pre- and postchemoradiation scans. Parameters were extracted for each pixel were K-trans (equilibrium rate for transfer of contrast reagent across the vascular wall), v(e) (volume fraction of interstitial space), and tau(i) (mean intracellular water lifetime). Five esophageal adenocarcinoma patients and two tumor-free control subjects underwent scanning. The mean K-trans value was 5.7 times greater in esophageal adenocarcinoma, and tau(i) is 2.0 times smaller, than in the control subjects. K-trans decreased by 11.4-fold after chemoradiation. Parametric maps qualitatively demonstrate a difference in K-trans. DCE MRI of the esophagus is feasible. K-trans, a parameter that has demonstrated discriminative ability in other malignancies, also shows promise in differentiating esophageal adenocarcinoma from benign tissue. The determination of K-trans represents an in vivo assay for endothelial permeability and thus may serve as a quantitative measure of response to induction chemoradiation.