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Imaging Features of Primary and Recurrent Esophageal Cancer at FDG PET¹

¹ From the Department of Nuclear Medicine and Radiology, McMaster University Medical Centre, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5 (S.J.S., A.L.B., M.T., G.C., C.N.); and the Department of Surgery, St Joseph's Hospital, Hamilton, Ontario, Canada (J.E.M.Y.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received April 20, 1999; revision requested May 11 and received July 12; accepted July 13. Address reprint requests to C.N. (e-mail: nahmias@fhs.mcmaster.ca).

Because of the poor prognosis for patients with esophageal cancer and the risks associated with surgical intervention, accurate staging is essential for optimal treatment planning. Positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) is a useful adjunct to more conventional imaging modalities in this setting. FDG PET is not an appropriate first-line diagnostic procedure in the detection of esophageal cancer and is not helpful in detecting local invasion by the primary tumor, and further studies are required to determine its efficacy in the detection of local nodal metastases. However, FDG PET is superior to anatomic imaging modalities in the ability to detect distant metastases. Metastases to the liver, lungs, and skeleton can readily be identified at FDG PET. In addition, FDG PET has proved valuable in determining the resectability of disease and allows scanning of a larger volume than is possible with computed tomography. Recurrent disease is readily diagnosed and differentiated from scar tissue with FDG PET. In addition, FDG PET may play a valuable role in the follow-up of patients who undergo chemotherapy and radiation therapy, allowing early changes in treatment for unresponsive tumors. The management of most patients with esophageal cancer can be improved with use of FDG PET.

Index Terms: Esophagus, neoplasms, 40.33, 60.33, 71.32, 761.332 • Esophagus, PET, 71.12163 • Esophagus, radionuclide studies, 71.12163 • Positron emission tomography (PET), comparative studies, 71.12163

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