HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Skehan, S. J. Articles by Nahmias, C. Search for Related Content PubMed PubMed Citation Articles by Skehan, S. J. Articles by Nahmias, C. Related Collections Nuclear Medicine Gastrointestinal Radiology

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).

View larger version (88K): [in a new window]   Figure 1.   Squamous cell carcinoma in a 68-year-old man. Sagittal PET scan demonstrates an extensive squamous cell tumor with marked FDG uptake in the upper esophagus (arrow).

View larger version (106K): [in a new window]   Figure 2a.   Adenocarcinoma in a 65-year-old man with underlying Barrett esophagus. (a) Coronal PET scan shows a tumor with intense focal uptake in the lower esophagus (straight arrow). Mild to moderate uptake is seen in the esophagus above and below this level due to inflammatory changes (curved arrows). (b) Axial PET scan also clearly depicts the tumor (straight arrow). Normal moderate FDG uptake is noted in the left ventricular myocardium (curved arrow).

View larger version (73K): [in a new window]   Figure 2b.   Adenocarcinoma in a 65-year-old man with underlying Barrett esophagus. (a) Coronal PET scan shows a tumor with intense focal uptake in the lower esophagus (straight arrow). Mild to moderate uptake is seen in the esophagus above and below this level due to inflammatory changes (curved arrows). (b) Axial PET scan also clearly depicts the tumor (straight arrow). Normal moderate FDG uptake is noted in the left ventricular myocardium (curved arrow).

View larger version (106K): [in a new window]   Figure 3a.   Primary adenocarcinoma of the gastroesophageal junction with metastatic nodal involvement in a 59-year-old man. (a) Coronal PET scan demonstrates a primary tumor (straight arrow) and a left-sided gastric lymph node (arrowhead) with increased FDG uptake. Normal uptake is seen in the left ventricle above the primary tumor (curved arrow). Metastatic involvement of the node was confirmed at total thoracic esophagectomy. (b) Axial CT scan demonstrates two lymph nodes in the same region (arrows) (cf a). The larger posterior node measured 18 mm in diameter.

View larger version (113K): [in a new window]   Figure 3b.   Primary adenocarcinoma of the gastroesophageal junction with metastatic nodal involvement in a 59-year-old man. (a) Coronal PET scan demonstrates a primary tumor (straight arrow) and a left-sided gastric lymph node (arrowhead) with increased FDG uptake. Normal uptake is seen in the left ventricle above the primary tumor (curved arrow). Metastatic involvement of the node was confirmed at total thoracic esophagectomy. (b) Axial CT scan demonstrates two lymph nodes in the same region (arrows) (cf a). The larger posterior node measured 18 mm in diameter.

View larger version (90K): [in a new window]   Figure 4a.   Adenocarcinoma of the lower esophagus with metastatic nodal involvement in a 48-year-old woman. (a) Coronal PET scan clearly depicts a tumor (curved arrow). A metastatic node is seen adjacent to the right superior border of the tumor (straight arrow). Normal uptake is seen in the kidneys (arrowheads) and descending colon. (b) Coronal PET scan obtained anterior to a demonstrates abnormal uptake in both a paraesophageal node (straight arrow) and, inferiorly, in a left-sided gastric node (curved arrow). Prominent uptake is also seen in the ascending colon and splenic flexure (arrowheads). The latter findings may be normal or may represent inflammatory change and were not investigated further.

View larger version (98K): [in a new window]   Figure 4b.   Adenocarcinoma of the lower esophagus with metastatic nodal involvement in a 48-year-old woman. (a) Coronal PET scan clearly depicts a tumor (curved arrow). A metastatic node is seen adjacent to the right superior border of the tumor (straight arrow). Normal uptake is seen in the kidneys (arrowheads) and descending colon. (b) Coronal PET scan obtained anterior to a demonstrates abnormal uptake in both a paraesophageal node (straight arrow) and, inferiorly, in a left-sided gastric node (curved arrow). Prominent uptake is also seen in the ascending colon and splenic flexure (arrowheads). The latter findings may be normal or may represent inflammatory change and were not investigated further.

View larger version (85K): [in a new window]   Figure 5a.   Squamous cell carcinoma of the lower esophagus in a 67-year-old man. (a, b) Coronal (a) and axial (b) PET scans demonstrate a tumor with increased FDG uptake (straight arrow), but there is no evidence of adjacent nodal involvement. Normal renal excretion of FDG is evident on the coronal image (curved arrows in a). (c) CT scan obtained at the same level as a shows circumferential thickening of the esophageal wall (arrow) without adjacent lymphadenopathy. Metastatic involvement of paraesophageal nodes was proved at histologic analysis of the specimen that was resected at total thoracic esophagectomy, indicating false-negative findings at FDG PET for local nodal metastases.

View larger version (68K): [in a new window]   Figure 5b.   Squamous cell carcinoma of the lower esophagus in a 67-year-old man. (a, b) Coronal (a) and axial (b) PET scans demonstrate a tumor with increased FDG uptake (straight arrow), but there is no evidence of adjacent nodal involvement. Normal renal excretion of FDG is evident on the coronal image (curved arrows in a). (c) CT scan obtained at the same level as a shows circumferential thickening of the esophageal wall (arrow) without adjacent lymphadenopathy. Metastatic involvement of paraesophageal nodes was proved at histologic analysis of the specimen that was resected at total thoracic esophagectomy, indicating false-negative findings at FDG PET for local nodal metastases.

View larger version (90K): [in a new window]   Figure 5c.   Squamous cell carcinoma of the lower esophagus in a 67-year-old man. (a, b) Coronal (a) and axial (b) PET scans demonstrate a tumor with increased FDG uptake (straight arrow), but there is no evidence of adjacent nodal involvement. Normal renal excretion of FDG is evident on the coronal image (curved arrows in a). (c) CT scan obtained at the same level as a shows circumferential thickening of the esophageal wall (arrow) without adjacent lymphadenopathy. Metastatic involvement of paraesophageal nodes was proved at histologic analysis of the specimen that was resected at total thoracic esophagectomy, indicating false-negative findings at FDG PET for local nodal metastases.

View larger version (106K): [in a new window]   Figure 6a.   Adenocarcinoma of the gastroesophageal junction in a 72-year-old woman. Coronal (a) and axial (b) PET scans of the upper abdomen demonstrate a focus of increased FDG uptake in the liver (arrow), a finding that is consistent with metastasis. Biopsy was not performed, and the patient died 6 months later with multiple hepatic metastases.

View larger version (86K): [in a new window]   Figure 6b.   Adenocarcinoma of the gastroesophageal junction in a 72-year-old woman. Coronal (a) and axial (b) PET scans of the upper abdomen demonstrate a focus of increased FDG uptake in the liver (arrow), a finding that is consistent with metastasis. Biopsy was not performed, and the patient died 6 months later with multiple hepatic metastases.

View larger version (85K): [in a new window]   Figure 7a.   Adenocarcinoma of the gastroesophageal junction in a 75-year-old man. (a) Coronal PET scan shows increased FDG uptake in a primary tumor (straight arrow), both pulmonary hila (curved arrows), and multiple sites within the mediastinum. The linear pattern of FDG uptake in the abdomen inferior to the primary tumor (arrowhead) is due to left-sided paraaortic nodal involvement. (b) Axial PET scan clearly shows a deposit of FDG in the right lung parenchyma (straight arrow). The other areas of abnormal increased uptake represent the pulmonary hila (curved arrows) and an azygoesophageal node (arrowhead).

View larger version (66K): [in a new window]   Figure 7b.   Adenocarcinoma of the gastroesophageal junction in a 75-year-old man. (a) Coronal PET scan shows increased FDG uptake in a primary tumor (straight arrow), both pulmonary hila (curved arrows), and multiple sites within the mediastinum. The linear pattern of FDG uptake in the abdomen inferior to the primary tumor (arrowhead) is due to left-sided paraaortic nodal involvement. (b) Axial PET scan clearly shows a deposit of FDG in the right lung parenchyma (straight arrow). The other areas of abnormal increased uptake represent the pulmonary hila (curved arrows) and an azygoesophageal node (arrowhead).

View larger version (88K): [in a new window]   Figure 8a.   Adenocarcinoma of the gastroesophageal junction in a 52-year-old man. (a) Axial PET scan demonstrates a tumor with increased FDG uptake (arrow). (b) Coronal PET scan shows nodal metastases in the paratracheal region (straight arrow) and extensive retroperitoneal involvement (curved arrows). (c) Axial PET scan obtained inferior to the primary tumor demonstrates a large area of FDG uptake anterior to the spine (straight arrow) corresponding to gross enlargement of celiac nodes (curved arrows).

View larger version (111K): [in a new window]   Figure 8b.   Adenocarcinoma of the gastroesophageal junction in a 52-year-old man. (a) Axial PET scan demonstrates a tumor with increased FDG uptake (arrow). (b) Coronal PET scan shows nodal metastases in the paratracheal region (straight arrow) and extensive retroperitoneal involvement (curved arrows). (c) Axial PET scan obtained inferior to the primary tumor demonstrates a large area of FDG uptake anterior to the spine (straight arrow) corresponding to gross enlargement of celiac nodes (curved arrows).

View larger version (92K): [in a new window]   Figure 8c.   Adenocarcinoma of the gastroesophageal junction in a 52-year-old man. (a) Axial PET scan demonstrates a tumor with increased FDG uptake (arrow). (b) Coronal PET scan shows nodal metastases in the paratracheal region (straight arrow) and extensive retroperitoneal involvement (curved arrows). (c) Axial PET scan obtained inferior to the primary tumor demonstrates a large area of FDG uptake anterior to the spine (straight arrow) corresponding to gross enlargement of celiac nodes (curved arrows).

View larger version (82K): [in a new window]   Figure 9a.   Adenocarcinoma of the lower esophagus in a 35-year-old man. (a) Sagittal PET scan clearly demonstrates a tumor with increased FDG uptake in the lower esophagus (straight arrow). A smaller focus of uptake is visible in the lower cervical region (curved arrow). (b, c) Coronal (b) and axial (c) PET scans obtained just above the level of the sternoclavicular joints help confirm abnormal FDG uptake in a left supraclavicular node (arrow). The patient underwent palliative surgery but died several months later with mediastinal, hepatic, and left supraclavicular metastases.

View larger version (93K): [in a new window]   Figure 9b.   Adenocarcinoma of the lower esophagus in a 35-year-old man. (a) Sagittal PET scan clearly demonstrates a tumor with increased FDG uptake in the lower esophagus (straight arrow). A smaller focus of uptake is visible in the lower cervical region (curved arrow). (b, c) Coronal (b) and axial (c) PET scans obtained just above the level of the sternoclavicular joints help confirm abnormal FDG uptake in a left supraclavicular node (arrow). The patient underwent palliative surgery but died several months later with mediastinal, hepatic, and left supraclavicular metastases.

View larger version (47K): [in a new window]   Figure 9c.   Adenocarcinoma of the lower esophagus in a 35-year-old man. (a) Sagittal PET scan clearly demonstrates a tumor with increased FDG uptake in the lower esophagus (straight arrow). A smaller focus of uptake is visible in the lower cervical region (curved arrow). (b, c) Coronal (b) and axial (c) PET scans obtained just above the level of the sternoclavicular joints help confirm abnormal FDG uptake in a left supraclavicular node (arrow). The patient underwent palliative surgery but died several months later with mediastinal, hepatic, and left supraclavicular metastases.

View larger version (76K): [in a new window]   Figure 10.   Adenocarcinoma in a 56-year-old man who had undergone total thoracic esophagectomy for regional nodal involvement 15 months earlier. Follow-up CT had demonstrated a soft-tissue mass in the azygos region. Axial PET scan shows intense FDG uptake in the mass (arrow), which proved to be recurrent tumor at CT-guided biopsy.

View larger version (85K): [in a new window]   Figure 11a.   Adenocarcinoma of the lower esophagus in an asymptomatic 70-year-old man who had undergone total thoracic esophagectomy 3 months earlier. Findings at follow-up CT were normal. Follow-up coronal (a) and axial (b) PET scans demonstrate abnormal uptake in the left supraclavicular fossa (arrows), which proved to be metastatic nodal disease at biopsy. The patient underwent radiation therapy but died 6 months later.

View larger version (51K): [in a new window]   Figure 11b.   Adenocarcinoma of the lower esophagus in an asymptomatic 70-year-old man who had undergone total thoracic esophagectomy 3 months earlier. Findings at follow-up CT were normal. Follow-up coronal (a) and axial (b) PET scans demonstrate abnormal uptake in the left supraclavicular fossa (arrows), which proved to be metastatic nodal disease at biopsy. The patient underwent radiation therapy but died 6 months later.

View larger version (89K): [in a new window]   Figure 12a.   Adenocarcinoma of the lower esophagus in a 70-year-old man who had undergone palliative esophagectomy 7 months earlier. (a) CT scan obtained 1 month prior to presentation shows a bilobed mass to the right of the descending aorta (arrows). A subcutaneous nodule (not shown) was subsequently excised. (b) Axial PET scan helps confirm pathologic FDG uptake in the region of the previous surgery (curved arrow) and demonstrates abnormal uptake in the right axilla and scapula (straight arrow). The latter lesion became clinically apparent 1 month later and was treated with local radiation therapy. The patient died 8 months later of disseminated metastatic disease.

View larger version (54K): [in a new window]   Figure 12b.   Adenocarcinoma of the lower esophagus in a 70-year-old man who had undergone palliative esophagectomy 7 months earlier. (a) CT scan obtained 1 month prior to presentation shows a bilobed mass to the right of the descending aorta (arrows). A subcutaneous nodule (not shown) was subsequently excised. (b) Axial PET scan helps confirm pathologic FDG uptake in the region of the previous surgery (curved arrow) and demonstrates abnormal uptake in the right axilla and scapula (straight arrow). The latter lesion became clinically apparent 1 month later and was treated with local radiation therapy. The patient died 8 months later of disseminated metastatic disease.

View larger version (116K): [in a new window]   Figure 13a.   Photopenic defect in a 57-year-old man who had undergone esophagectomy for esophageal cancer. Coronal (a) and axial (b) FDG PET scans demonstrate a right-sided paravertebral photopenic defect (arrow) due to a gastric "pull-up" procedure that was performed following esophagectomy.

View larger version (98K): [in a new window]   Figure 13b.   Photopenic defect in a 57-year-old man who had undergone esophagectomy for esophageal cancer. Coronal (a) and axial (b) FDG PET scans demonstrate a right-sided paravertebral photopenic defect (arrow) due to a gastric "pull-up" procedure that was performed following esophagectomy.