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[Initial experiences with magnetic resonance endoscopy]
D Külling1, D R Feldman, C L Kay
1Department of Gastroenterology; Medical University of South Carolina, Charleston 29425, USA.
Background:
In contrast to endorectal surface coils used to assess pelvic tumors, the magnetic resonance endoscope (MR) has all the features of a standard endoscope. In ex-vivo imaging of the porcine gastrointestinal tract, endoscopic MR demonstrates distinct histological layers of the gastrointestinal wall. The aim of this study was to assess the feasibility and the accuracy of endoscopic MR in local staging of patients with esophageal and rectal cancer.
Methods:
From April to August 1996, 12 patients (5 female and 7 male, mean age 63 [range 44-84] years) with histologically proven esophageal (n = 6) and rectal (n = 6) cancer prospectively underwent endoscopic ultrasound (EUS) followed by endoscopic MR. The two radiologists reviewing the endoscopic MR images were blinded to the EUS results. Assessment of T and N stages was compared to EUS and histology.
Results:
Endoscopic MR was well tolerated in all patients and there were no complications. Image quality was sufficient in 75%. Endoscopic MR T-staging correlated with EUS and histology in 7/12 and 5/7 patients respectively. Discordance was due to overstaging by endoscopic MR. N-staging correlated with EUS and histology in 10/12 and 6/8 cases respectively. Non-correlation was due to a number of false negative results at endoscopic MR.
Conclusion:
These early results demonstrate endoscopic MR to be feasible and to produce comparable local staging to EUS in patients with esophageal and rectal cancer. The ultimate goal will be to combine endoscopic MR with body coil MR imaging (for the assessment of distant metastases) in order to provide "one-step staging" for the entire evaluation of gastrointestinal tumors.
Insights
Endoscopic magnetic resonance imaging (MR) is a feasible tool for staging esophageal and rectal cancer, showing comparable accuracy to endoscopic ultrasound. Further development aims for "one-step staging" by combining with body coil MR imaging.
Area of Science:
- Gastrointestinal oncology
- Medical imaging technology
- Endoscopic procedures
Context:
- Endorectal surface coils are used for pelvic tumor assessment.
- Endoscopic MR demonstrates distinct histological layers in ex-vivo porcine GI tract imaging.
- Accurate local staging is crucial for esophageal and rectal cancer treatment planning.
Purpose:
- To assess the feasibility and accuracy of endoscopic magnetic resonance (MR) for local staging of esophageal and rectal cancer.
- To compare the staging accuracy of endoscopic MR with endoscopic ultrasound (EUS) and histology.
Summary:
- Endoscopic MR was feasible and well-tolerated in 12 patients with esophageal and rectal cancer.
- T-staging correlated with EUS in 7/12 and histology in 5/7 patients; N-staging correlated with EUS in 10/12 and histology in 6/8 patients.
- Image quality was sufficient in 75% of cases, with discordance attributed to overstaging (T-stage) and false negatives (N-stage).
Impact:
- Endoscopic MR shows comparable local staging accuracy to EUS for esophageal and rectal cancer.
- This technique offers potential for improved diagnostic capabilities in gastrointestinal tumor evaluation.
- Future integration with body coil MR imaging could enable comprehensive "one-step staging" for gastrointestinal tumors.