The radiographic evaluation of the patient with esophageal carcinoma.

Barium swallow and endoscopy are complementary procedures in the detection of early esophageal carcinoma. CT is useful in the detection of distant metastases, and mediastinal invasion of key structures such as airway, aorta, and pericardium, but does not reliably differentiate T2 from T3 lesions or define subtle upper abdominal adenopathy. The disparity in reported results from different series published over the last 12 years can be accredited to two causes. First is the lack of uniformity in the way the studies were performed. Most authors agree that slice thickness should be 1 cm and contiguous. Lehr et al used 2-cm slices through the upper abdomen with additional slices through areas of special interest. Similarly, Markland defines his technique as "1-cm intervals from the thoracic inlet to the carina and below this at 1.5 cm intervals to the level of the adrenal glands." Such parameters are hardly optimized for the detection of 8-mm lymph nodes. The other cause of the disparity is interobserver variation in study interpretation. Goei et al staged 35 cases of esophageal cancer using CT. The CT interpretations of each of three readers were subsequently correlated with surgical and pathologic findings of 17 patients. CT pathologic correlation of the three observers showed sensitivities ranging from 50% to 57%, specificities ranging from 50% to 60%, and accuracies ranging from 46% to 71%. CT is useful as a surveillance tool in the postoperative patient. MR imaging does not have a defined role in the workup of esophageal tumors at this time.