Imaging

Squamous Cell Carcinoma of the Esophagus

Preliminary Diagnosis: Squamous Cell Carcinoma of the Esophagus

I. What imaging technique is first-line for this diagnosis?

Fluoroscopic guided double contrasted esophagram.

II. Describe the advantages and disadvantages of this technique for diagnosing squamous cell carcinoma of the esophagus.

Advantages

  • Highly portable, relative quick imaging modality.

  • Double contrast esophagraphy offers exquisite detail of the esophageal mucosa.

  • Highly sensitive.

Disadvantages

  • Less specific in a detecting primary esophageal neoplasm compared to other imaging modalities.

  • May expose patients to large amounts of ionizing radiation.

  • Limited in detecting the depth and extent of spread of an esophageal neoplastic process.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to fluoroscopic imaging exist.

IV. What alternative imaging techniques are available?

  • CT of the chest and abdomen with IV contrast.

  • MR imaging of the chest and abdomen.

  • Endoscopic ultrasound.

  • PET/CT imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing squamous cell carcinoma of the esophagus.

CT of the Chest and Abdomen with IV contrast

Advantages

  • Highly sensitive and specific in detecting the depth of invasion and extent of invasion of a primary esophageal neoplasm.

  • Highly adept in staging an esophageal neoplasm by helping localize and characterize any metastatic lymphadenopathy.

Disadvantages

  • Exposes patients to ionizing radiation.

MR imaging of the chest and abdomen

Advantages

  • Offers exquisite detail of the surrounding soft tissues.

Disadvantages

  • Expensive.

  • Time consuming.

  • May be subject to motion artifact, limiting sensitivity of the exam.

Endoscopic ultrasound

Advantages

  • Better evaluates the depth of the primary lesion than other imaging modalities.

  • Does not expose patients to ionizing radiation.

  • Highly portable.

Disadvantages

  • Invasive procedure

PET/CT imaging

Advantages

  • Offers exquisite anatomical and functional imaging capabilities.

  • Highly sensitive and specific in detecting regional and distant metastasis.

Disadvantages

  • Lengthy imaging modality.

  • Exposure to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest and abdomen with IV contrast

  • May be contraindicated in pregnant patients.

  • May be contraindicated in patients with renal failure or contrast allergy.

MR imaging of the chest and abdomen

  • May be contraindicated in patients with non-MR compatible hardware.

Endoscopic ultrasound

  • No specific contraindications to endoscopic ultrasound exist.

PET/CT imaging

  • Contraindicated in pregnant patients and those that are breastfeeding.

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