32 Diseases of the Esophagus (2004) 17, 32–37 © 2004 ISDE Blackwell Publishing Ltd. Original article Comparison of CT and MRI for the diagnosis recurrent esophageal carcinoma after operation M. Kantarcı, 1 P. Polat, 1 F. Alper, 1 A. Eroglu, 2 S. Eren, 1 A. Okur, 1 O. Onbaß 1 1 Department of Radiology and 2 Department of Thoracic Surgery, School of Medicine, Atatürk University, Erzurum, Turkey SUMMARY. Despite an increase in radical surgery for esophageal carcinoma, many patients continue to develop recurrent disease. Some reports have suggested that recurrent tumors should be treated aggressively with a combination of chemotherapy and radiotherapy. The aim of this study was to assess the comparative utility of computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of recurrence after curative resection of cancer of the esophagus and gastroesophageal junction. To maximize survival benefit, detection of tumor recurrence as early and accurately as possible is important. Twenty-three patients who developed recurrent tumors after curative transthoracic esophagogastrectomy for esophageal carcinoma were analyzed retrospectively. The CT and MRI findings were correlated with pathology or with endoscopic and clinical follow-up. Primary tumor recurrence was detected at the anastomosis side in 19 patients (intraluminal mass in 13 and as diffuse or focal wall thickening in six). Distant recurrence was seen in the liver (n = 5), lung (n = 4), bone (n = 3), abdominal lymph node (n = 4), pleural effusion (n = 2) and pericardial effusion (n = 1). CT and MRI were found equal in showing the intraluminal mass, liver metastasis, pleural and pericardial effusion. Thickening of esophageal wall was demonstrated in nine patients using CT, but only seven of these tumor recurrences were confirmed by MRI, the remaining two were related to secondary fibrosis. Both CT and MRI showed diffuse gastric wall thickening determined as false tumor recurrence due to severe gastritis in one case. There were two (50%) false negatives for lung metastasis in MRI and one bone metastasis (33%) false negative in CT. CT was found superior in the demonstration of lung metastasis and MRI was superior in the evaluation of wall thickening and bone metastasis. KEY WORDS: CT, esophagus, MRI, recurrent carcinoma. INTRODUCTION Long-term survival after cancer of the esophagus or the gastroesophageal junction remains poor despite significant improvements in surgical tech- niques and postoperative management. 1,2 Even after curative surgery, two thirds of patients have a recurrence within 1 year and nearly all within 2 years. 1 Five-year survival ranges from 20% to 80%. 1–4 The recurrence is generally seen at or near the operative field, in one-third of patients. 5 In most cases, recurrent lesions first appear at the level of the primary tumor and are thus considered recurrent growth either from residual esophageal tumor or from adjacent lymph node metastases. 5 This disease is seen more frequently in the East Anatolia region than in other regions of Turkey. While the proportion of EC among gastrointestinal (GI) tract cancer is found to be about 7% in Turkey, it is 16% in our region. 1 Despite innovations and developments in diagnostic procedures the patients from this region are generally admitted to hospital at advanced stages of disease which may lead to difficulties in performing curative surgery. Although there are some studies on the compari- son of MRI with CT in the staging of EC, to our knowledge this is the first study of the comparison of CT and MRI for the diagnosis of recurrent EC after operation. Patients and methods Twenty-three patients, who had undergone trans- thoracic esophagectomy for esophageal carcinoma, on clinical and radiologic examinations and had Address correspondence to: Dr Mecit Kantarcı, 200 Evler Mah. 14. Sok no. 5, Dadaßkent, Erzurum, Turkey. Tel: +90 442 236 1212; Fax: +90 442 236 1301; Email: akkanrad@hotmail.com