Diagnostic Imaging of Esophageal Cancer

Accurate staging of esophageal squamous cell carcinoma (ESCC) is essential for determining appropriate treatment strategies and predicting prognosis. This chapter provides a comprehensive overview of the diagnostic imaging modalities used in the evaluation of ESCC, including barium esophagography, computed tomography (CT), magnetic resonance imaging (MRI), and 18F-FDG (2-[18F]-fluoro-2-deoxy-D-glucose) positron emission tomography (PET). Each modality has unique advantages and limitations in assessing tumor depth (T factor), lymph node metastasis (N factor), and distant metastasis (M factor). CT remains the mainstay of staging, particularly for evaluating tumor extent and detecting distant spread. MRI offers superior soft tissue contrast and plays a valuable role in local staging, especially in the cervical esophagus and in assessing invasion into adjacent structures. 18F-FDG-PET complements CT and MRI by providing metabolic information, improving the detection of nodal and distant metastases. The integration of multiple imaging modalities allows for a more accurate and comprehensive assessment of disease extent, which is essential for selecting optimal therapeutic approaches for ESCC patients.