OBJECTIVES To evaluate the diagnostic accuracy of unenhanced and contrast-enhanced MRI in the differentiation of mucosal high-grade neoplasia (MHN) from early invasive squamous cell cancer (EISCC) of the esophagus. METHODS Between March 2015 and January 2019, 72 study participants with MHN (n = 46) and EISCC (n = 26) of the esophagus were enrolled in this prospective study. Postoperative histopathologic analysis was the reference standard. All participants underwent MRI (T2-multi-shot turbo spin-echo sequence (msTSE), diffusion-weighted imaging (DWI), and 3D gradient-echo-based sequence (3D-GRE)). Two radiologists, blinded to participants' data, independently evaluated MRI and assigned MR features including shape (mucosal thickening or focal mass), signal on T2-msTSE and DWI, enhancement degree (intense or slight), and enhancement pattern (homogeneous, heterogeneous, or heart-shaped). Diagnostic performance of the 5 features was compared using the chi-square test; kappa values were assessed for reader performance. RESULTS Surgery was performed within 3.6 + 3.5 days after MR imaging. Inter-reader agreement on MR features was excellent (kappa value = 0.854, p < 0.001). All 8 mass-like MHN were "heart-shaped" in appearance. The degree of enhancement showed the best diagnosis performance in differentiating between MHN and EISCC of the esophagus. The combination of all 5 features had only borderline improved sensitivity, specificity, and AUC of 100%, 96.2%, and 0.999, respectively, which was not statistically significant compared with the degree of enhancement alone. CONCLUSIONS MRI can differentiate MHN from EISCC in esophagus; the presence of "heart-shaped" appearance favors the diagnosis of MHN. KEY POINTS • All 8 mass-like MHN showed a "heart-shaped" enhancement pattern which may help differentiating MHN from EISCC. • Degree of enhancement had the best diagnostic performance in differentiating between MHN and EISCC in esophagus. • The combined 5 features (shape, signal in T2-msTSE and DWI, enhancement degree, and enhancement pattern) provided sensitivity, specificity, and AUC of 100%, 96.2%, and 0.999, respectively, which was not statistically significant than tumor enhancement alone in distinguishing MHN from EISCC.

中文翻译：

---

MRI 鉴别黏膜高级别肿瘤与早期浸润性食管鳞状细胞癌的特征。

目的 评估平扫和对比增强 MRI 在鉴别食管黏膜高级别肿瘤 (MHN) 与早期浸润性鳞状细胞癌 (EISCC) 中的诊断准确性。方法 2015 年 3 月至 2019 年 1 月，72 名患有食道 MHN（n = 46）和 EISCC（n = 26）的研究参与者参加了这项前瞻性研究。术后组织病理学分析是参考标准。所有参与者都接受了 MRI（T2 多脉冲涡轮自旋回波序列（msTSE）、弥散加权成像（DWI）和基于 3D 梯度回波的序列（3D-GRE））。两名对参与者数据不知情的放射科医师独立评估 MRI 并分配 MR 特征，包括形状（粘膜增厚或局灶性肿块）、T2-msTSE 和 DWI 上的信号、增强程度（强烈或轻微），和增强模式（同质、异质或心​​形）。使用卡方检验比较 5 个特征的诊断性能；对读取器性能评估了 kappa 值。结果 MR 成像后 3.6 + 3.5 天内进行了手术。MR 特征的读者间一致性非常好（kappa 值 = 0.854，p < 0.001）。所有8颗质量状的MHN在外观上都是“心形”的。增强程度显示鉴别食管MHN和EISCC的最佳诊断性能。所有 5 个特征的组合仅使敏感性、特异性和 AUC 分别提高了 100%、96.2% 和 0.999，这与单独的增强程度相比没有统计学意义。结论 MRI可鉴别食管MHN和EISCC；“心形”外观的存在有利于MHN的诊断。要点 • 所有 8 个肿块状 MHN 均显示“心形”增强模式，这可能有助于将 MHN 与 EISCC 区分开来。• 增强程度在区分食管MHN 和EISCC 方面具有最佳诊断性能。• 组合的 5 个特征（形状、T2-msTSE 和 DWI 中的信号、增强程度和增强模式）分别提供了 100%、96.2% 和 0.999 的灵敏度、特异性和 AUC，与肿瘤增强相比没有统计学意义单独区分 MHN 和 EISCC。• 增强程度在区分食管MHN 和EISCC 方面具有最佳诊断性能。• 组合的 5 个特征（形状、T2-msTSE 和 DWI 中的信号、增强程度和增强模式）分别提供了 100%、96.2% 和 0.999 的灵敏度、特异性和 AUC，与肿瘤增强相比没有统计学意义单独区分 MHN 和 EISCC。• 增强程度在区分食管MHN 和EISCC 方面具有最佳诊断性能。• 组合的 5 个特征（形状、T2-msTSE 和 DWI 中的信号、增强程度和增强模式）分别提供了 100%、96.2% 和 0.999 的灵敏度、特异性和 AUC，与肿瘤增强相比没有统计学意义单独区分 MHN 和 EISCC。