Objective:To development a deep learning（DL） model based on conventional MRI for automatic segmentation and differential diagnosis of nasopharyngeal carcinoma（NPC） and nasopharyngeal lymphoma（NPL）. Methods:The retrospective study included 142 patients with NPL and 292 patients with NPC who underwent conventional MRI at Renmin Hospital of Wuhan University from June 2012 to February 2023. MRI from 80 patients were manually segmented to train the segmentation model. The automatically segmented regions of interest（ROIs） formed four datasets: T1 weighted images（T1WI）, T2 weighted images（T2WI）, T1 weighted contrast-enhanced images（T1CE）, and a combination of T1WI and T2WI. The ImageNet-pretrained ResNet101 model was fine-tuned for the classification task. Statistical analysis was conducted using SPSS 22.0. The Dice coefficient loss was used to evaluate performance of segmentation task. Diagnostic performance was assessed using receiver operating characteristic（ROC） curves. Gradient-weighted class activation mapping（Grad-CAM） was imported to visualize the model's function. Results:The DICE score of the segmentation model reached 0.876 in the testing set. The AUC values of classification models in testing set were as follows: T1WI: 0.78（95%CI 0.67-0.81）, T2WI: 0.75（95%CI 0.72-0.86）, T1CE: 0.84（95%CI 0.76-0.87）, and T1WI+T2WI: 0.93（95%CI 0.85-0.94）. The AUC values for the two clinicians were 0.77（95%CI 0.72-0.82） for the junior, and 0.84（95%CI 0.80-0.89） for the senior. Grad-CAM analysis revealed that the central region of the tumor was highly correlated with the model's classification decisions, while the correlation was lower in the peripheral regions. Conclusion:The deep learning model performed well in differentiating NPC from NPL based on conventional MRI. The T1WI+T2WI combination model exhibited the best performance. The model can assist in the early diagnosis of NPC and NPL, facilitating timely and standardized treatment, which may improve patient prognosis.
Humans ; Nasopharyngeal Carcinoma/diagnostic imaging* ; Deep Learning ; Magnetic Resonance Imaging ; Retrospective Studies ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Lymphoma/diagnostic imaging* ; Diagnosis, Differential ; ROC Curve ; Male ; Female ; Middle Aged ; Adult

Objective:To explore the value of spectral CT parameters combined with dynamic contrast enhanced magnetic resonance imaging（DCE-MRI） parameters in the short-term efficacy of concurrent chemoradiotherapy for nasopharyngeal carcinoma. Methods: A total of 110 cases with nasopharyngeal carcinoma Ⅲ-Ⅳ staging who received synchronous radiotherapy and chemotherapy at our Hospital from October 2022 to October 2024 were regarded as the study subjects. Complying with the evaluation results after radiotherapy and chemotherapy, they were divided into a complete remission（CR） group of 53 cases and a non CR group of 57 cases. All patients underwent DCE-MRI and energy dispersive CT scans to obtain parameters, such as iodine concentration（IC）, volume transfer constant（Ktrans）, slope of spectral HU curve（λHU）, rate constant（Kep）, and normalized iodine concentration（NIC）. Logistic regression analysis was used to screen for influencing factors. ROC curve was used to analyze the evaluation value of various parameters. In addition, Z-test was used to compare area under the curve（AUC）. Results:The proportion of retropharyngeal lymph node metastasis and λHUvalue in the non CR group were higher than those in the CR group, while Ktrans, Kep, IC value, and NIC value were lower than those in the CR group（P<0.05）. Retropharyngeal lymph node metastasis, Ktrans, Kep, IC value, λHUvalue, and NIC value were all influencing factors（P<0.05）. The AUC of individual prediction of Ktrans, Kep, IC value, λHUvalue, and NIC value was 0.817, 0.800, 0.785, 0.783, and 0.835, respectively. The AUC of the combination of DCE-MRI parameters, the combination of spectral CT parameters, and the combination of the five parameters were 0.874, 0.900, and 0.980, respectively, the AUC of the combination of the five parameters was significantly higher than the AUC of each indicator alone, the AUC of the combination of DCE-MRI parameters, and the AUC of the combination of spectral CT parameters（P<0.05）. Conclusion:The DCE-MRI, and spectral CT parameters （Ktrans, Kep, IC value, λHUvalue, and NIC value）can be used to evaluate concurrent radiotherapy and chemotherapy short-term efficacy for nasopharyngeal carcinoma. And the combination of various parameters can greatly improve the predictive value of efficacy, which has important clinical application value.
Humans ; Chemoradiotherapy ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Magnetic Resonance Imaging ; Nasopharyngeal Carcinoma ; Tomography, X-Ray Computed ; Male ; Female ; Contrast Media ; Middle Aged ; Adult ; Lymphatic Metastasis ; Dynamic Contrast Enhanced Magnetic Resonance Imaging

OBJECTIVES: To explore the synthesis of high-quality CT (sCT) from cone-beam CT (CBCT) using PE-CycleGAN for adaptive radiotherapy (ART) for nasopharyngeal carcinoma. METHODS: A perception-enhanced CycleGAN model "PE-CycleGAN" was proposed, introducing dual-contrast discriminator loss, multi-perceptual generator loss, and improved U-Net structure. CBCT and CT data from 80 nasopharyngeal carcinoma patients were used as the training set, with 7 cases as the test set. By quantifying the mean absolute error (MAE), peak signal-to-noise ratio (PSNR), structural similarity index (SSIM), as well as the dose gamma pass rate and the relative dose deviations of the target area and organs at risk (OAR) between sCT and reference CT, the image quality and dose calculation accuracy of sCT were evaluated. RESULTS: The MAE of sCT generated by PE-CycleGAN compared to the reference CT was (56.89±13.84) HU, approximately 30% lower than CBCT's (81.06±15.86) HU (P<0.001). PE-CycleGAN's PSNR and SSIM were 26.69±2.41dB and 0.92±0.02 respectively, significantly higher than CBCT's 21.54±2.37dB and 0.86±0.05 (P<0.001), indicating substantial improvements in image quality and structural similarity. In gamma analysis, under the 2 mm/2% criterion, PE-CycleGAN's sCT achieved a pass rate of (90.13±3.75)%, significantly higher than CBCT's (81.65±3.92)% (P<0.001) and CycleGAN's (87.69±3.50)% (P<0.05). Under the 3 mm/3% criterion, PE-CycleGAN's sCT pass rate of (90.13±3.75)% was also significantly superior to CBCT's (86.92±3.51)% (P<0.001) and CycleGAN's (94.58±2.23)% (P<0.01). The mean relative dose deviation of the target area and OAR between sCT and planned CT was within ±3% for all regions, except for the Lens Dmax (Gy), which had a deviation of 3.38% (P=0.09). The mean relative dose deviations for PTVnx HI, PTVnd HI, PTVnd CI, PTV1 HI, PRV_SC, PRV_BS, Parotid, Larynx, Oral, Mandible, and PRV_ON were all less than ±1% (P>0.05). CONCLUSIONS PE-CycleGAN demonstrates the ability to rapidly synthesize high-quality sCT from CBCT, offering a promising approach for CBCT-guided adaptive radiotherapy in nasopharyngeal carcinoma.
Humans ; Cone-Beam Computed Tomography/methods* ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Nasopharyngeal Carcinoma/radiotherapy* ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Signal-To-Noise Ratio ; Radiotherapy, Intensity-Modulated

OBJECTIVES: We propose a novel deep learning segmentation algorithm (DSRF) based on multi-scale supervision and residual feedback strategy for precise segmentation of the optic chiasm and optic nerves in CT images of nasopharyngeal carcinoma (NPC) patients. METHODS: We collected 212 NPC CT images and their ground truth labels from SegRap2023, StructSeg2019 and HaN-Seg2023 datasets. Based on a hybrid pooling strategy, we designed a decoder (HPS) to reduce small organ feature loss during pooling in convolutional neural networks. This decoder uses adaptive and average pooling to refine high-level semantic features, which are integrated with primary semantic features to enable network learning of finer feature details. We employed multi-scale deep supervision layers to learn rich multi-scale and multi-level semantic features under deep supervision, thereby enhancing boundary identification of the optic chiasm and optic nerves. A residual feedback module that enables multiple iterations of the network was designed for contrast enhancement of the optic chiasm and optic nerves in CT images by utilizing information from fuzzy boundaries and easily confused regions to iteratively refine segmentation results under supervision. The entire segmentation framework was optimized with the loss from each iteration to enhance segmentation accuracy and boundary clarity. Ablation experiments and comparative experiments were conducted to evaluate the effectiveness of each component and the performance of the proposed model. RESULTS: The DSRF algorithm could effectively enhance feature representation of small organs to achieve accurate segmentation of the optic chiasm and optic nerves with an average DSC of 0.837 and an ASSD of 0.351. Ablation experiments further verified the contributions of each component in the DSRF method. CONCLUSIONS The proposed deep learning segmentation algorithm can effectively enhance feature representation to achieve accurate segmentation of the optic chiasm and optic nerves in CT images of NPC.
Humans ; Tomography, X-Ray Computed/methods* ; Optic Chiasm/diagnostic imaging* ; Optic Nerve/diagnostic imaging* ; Algorithms ; Nasopharyngeal Carcinoma ; Deep Learning ; Nasopharyngeal Neoplasms/diagnostic imaging* ; Neural Networks, Computer ; Image Processing, Computer-Assisted/methods*

Objective:To evaluate the diagnostic accuracy of the convolutional neural network（CNN） in diagnosing nasopharyngeal carcinoma using endoscopic narrowband imaging. Methods:A total of 834 cases with nasopharyngeal lesions were collected from the People's Hospital of Guangxi Zhuang Autonomous Region between 2014 and 2016. We trained the DenseNet201 model to classify the endoscopic images, evaluated its performance using the test dataset, and compared the results with those of two independent endoscopic experts. Results:The area under the ROC curve of the CNN in diagnosing nasopharyngeal carcinoma was 0.98. The sensitivity and specificity of the CNN were 91.90% and 94.69%, respectively. The sensitivity of the two expert-based assessment was 92.08% and 91.06%, respectively, and the specificity was 95.58% and 92.79%, respectively. There was no significant difference between the diagnostic accuracy of CNN and the expert-based assessment （P=0.282, P=0.085）. Moreover, there was no significant difference in the accuracy in discriminating early-stage and late-stage nasopharyngeal carcinoma（P=0.382）. The CNN model could rapidly distinguish nasopharyngeal carcinoma from benign lesions, with an image recognition time of 0.1 s/piece. Conclusion:The CNN model can quickly distinguish nasopharyngeal carcinoma from benign nasopharyngeal lesions, which can aid endoscopists in diagnosing nasopharyngeal lesions and reduce the rate of nasopharyngeal biopsy.
Humans ; Nasopharyngeal Carcinoma ; Narrow Band Imaging ; China ; Neural Networks, Computer ; Nasopharyngeal Neoplasms/diagnostic imaging*

OBJECTIVETo find a rational way in early detecting the residual tumor in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.

METHODSA total of 47 NPC patients who were diagnosed residual tumor after radiotherapy and treated in our hospital from Dec 2009 to Aug 2012 were included in this study and their clinicopathological and follow-up data were reviewed and analyzed. The patients were checked by nasopharynx MRI, FDG PET-CT and were examined by biopsy of the residual tumors within two weeks after radiotherapy. The diagnosis of relapses was determined by pathological re-examination.

RESULTSAll the 47 patients were followed up for 10-42 months. Three of them had nasopharynx relapse. The others had not tumor relapse and their residual tumors disappeared completely. The specificity of MRI, FDG PET-CT and pathological tumor response in diagnosing residual tumors were 9.1%, 77.3%, and 95.5% (P<0.001). Their accuracy rates were 14.9%, 78.9%, and 95.7%, respectively (P<0.001). The M of SUVmax in the team who had moderate and severe pathologic tumor response (team A) was 3.05 and that in the team who had mild pathologic tumor response (team B) was 4.68 (P=0.012). None of patients in the team A had nasopharynx relapse. Three patients in the team B who had SUVmax ≥4 had nasopharynx relapses, and in other 2 patients who had SUVmax <4, the residual tumors disappeared during the following-up. The specificity and accuracy in diagnosing residual tumors were increased when mild pathologic tumor response combined with SUVmax4 were used.

CONCLUSIONPET-CT combined with pathologic tumor response is beneficial for early diagnosis of residual nasopharyngeal tumors after radiotherapy.

Carcinoma ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms ; diagnosis ; diagnostic imaging ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; diagnosis ; diagnostic imaging ; radiotherapy ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVE: To assess the diagnostic value of 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in detecting residual/recurrent nasopharyngeal carcinoma. METHOD: The literatures published between January 1990 and September 2013 were searched in PubMed, EM-BASE, EBSCO, Web of Science, CBM, CNKI, VIP and Wanfang databases. Two researchers independently selected studies, extracted data and assessed the quality of included studies according to the QUADAS tool. Summary sensitivity, specificity, diagnostic odds ratios (DOR), and receiver-operating characteristic (SROC) curves were obtained using Meta-Disc software. Subgroup analysis was also conducted. RESULT: Twenty-six studies were included in this meta-analysis, involving 1203 patients. The pooled sensitivity, specificity and DOR were 0. 92 (95% CI:0.89-0.94), 0. 87 (95% CI:0.84-0.90) and 51. 10 (95% CI:34.29-76.15), respectively. The area under the curve (AUC) and Q index estimate for PET/CT were 0. 9494 and 0. 8897, respectively. The results of subgroup analysis showed no significant differences between subgroups(P>0.05). CONCLUSION In a word, 18F-FDG PET/CT performed well for diagnosis of residual/recurrent nasopharyngeal carcinoma, with relatively high sensitivity and specificity.
Carcinoma ; Fluorodeoxyglucose F18 ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; diagnostic imaging ; Positron-Emission Tomography ; ROC Curve ; Radiopharmaceuticals ; Recurrence ; Sensitivity and Specificity ; Tomography, X-Ray Computed

The parapharyngeal space (PPS) is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The differential diagnosis of PPS tumors remains challenging for radiologists. This study aimed to develop and test a modified method for locating PPS tumors on magnetic resonance (MR) images to improve preoperative differential diagnosis. The new protocol divided the PPS into three compartments: a prestyloid compartment, the carotid sheath, and the areas outside the carotid sheath. PPS tumors were located in these compartments according to the displacements of the tensor veli palatini muscle and the styloid process, with or without blood vessel separations and medial pterygoid invasion. This protocol, as well as a more conventional protocol that is based on displacements of the internal carotid artery (ICA), was used to assess MR images captured from a series of 58 PPS tumors. The consequent distributions of PPS tumor locations determined by both methods were compared. Of all 58 tumors, our new method determined that 57 could be assigned to precise PPS compartments. Nearly all (13/14; 93%) tumors that were located in the pre-styloid compartment were salivary gland tumors. All 15 tumors within the carotid sheath were neurogenic tumors. The vast majority (18/20; 90%) of trans-spatial lesions were malignancies. However, according to the ICA-based method, 28 tumors were located in the pre-styloid compartment, and 24 were located in the post-styloid compartment, leaving 6 tumors that were difficult to locate. Lesions located in both the pre-styloid and the post-styloid compartments comprised various types of tumors. Compared with the conventional ICA-based method, our new method can help radiologists to narrow the differential diagnosis of PPS tumors to specific compartments.
Carcinoma ; Diagnosis, Differential ; Humans ; Lymphoma ; diagnosis ; diagnostic imaging ; Magnetic Resonance Spectroscopy ; Nasopharyngeal Neoplasms ; diagnosis ; diagnostic imaging ; Neck ; diagnostic imaging ; Nervous System Neoplasms ; diagnosis ; diagnostic imaging ; Pharynx ; diagnostic imaging ; Radiography ; Salivary Gland Neoplasms ; diagnosis ; diagnostic imaging

BACKGROUND AND OBJECTIVEMonitoring the therapeutic effects of radiotherapy for nasopharyngeal carcinoma (NPC) is critical to providing individualized treatment. This in-vivo study was initially designed to evaluate the therapeutic effect of radiotherapy using 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) imaging.

METHODS18F-FDG PET-CT imaging was performed on all of the 10 nude mice bearing NPC xenografts before radiotherapy, and early-phase and delayed-phase PET-CT images were performed on 7 of the 10 mice. All mice were randomly divided into either a control group or a radiotherapy group. The 5 mice in the control group were immediately killed after the imaging and pathology were performed. After receiving radiotherapy of 12 Gy, 5 animals in the radiotherapy group were given 18F-FDG PET-CT imaging on days 2, 4, and 6, and then were killed for pathologic evaluation. Regions of interest (ROI) technology was used to measure the tumor target/non-target (T/NT) ratio and the volume of the tumors.

RESULTSThe average T/NT ratios of early- and delayed-phase imaging were 1.806 +/- 0.532 and 1.777 +/- 0.597, respectively, with no significance (P > 0.05). For the radiotherapy group, the average T/NT ratios for 18F-FDG PET-CT before radiotherapy, and on days 2, 4, and 6 after radiotherapy, were 1.735 +/- 0.466, 1.818 +/- 0.396, 1.096 +/- 0.101, and 0.604 +/- 0.108, respectively, The tumor volumes were (1.48 +/- 0.27) cm3, (1.57 +/- 0.31) cm3, (1.59 +/- 0.31) cm3 and (1.60 +/- 0.29) cm3, respectively. The average T/NT ratios of day 6 after radiotherapy and the other time points were significant (P < 0.05). The average death ratio of the tumor cells was (93.00 +/- 7.42)% after 6 days of post-radiotherapy.

CONCLUSIONS18F-FDG PET-CT imaging can be used for the early assessment of radiotherapeutic effect of NPC in vivo. Day 6 after radiotherapy may be an appropriate time point for the imaging. However, the T/NT ratio measurement of delayed-phase imaging might make no sense for the diagnosis of NPC.

Animals ; Carcinoma, Squamous Cell ; diagnostic imaging ; pathology ; radiotherapy ; Cell Line, Tumor ; Fluorodeoxyglucose F18 ; Humans ; Ki-67 Antigen ; metabolism ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Multimodal Imaging ; methods ; Nasopharyngeal Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Neoplasm Transplantation ; Positron-Emission Tomography ; Random Allocation ; Tomography, X-Ray Computed ; Tumor Burden ; radiation effects

BACKGROUND AND OBJECTIVEThe level-Ib lymph node metastasis is rare in nasopharyngeal carcinoma (NPC). When and how this level should be irradiated with precise radiotherapy remains controversial. This study evaluated the prevalence and prognostic significance of level-Ib lymphadenopathy on the prognosis of NPC patients.

METHODSFrom January 1990 and December 1999, 933 newly diagnosed patients with NPC treated at Sun Yat-sen University Cancer Center were randomly selected, examined with computed tomography (CT) imagining for evidence of level-Ib lymphadenopathy before treatment. All patients received radical radiotherapy with or without chemotherapy. The relationship between level-Ib lymphadenopathy and post-treatment outcomes including overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using Kaplan-Meier methods. The Cox proportional hazards regression model was used to adjust for other prognostic factors.

RESULTSOf the 933 patients, 55 (5.9%) were found to have level-Ib lymphadenopathy, which was associated with carotid sheath involvement, oropharynx involvement and levels, and lateral cervical lymph node involvement. In the subgroup with carotid sheath involvement, with multivariate analysis accounting for all previously known prognostic factors, level-Ib lymphadenopathy was still associated with a risk of decreased OS (RR, 2.124; P<0.001), DMFS (RR, 2.168; P<0.001), and LRFS (RR, 1.989; P=0.001).

CONCLUSIONLevel-Ib lymphadenopathy in the patients with carotid sheath involvement is an independent prognostic factor.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Chemotherapy, Adjuvant ; Child ; Cobalt Radioisotopes ; therapeutic use ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; radiotherapy ; Neck ; pathology ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Particle Accelerators ; Pharynx ; pathology ; Prognosis ; Proportional Hazards Models ; Radiography ; Radioisotope Teletherapy ; Retrospective Studies ; Survival Rate ; Young Adult