Evaluation of Time-Phase Effect on 18F-FDG PET/CT Delineation Methods for Treatment Planning of Nasopharyngeal Carcinoma

Does consensus contours improve robustness and accuracy on [Formula: see text]F-FDG PET imaging tumor delineation?

PURPOSE

The aim of this study is to explore the robustness and accuracy of consensus contours with 225 nasopharyngeal carcinoma (NPC) clinical cases and 13 extended cardio-torso simulated lung tumors (XCAT) based on 2-deoxy-2-[[Formula: see text]F]fluoro-D-glucose ([Formula: see text]F-FDG) PET imaging.

METHODS

Primary tumor segmentation was performed with two different initial masks on 225 NPC [Formula: see text]F-FDG PET datasets and 13 XCAT simulations using methods of automatic segmentation with active contour, affinity propagation (AP), contrast-oriented thresholding (ST), and 41% maximum tumor value (41MAX), respectively. Consensus contours (ConSeg) were subsequently generated based on the majority vote rule. The metabolically active tumor volume (MATV), relative volume error (RE), Dice similarity coefficient (DSC) and their respective test-retest (TRT) metrics between different masks were adopted to analyze the results quantitatively. The nonparametric Friedman and post hoc Wilcoxon tests with Bonferroni adjustment for multiple comparisons were performed with [Formula: see text] 0.05 considered to be significant.

RESULTS

AP presented the highest variability for MATV in different masks, and ConSeg presented much better TRT performances in MATV compared with AP, and slightly poorer TRT in MATV compared with ST or 41MAXin most cases. Similar trends were also found in RE and DSC with the simulated data. The average of four segmentation results (AveSeg) showed better or comparable results in accuracy for most cases with respect to ConSeg. AP, AveSeg and ConSeg presented better RE and DSC in irregular masks as compared with rectangle masks. Additionally, all methods underestimated the tumour boundaries in relation to the ground truth for XCAT including respiratory motion.

CONCLUSIONS

The consensus method could be a robust approach to alleviate segmentation variabilities, but did not seem to improve the accuracy of segmentation results on average. Irregular initial masks might be at least in some cases attributable to mitigate the segmentation variability as well.

The role of PET/CT in radiotherapy for nasopharyngeal carcinoma

Radiotherapy has already been developed as the standard of care for patients with nasopharyngeal carcinoma (NPC), and precision staging, target volume delineation, prognosis prediction, and post-treatment surveillance are essential in the management of NPC. Positron emission tomography/computed tomography (PET/CT) is increasingly recognized as an imaging modality to guide precision radiotherapy in these areas. The feasibility and efficacy of 18F-FDG PET/CT have been confirmed in tumor diagnosis, treatment planning, prognosis, surveillance, and assessment. Coupled with the capability of revealing tumor metabolic information, 18F-FDG PET/CT is more accurate in identifying primary lesions and metastases of NPC than other conventional imaging methods including CT and MRI and shows the independently diagnostic and prognostic value for radiotherapy. However, 18F-FDG has limitations due to its physiological distribution in brain tissue and increasing uptake in post-radiation inflammation. Novel PET radiotracers including FAPI, NaF, CHO, and FLT are explored as alternatives with potential superiority for radiotherapy in NPC. In this review, we summarized the evolving role of PET/CT in the management of radiotherapy in NPC patients, aiming to facilitate precision radiotherapy from a molecular imaging aspect.

Predictive value and changes of miR-34a after concurrent chemoradiotherapy and its association with cognitive function in patients with nasopharyngeal carcinoma

This study explored the changes and predictive value of miR-34a in nasopharyngeal carcinoma (NPC) after concurrent chemoradiotherapy (CCRT), and its association with cognitive function. Fifty NPC patients admitted to Shunde Hospital, and another fifty healthy individuals were assigned into treated group and control group, respectively. Patients in the treated group received 3 courses of CCRT. The relative expression of miR-34a in the two groups was detected, and the cognitive function of patients was assessed. Diagnostic and predictive values of miR-34a in advanced NPC were analyzed. The expression of miR-34a in the control group was significantly higher than that in the treated group (t=13.364, P<0.001), with an area under the curve (AUC) of 0.979. The expression of miR-34a was significantly upregulated after treatment (t=4.559, P<0.001). After treatment, there were 32 complete remission (CR) patients and 18 partial remission (PR) patients. According to efficacy, CR patients were classified as significant group and PR patients as general group. The expression of miR-34a in the significant group was higher than that in the general group before treatment (t=4.704, P<0.001), with an AUC of 0.852. The Montreal Cognitive Assessment (MoCA) score was significantly decreased after treatment (t=13.042, P<0.001). The expression of miR-34a was positively correlated with the MoCA score after treatment, that is, MoCA score gradually increased with the upregulation of miR-34a expression (r=0.379, P=0.006). There is a positive correlation between miR-34a and cognitive function of patients. Moreover, the expression of miR-34a can be used as a potential predictor of the efficacy of CCRT in patients with NPC.

Feasibility of multiparametric imaging with PET/MR in nasopharyngeal carcinoma: A pilot study

OBJECTIVE

The aim of this pilot study was to explore the integrated positron emission tomography and magnetic resonance imaging scanner (PET/MR) for biological characterization of nasopharyngeal carcinoma (NPC) and potential therapeutic applications of dose painting (DP).

PATIENTS AND METHODS

Twenty-one NPC patients with PET/MR were included in this study. Overlap of tumor volumes was analyzed on T2-weighted images (volume of interest, VOI_T2), diffusion-weighted magnetic resonance imaging (VOI_DWI) and ¹⁸F-fluorodeoxyglucose positron emission tomography (VOI_PET). The overlap percentages of low-metabolic sub-region (cluster 1) and high-metabolic sub-region (cluster 2) in VOI_PET and VOI_DWI were analyzed by cluster analysis.

RESULTS

Both the VOI_DWI and VOI_PET were encompassed in the VOI_T2, respectively 99.6% and 97.5%. The median tumor overlap was 94.4% (VOI_DWI within VOI_PET). The median overlap of cluster 2 in VOI_PET and VOI_DWI was 43.61% (27.67-52.66%) and 21.86%(10.47-40.89%), respectively. The median overlap of cluster 1 in VOI_PET and VOI_DWI was 48.03% (23.91-63.15%) and 24.40% (7.44-51.44%), respectively. Separation between clusters appeared to be defined by a SUV value.

CONCLUSION

For NPC, the VOIs of DWI and FDG PET were not overlapped completely and the volume defined by cluster-analysis might be meaningful for DP.

Synthesis and characterization of a bimodal nanoparticle based on the host-guest self-assembly for targeted cellular imaging

Multimodal imaging provides distinct advantages over traditional single modal imaging. The combined modalities of magnetic resonance imaging (MRI) and near-infrared imaging (NIR), in particular, provide a powerful tool for tumor diagnosis. In this study, a bimodal MRI and NIR self-assembled supramolecular nanoparticle was developed via the self-assembly of host-guest interactions between hyaluronic acid-β-cyclodextrin (HA-CD) and amantadine (Ad)-modified imaging agents (Gd-DOTA and NIR cyanine dye Cy7). The supramolecular HA-CD-GC nanoparticles (NPs) were characterized by transmission electron microscopy (TEM), Zeta potential, and dynamic light-scattering (DLS) experiments. The relaxivity and fluorescent properties of the NPs were also determined. HA-CD-GC NPs exhibited an enhanced relaxivity of 11.4mM^-1S^-1, which was three-fold higher than that of clinical Gd³⁺-chelated complex, for MRI imaging. Moreover, HA-CD-GC NPs displayed excellent fluorescence. In addition, HA-CD-GC NPs were internalized into tumor cells via HA-receptor CD44-mediated endocytosis. Therefore, the self-assembled HA-CD-GC NPs are effective targeted tumor cell imaging systems and have potential applications in cancer diagnosis and treatment.