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 prognostic value of the ratio of standard uptake value of lymph node to primary tumor before treatment of locally advanced nasopharyngeal carcinoma.

BACKGROUND: To evaluate the prognostic value of the ratio of the standard uptake value of the lymph node and primary tumor before the treatment of locally advanced nasopharyngeal carcinoma and examine the prognostic value of the tumor metabolic parameters (SUVmax, MTV, and TLG) of the lymph node and primary tumor of locally advanced nasopharyngeal carcinoma. METHODS: A total of 180 patients with locally advanced nasopharyngeal carcinoma diagnosed pathologically from January 1, 2016 to December 31, 2018 were selected, and the MEDEX system was used to automatically delineate the SUVmax, MTV, and TLG of the lymph node metastases and nasopharyngeal carcinoma primary tumor. In addition, the ratio of LN-SUVmax (SUVmax of the lymph node metastases) to T-SUVmax (SUVmax of the nasopharyngeal carcinoma primary tumor) was calculated, and a ROC curve was drawn to obtain the best cut-off value. Kaplan-Meier and Cox regression models were used for survival and multivariate analyses, respectively. RESULTS: The median follow-up period for participants was 32 (4-62) months. Univariate analysis showed that age (P = 0.013), LN-SUVmax (P = 0.001), LN-TLG (P = 0.007) and NTR (P = 0.001) were factors influencing the overall survival (OS). Factors affecting local progression-free survival (LPFS) were LN-SUVmax (P = 0.005), LN-TLG (P = 0.003) and NTR (P = 0.020), while clinical stage (P = 0.023), LN-SUVmax (P = 0.007), LN-TLG (P = 0.006), and NTR (P = 0.032) were factors affecting distant metastasis-free survival (DMFS). Multivariate analysis showed that NTR was an independent influencing factor of OS (HR 3.00, 95% CI 1.06-8.4, P = 0.038), LPFS (HR 3.08, 95% CI 1.27-7.50, P = 0.013), and DMFS (HR 1.84, 95% CI 0.99-3.42, P = 0.054). Taking OS as the main observation point, the best cut-off point of NTR was 0.95. Kaplan-Meier results showed that the 3-year OS (97.0% vs 85.4%, χ2 = 11.25, P = 0.001), 3-year LPFS (91.3% vs 82.1%, χ2 = 4.035, P = 0.045), and 3-year DMFS (92.3% vs 87.9%, χ2 = 4.576, P = 0.032) of patients with NTR < 0.95 were higher than those with NTR > 0.95. CONCLUSIONS: High NTR before treatment indicates a poor prognosis for patients with nasopharyngeal carcinoma. This can serve as a reference value for the reasonable treatment and prognosis monitoring of such patients.

Predictive Value of Pretreatment Lymphocyte-to-Monocyte Ratio and Platelet-to-Lymphocyte Ratio in the Survival of Nasopharyngeal Carcinoma Patients.

OBJECTIVE: The present study aimed to investigate the predictive value of some indexes, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory response index (SIRI), and systemic immune-inflammatory index (SII) in the survival of nasopharyngeal carcinoma (NPC) and provide reference for the treatment. METHODS: A retrospective analysis was performed on 216 patients from 2016 to 2018. The cutoff values of these indexes were determined by the receiver operating characteristic (ROC) curve. The prognostic value of the indexes was evaluated according to the rate of overall survival (OS), regional recurrence-free survival (RRFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS). RESULTS: The survival analysis showed that NLR ≤2.695 (P = 0.017) and PLR ≤140.065 (P = 0.041) were associated with poor OS; however, the LMR and SIRI showed no significant statistical significance. NLR ≤2.045 (P = 0.018) and PLR ≤125.605 (P = 0.003) were associated with poor RRFS, LMR ≤2.535 (P = 0.027) and PLR ≤140.065 (P = 0.009) were associated with poor DMFS, NLR ≤2.125 (P = 0.018) and PLR ≤132.645 (P = 0.026) were associated with poor LRRFS, respectively. Logistic regression analysis showed that low LMR (≤2.535) was significantly inferior in OS (HR 23.085, 95% CI 3.425-155.622, P = 0.001) and DMFS (HR 22.839, 95% CI 4.096-127.343, P < 0.001). Moreover, low PLR (≤140.065) remained significantly related to worse OS (HR 11.908, 95% CI 1.295-109.517, P = 0.029) and DMFS (HR 9.556, 95% CI 1.448-63.088, P = 0.019). CONCLUSION: The index LMR and PLR can be used for predicting survival in NPC patients.

[Diagnostic analysis of the radiologic characteristics in osteoporotic Kiinmmel's disease].

OBJECTIVE: To explore the diagnostic value of the radiologic characteristics of osteoporotic Kummell's disease. METHODS: Total 16 patients with pathologically confirmed osteoporotic Kummell's diseases were reviewed from May 2010 to May 2012, including 4 males and 12 females with the mean age of 73.4 years (ranged, 67 to 83 years old). Radiologic imagings of all patients, including X-ray, CT and MRI, were analyzed retrospectively. RESULTS: Intravertebral linear clefts could be seen on the AP and lateral X-ray films of vertebrae. Sagittal and axial CT scans demonstrated the vacuum cleft phenomenon with liquid and air was identified within the vertebral body. Sagittal MRI showed the callapsed vertebral segment and the area of fluid signal with clear and intact border within the vertebral body. The fluid signal was low on T1-weighted images and high on T2-weighted images and stir images, which was corresponding to an intravertebral vacuum cleft. CONCLUSION: The radiologic characteristics of Kurmmell's diseases can provide valuable evidences for the early diagnosis.

[Reduction and fixation of fracture of pubic rami by inserting construction plate through the punctiform-incision approach].

OBJECTIVE: To observe the effect of pubic fractures reducted and fixed thorough the punctiform incision approach. METHODS: From 2002 to 2005, 10 cases with 18 fractures of pubis rami (8 male and 2 female) were treated with inserting construction plate by the punctiform incision approach. The average age of these patients was 37.2 years (range, 24 to 56 years). The mean duration between injury and operation was 8.7 days (range, 4 to 14 days). RESULTS: Internal fixation for eighteen pubis fractures were accomplished by 28 punctiform incisions. The blood loss for each incision was averagely 30 ml, operation time of each pubic was about 45 minutes. Function restoration was evaluated by Majeed' score and all patients gained excellent result. CONCLUSION: The fracture of pubic rami can be fixed sucessfully by punctiform incision approach. It provides smaller incision, less postoperative complications and excellent function rehabilitation.