Background The prognosis of patients undergoing hepatectomy combined with transarterial chemoembolization (TACE) and TACE alone was examined in order to better understand the role of hepatectomy in the treatment of hepatocellular carcinoma (HCC). In this work, we also created a model and investigated the variables influencing overall survival (OS) in HCC patients. Methods Retrospective analysis of 1083 patients who received TACE alone as the control group and 188 patients who received TACE after surgery in a total of 1271 HCC patients treated with LR + TACE or TACE at three third-class hospitals in China. It was done using the Propensity Score Matching (PSM) technique. The differences in OS between the two groups were compared, and OS-influencing factors were looked at. The main endpoint is overall survival. In this study, the COX regression model was used to establish the nomogram. Results The median OS of the LR + TACE group was not attained after PSM. The median OS for the TACE group was 28.8 months (95% CI: 18.9–38.7). The median OS of the LR + TACE group was higher than that of the TACE group alone, indicating a significant difference between the two groups (χ 2 = 16.75, P < 0.001). While it was not achieved in the LR + TACE group, the median OS for patients with lymph node metastases in the TACE group alone was 18.8 months. The two groups differed significantly from one another (χ 2 = 4.105, P = 0.043). In patients with distant metastases, the median OS of the LR + TACE treatment group was not achieved, and the median OS of the TACE group alone was 12.0 months. The difference between the two groups was sizable (χ 2 = 5.266, P = 0.022). The median OS for patients with PVTT following PSM was 30.1 months in the LR + TACE treatment group and 18.7 months in the TACE alone group, respectively. The two groups differed significantly from one another (χ 2 = 5.178, P = 0.023); There was no discernible difference between the two groups in terms of median overall survival (OS), which was 30.1 months for patients with lymph node metastasis and 19.2 months for those without ( P > 0.05); Regarding the median OS for patients with distant metastases, which was not achieved and 8.5 months, respectively, there was a significant difference between the two groups (χ 2 = 5.759, P = 0.016). We created a new nomogram to predict 1-, 2-, and 3-year survival rates based on multiple independent predictors in COX multivariate analysis. The cohort's C-index is 0.705. The area under the curve (AUC value) for predicting 1-, 2-, and 3-year survival rates were shown by the subject operating characteristic (ROC) curve linked to the nomogram to be 0.730, 0.728, and 0.691, respectively. Conclusions LR + TACE can increase OS, delay tumor recurrence, and improve prognosis in HCC patients when compared to TACE alone. Additionally, the nomogram we created does a good job of forecasting the 1-year survival rate of hepatocellular carcinoma.

The goal was to investigate the feasibility of the registration generative adversarial network (RegGAN) model in image conversion for performing adaptive radiation therapy on the head and neck and its stability under different cone beam computed tomography (CBCT) models. A total of 100 CBCT and CT images of patients diagnosed with head and neck tumors were utilized for the training phase, whereas the testing phase involved 40 distinct patients obtained from four different linear accelerators. The RegGAN model was trained and tested to evaluate its performance. The generated synthetic CT (sCT) image quality was compared to that of planning CT (pCT) images by employing metrics such as the mean absolute error (MAE), peak signal-to-noise ratio (PSNR), and structural similarity index measure (SSIM). Moreover, the radiation therapy plan was uniformly applied to both the sCT and pCT images to analyze the planning target volume (PTV) dose statistics and calculate the dose difference rate, reinforcing the model’s accuracy. The generated sCT images had good image quality, and no significant differences were observed among the different CBCT modes. The conversion effect achieved for Synergy was the best, and the MAE decreased from 231.3 ± 55.48 to 45.63 ± 10.78; the PSNR increased from 19.40 ± 1.46 to 26.75 ± 1.32; the SSIM increased from 0.82 ± 0.02 to 0.85 ± 0.04. The quality improvement effect achieved for sCT image synthesis based on RegGAN was obvious, and no significant sCT synthesis differences were observed among different accelerators. The sCT images generated by the RegGAN model had high image quality, and the RegGAN model exhibited a strong generalization ability across different accelerators, enabling its outputs to be used as reference images for performing adaptive radiation therapy on the head and neck.

目的 对MR引导下食管癌自适应放射治疗的潜在优势、面临的问题以及与深度学习相结合的发展趋势进行综述.方法 以"MR、食管癌、自适应放射治疗、自动勾画"为中文关键词,"MR、esophageal cancer、adaptive radiotherapy、automatic delineation"为英文关键词,系统检索中国知网及PubMed数据库2010-01-01-2022-08-30相关文献.纳入标准:(1)食管癌自适应放射治疗相关文献;(2)MR引导的自适应放射治疗相关文献;(3)在自适应放射治疗过程中应用人工智能自动勾画相关文献.排除标准:数据陈旧文献.最终共纳入62篇文献.结果 集成的MR引导放射治疗系统(例如MR-Linac)可以通过使用实时成像和运动追踪来克服由于呼吸引起的食管运动.另外,MR-Linac通过靶区轮廓的精确识别、呼吸门控以及在线自适应计划可以使投照剂量更加严格和准确,保证靶区足量的同时又能减少周围危及器官的受照射剂量,从而使放疗引起的心脏和肺的毒副作用减少.最后,随着深度学习人工智能在图像分割和三维剂量预测领域的快速发展,实现了靶区的快速勾画和治疗计划的快速生成,为短时间内实现MR引导的在线自适应放射治疗提供了技术支持.结论 MR引导的自适应放射治疗投照剂量更加严格和准确,未来需要进一步结合人工智能,实现更快地自动勾画与自动计划,缩短治疗时间,减小靶区和危及器官发生形变与位移的概率,进一步提升放射治疗的准确性.

Background To research the pathological and clinical staging uses of arterial spin labeling (ASL) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and methods 64 newly diagnosed nasopharyngeal carcinoma (NPC) patients were enrolled from December 2020 to January 2022, and 3.0 T MRI (Discovery 750W, GE Healthcare, USA) were used for ASL and DCE-MRI scans. The DCE-MRI and ASL raw data were processed post-acquisition on the GE image processing workstation (GE Healthcare, ADW 4.7, USA). The volume transfer constant (Ktrans), blood flow (BF), and accompanying pseudo-color images were generated automatically. Draw the region of interest (ROIs), and the Ktrans and BF values for each ROI were recorded separately. Based on pathological information and the most recent AJCC staging criteria, patients were divided into low T stage groups = T 1–2 and high T stage groups = T 3–4 , low N stage groups = N 0–1 and high N stage groups = N 2–3 , and low AJCC stage group = stage I–II and high AJCC stage group = stage III–IV. The association between the Ktrans t and BF parameters and the T, N, and AJCC stages was compared using an independent sample t-test. Using a receiver operating characteristic (ROC) curve, the sensitivity, specificity, and AUC of Ktrans t , BF t , and their combined use in T and AJCC staging of NPC were investigated and assessed. Result The tumor-BF (BF t ) (t = − 4.905, P < 0.001) and tumor-Ktrans (Ktrans t ) (t = − 3.113, P = 0.003) in the high T stage group were significantly higher than those in the low T stage group. The Ktrans t in the high N stage group was significantly higher than that in the low N stage group (t = − 2.071, P = 0.042). The BF t (t = − 3.949, P < 0.001) and Ktrans t (t = − 4.467, P < 0.001) in the high AJCC stage group were significantly higher than those in the low AJCC stage group. BF t was moderately positively correlated with the T stage (r = 0.529, P < 0.001) and AJCC stage (r = 0.445, P < 0.001). Ktrans t was moderately positively correlated with T staging (r = 0.368), N staging (r = 0.254), and AJCC staging (r = 0.411). There was also a positive correlation between BF and Ktrans in gross tumor volume (GTV) (r = 0.540, P < 0.001), parotid (r = 0.323, P < 0.009) and lateral pterygoid muscle (r = 0.445, P < 0.001). The sensitivity of the combined application of Ktrans t and BF t for AJCC staging increased from 76.5 and 78.4 to 86.3%, and the AUC value increased from 0.795 and 0.819 to 0.843, respectively. Conclusion Combining Ktrans and BF measures may make it possible to identify the clinical stages in NPC patients.

目的 应用动态增强磁共振成像(DCE-MRI)定量分析鼻咽癌调强放疗后肿瘤靶区、腮腺及翼外肌血流灌注变化,为鼻咽癌放疗疗效评估提供依据.方法 回顾性分析2020-12-21-2022-01-17山东省肿瘤医院确诊为鼻咽癌且接受放射治疗的17例患者.获取患者放疗前、中及结束时磁共振(MR)图像,包括T1加权成像(T1WI)、T2加权成像(T2WI)、T2加权脂肪抑制成像(T2 WI-FS)和DCE-MRI图像.在T2 WI-FS上勾画大体肿瘤靶区(GTV)、腮腺和翼外肌,获取不同区域DCE-MRI成像的Ktrans值.分析GTV、腮腺和翼外肌的体积和Ktrans变化规律及其相关性.结果 GTV体积在放疗中呈现持续减小趋势,放疗前、中、后体积分别为16.69(12.90,30.69)、7.80(6.25,15.06)和6.03(4.44,10.18)cm3,差异均有统计学意义,F=5.831,P后-前<0.001;F=2.915,P后-中=0.004;F=2.915,P中-前=0.004;腮腺体积在放疗中呈现持续减小趋势,放疗前、中、后体积分别为21.57(16.61,26.62)、14.61(12.00,20.78)和12.35(10.08,17.51)cm3,差异均有统计学意义,F=5.831,P后-前<0.001;F=2.915,P后-中=0.004;F=2.915,P中-前=0.004;翼外肌体积变化不大,放疗前、中、后体积分别为(8.07±2.35)、(7.83±2.25)和(7.36±2.29)cm3,差异无统计学意义,F=2.362,P=0.110.放疗中GTV Ktrans值呈下降趋势,放疗前、中、后Ktrans值分别为0.52(0.42,0.74)、0.37(0.30,0.45)和0.27(0.15,0.34)min-1,差异均有统计学意义,F=5.831,P后-前<0.001;F=2.915,P后-中=0.004;F=2.915,P中-前=0.004;放疗中腮腺Ktrans值变化呈持续升高趋势,放疗前、中、后Ktrans值分别为0.29(0.26,0.55)、0.49(0.33,0.81)和0.76(0.51,1.31)min-1,放疗前、后,放疗前、中差异有统计学意义,F=5.316,P后-前<0.001;F=3.430,P中-前=0.001,放疗中、后差异无统计学意义,F=1.886,P中-后>0.05;放疗中翼外肌Ktrans呈先升高后下降的趋势,整体呈升高趋势,放疗前、中、后Ktrans平均为(0.1±0.05)、(0.23±0.12)和(0.15±0.07)min-1,差异均有统计学意义,P后-前<0.001、P后-中=0.023、P中-前=0.001.GTV、腮腺、翼外肌放疗前、中、后体积和Ktrans的变化率之间均无相关性,均P>0.05.结论 鼻咽癌调强放疗中GTV、腮腺及翼外肌的体积与血流灌注变化呈不相关性,在疗效、损伤评估中应该引入血流灌注的生物学信息.

目的 分析基于CT/MR图像配准的脑转移瘤自适应放疗剂量累加的差异.方法 选取山东省肿瘤医院2018-11-07-2021-03-08接受放疗的33例脑转移瘤患者,初次和复位均行CT和MR模拟定位,制定自适应放疗计划,将2次计划基于CT和MR进行配准剂量累加,比较两者的差异.结果 初、复位基于MR确定的大体肿瘤靶区(GTV)较CT增加17％和27％(均P<0.05);危及器官(OAR)体积基本相当(均P>0.05);CT/MR确定的GTV初复位变化基本一致.GTV刚性配准的戴斯相似性系数(DSC)为0.673和0.688,全脑和局部形变配准的DSC为0.712、0.709和0.823、0.817.全脑与局部形变配准剂量累加的结果基本相当,形变配准与刚性配准相比,计划靶区(PTV)各指标变化率<2.9％;OAR的变化率<5.1％.基于MR的配准与CT比较,除Dmin、D98％和D99％变化较大外,其余变化率均<0.93％(均P>0.05);OAR变化率<7.0％(均P>0.05).结论 放疗过程中肿瘤靶区变化明显,自适应放疗为剂量评估提供一种可靠的方法.CT/MR肿瘤靶区的显示差异较大,MR图像配准较CT更具有优势,在脑转移瘤自适应放疗中MR图像应作为首选.

鼻咽癌是头颈部最常见的恶性肿瘤之一,放射治疗为首选的治疗方式.影像学在鼻咽癌放疗的各个环节发挥了重要作用,如靶区勾画、计划设计、剂量计算、计划评估和疗效毒性评估等.磁共振成像(MRI)因优越的软组织分辨率,已成为鼻咽癌诊断及放疗的必备影像学方式,而多维多参数的功能MR进一步提高了MR在鼻咽癌诊疗的应用范围及深度.动态对比增强磁共振成像(DCE-MRI)可以定量分析及评估正常和肿瘤组织中的血液灌注以及毛细血管通透性等信息.DCE-MRI的增强曲线下初始面积(AUC)、容积转移常量(Ktrans)、速率常数(Kep)和细胞外容积(Ve)等一系列半定量及定量参数值为进一步评估组织毛细血管血流灌注及微血管通透性的生成变化情况提供了量化依据.DCE-MRI不仅能为鼻咽癌临床分期提供更多形态学信息,还能运用其量化参数提供更丰富的微观分子生物学信息,使其在临床鼻咽癌治疗方案的制订、疗效监测及预后评估等方面有着更为广泛的应用,在提高鼻咽癌诊断的敏感性、良恶性肿瘤的鉴别诊断、肿瘤分级以及放化疗疗效评估等方面也具有重要临床指导意义.

目的 评估1.5T磁共振引导放疗(MRgRT)在肝癌放射治疗中的应用,制定标准的工作流程,并评估流程的可行性.方法 分析2021-04-12-2022-04-18在山东省肿瘤医院使用MRgRT的62例肝肿瘤患者临床资料.其中肝细胞癌31例,肝转移瘤31例;放疗方案:7 Gy×9次患者20例,常规分割42例.将疾病部位、放疗方案、使用MRgRT的临床依据、物理计划细节、腹部压力呼吸控制和配准误差等因素进行汇总,并在个体之间进行分层次比较,以确定流程实践模式的可行性和普适性.结果 34例(54.8％)患者使用8野调强放射治疗;偏移误差X向量位移为(0.55±0.50)cm,Y向量位移为(0.69±0.44)cm,Z向量位移为(0.34±0.31)cm;总体患者计划靶区(PTV)的均匀性指数(HI)平均值为1.10(1.06～1.62),适形性指数(CI)平均值为0.69(0.04～0.9),所有患者靶区体积平均值为(48.16±62.04)cm3,靶区体积与HI(t=5.923,P=0.286)和CI(t=5.980,P=0.06)差异均无统计学意义.身体质量指数(BMI)与X、Y、Z轴向量摆位误差差异均无统计学意义(tx=-0.973,Px=0.339;ty=0.778,Py=0.443;tz=-1.025,Pz=0.314).单次剂量(HI:t=2.657,P=0.013;CI:t=-3.073,P=0.005)及分割次数(HI:t=2.285,P=0.035;CI:t=-3.504,P=0.003)均与HI/CI存在相关性,放疗计划中<7 Gy组及大分割组(≤9次)中的HI、CI更优.性别、BMI与摆位误差在X、Y、Z轴上差异均无统计学意义,均P>0.05.疗效评估结果显示,病情稳定(SD)率为75.8％,疾病进展(PD)率为21.0％,且总体放疗不良反应轻微,未发现放射性肝炎病例.结论 本研究制定了MRgRT在肝肿瘤患者中的工作流程,并表明其工作流程是可行的,为进一步开展肝肿瘤磁共振引导放疗提供了理论基础,具有实践意义.