With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important ...With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important for managing BMs.Radiation therapy(RT),including photon therapy,has been essential in managing BMs.Recent technological advances have significantly enhanced the precision,efficacy,and safety of these treatments.This comprehensive review provides an in-depth examination of the latest advancements in radiation and photon therapy technologies for treating BMs,focusing on innovations such as stereotactic radiosurgery(SRS),whole-brain radiation therapy(WBRT),laser interstitial thermal therapy(LITT),and other radiation-related treatment modalities.Additionally,we discuss clinical outcomes,challenges,and future directions in this rapidly evolving field.While a detailed comparison of techniques is beyond the scope of this paper,this paper provides up-to-date technical information for physicians,medical physicists,patients,and researchers in related fields,potentially enhancing clinical outcomes.Among the treatment modalities,SRS has become a cornerstone of RT for BMs,with its implementation spanning multiple modalities over the past few decades.Given its inherent minimally invasive nature and growing clinical acceptance,SRS is positioned to further evolve as a key therapeutic tool in both neurosurgery and radiotherapy.展开更多
Background:Nonalcoholic fatty liver disease(NAFLD)is closely associated with obesity.However,this association could be influenced by the coexisting metabolic abnormalities.This study aimed to investigate the role of o...Background:Nonalcoholic fatty liver disease(NAFLD)is closely associated with obesity.However,this association could be influenced by the coexisting metabolic abnormalities.This study aimed to investigate the role of obesity and metabolic abnormalities in NAFLD among elderly Chinese.Methods:A cross-sectional study was performed among elderly residents who took their annual health checkups during 2016 in Keqiao District,Shaoxing,China.Results:A total of 3359 elderly adults were retrospectively included in this study.The overall prevalence of NAFLD was 28.7%.The prevalence of NAFLD were 7.14%,27.92%,34.80%,and 61.02%in participants with metabolically healthy normal weight(MHNW),metabolically abnormal normal weight(MANW),metabolically healthy obese(MHO),and metabolically abnormal obese(MAO),respectively.NAFLD patients in MHO group had more unfavorable metabolic profiles than those in MHNW group.Logistic regression analysis showed that sex,body mass index(BMI),fasting blood glucose,and serum uric acid were the risk factors of NAFLD.Conclusions:Both obesity and metabolic health were significantly associated with NAFLD in elderly Chinese.Screening for obesity and other metabolic abnormalities should be routinely performed for early risk stratification of NAFLD.展开更多
Background:Hepatic radiation injury severely restricts irradiation treatment for liver carcinoma.The purpose of this study was to investigate the clinical application of gadolinium ethoxybenzyl diethylenetriamine pent...Background:Hepatic radiation injury severely restricts irradiation treatment for liver carcinoma.The purpose of this study was to investigate the clinical application of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI(EOB-MRI)in the assessment of liver function after external radiation therapy and to determine the relationship between focal liver reaction(FLR)and liver function.Methods:A total of 47 patients with liver malignancies who underwent external beam radiation therapy were enrolled.EOB-MRI was performed on each patient at approximately one month post-radiotherapy.The hepatobiliary(HPB)phase images from EOB-MRI were fused with the planning CT images,and the isodose lines from the patients’treatment plans were overlaid onto the fused images.The correlation of the EOB-MR image intensity distribution with the isodose lines was studied.We also compared liver function in patients between pre-treatment and post-treatment.Results:Decreased uptake of Gd-EOB-DTPA,which was manifested by well-demarcated focal hypointensity of the liver parenchyma or FLR to high-dose radiation,was observed in the irradiated areas of 38 patients.The radiotherapy isodose line of decreased uptake area of Gd-EOB-DTPA was 30–46 Gy.The median corresponding dose curve of FLR was 34.4 Gy.Nine patients showed the absence of decreased uptake area of Gd-EOB-DTPA in the irradiated areas.Compared to the 38 patients with the presence of decreased uptake area of Gd-EOB-DTPA,9 patients with the absence of decreased uptake area of Gd-EOB-DTPA showed significant higher levels of total bile acid,total bilirubin,direct bilirubin and alpha-fetoprotein(P<0.05).There were no significant differences in alanine transaminase,aspartate aminotransferase,gamma-glutamyl transpeptidase or albumin levels between the two groups(P>0.05).Conclusions:Visible uptake of Gd-EOB-DTPA by the liver parenchyma was significantly associated with liver function parameters.EOB-MRI can be a valuable imaging biomarker for the assessment of liver parenchyma function outside of radiation area.展开更多
Tissue-classification-based attenuation correction strategies have been previously proposed to correct for bone attenuation in PET/MR imaging and simulated using computed tomography. However, the complication of voxel...Tissue-classification-based attenuation correction strategies have been previously proposed to correct for bone attenuation in PET/MR imaging and simulated using computed tomography. However, the complication of voxel averaging uniquely associated with bone has not been considered explicitly in the past. This study investigated the effect of voxel averaging between bone and soft tissue in attenuation images and determined how accurately bone must be detected in MR images in order to perform acceptable attenuation correction of PET data by using CT-simulated attenuation correction. We found out that treating bone as soft tissue caused a mean quantification difference of -9.9% ± 5.5% in all 119 bone lesions. There were no significant differences between lesions in the pelvis and the vertebrae. The nominal difference in lesions in the ribs was significantly lower, likely due to the spatial misregistration between the emission and attenuation images. Interestingly, a non-monotonic relationship between the bone imaging ability and the absolute PET quantification accuracy was observed, with the minimal quantification difference achieved at a BVF around 40% for skull lesions (2.6% ± 2.1%), and 30% for non-skull lesions (1.4% ± 1.1%) and all lesions (1.5% ± 1.3%). This study established that a bone classification sensitivity of approximately 30% BVF is required in order for MR-based attenuation correction methods to achieve optimal quantification in whole-body PET/MR studies. For this purpose, higher bone imaging ability of MR may not be necessary.展开更多
Purpose: To develop and test an integrated simulation system based on the digital Extended Cardio Torso (XCAT) phantom for 4-dimensional (4D) radiation therapy of lung cancer. Methods: A computer program was developed...Purpose: To develop and test an integrated simulation system based on the digital Extended Cardio Torso (XCAT) phantom for 4-dimensional (4D) radiation therapy of lung cancer. Methods: A computer program was developed to facilitate the characterization and implementation of the XCAT phantom for 4D radiation therapy applications. To verify that patient-specific motion trajectories are reproducible with the XCAT phantom, motion trajectories of the diaphragm and chest were extracted from previously acquired MRI scans of five subjects and were imported into the XCAT phantom. The input versus the measured trajectories was compared. Simulation methods of 4D-CT and 4D-cone-beam CT (CBCT) based on the XCAT phantom were developed and tested for regular and irregular respiratory patterns. Simulation of 4D dose delivery was illustrated in a simulated lung stereotactic-body radiation therapy (SBRT) case based on the XCAT phantom. Dosimetric comparison was performed between the planned dose and simulated delivered dose. Result: The overall mean (±standard deviation) difference in motion amplitude between the input and measured trajectories was 1.19 (±0.79) mm for the XCAT phantoms with voxel size of 2 mm. 4D-CT and 4D-CBCT images simulated based on the XCAT phantom were validated using regular respiratory patterns and tested for irregular respiratory patterns. Comparison between simulated 4D dose delivery and planned dose for the lung SBRT case showed comparable results in all dosimetric matrices: the relative differences were 0.3%, 4.0%, 0%, and 2.8%, respectively, for max cord dose, max esophagus dose, mean heart dose, and V20Gy of the lungs. 97.5% of planning target volume (PTV) received prescription dose in the simulated 4D delivery, as compared to 95% of PTV received prescription dose in the plan. Conclusion: We developed an integrated simulation system based on the XCAT digital phantom and illustrated its utility in 4D radiation therapy of lung cancer. This simulation system is potentially a useful tool for quality control and development of imaging and treatment techniques for 4D radiation therapy of lung cancer.展开更多
Background:Colorectal cancer is harmful to the patient’s life.The treatment of patients is determined by accurate preoperative staging.Magnetic resonance imaging(MRI)played an important role in the preoperative exami...Background:Colorectal cancer is harmful to the patient’s life.The treatment of patients is determined by accurate preoperative staging.Magnetic resonance imaging(MRI)played an important role in the preoperative examination of patients with rectal cancer,and artificial intelligence(AI)in the learning of images made significant achievements in recent years.Introducing AI into MRI recognition,a stable platform for image recognition and judgment can be established in a short period.This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network.Methods:A total of 183 rectal cancer patients’data were collected retrospectively as research objects.Faster region-based convolutional neural networks(Faster R-CNN)were used to build the platform.And the platform was evaluated according to the receiver operating characteristic(ROC)curve.Results:An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI.The areas under the ROC curve(AUC)were 0.99 in the horizontal plane,0.97 in the sagittal plane,and 0.98 in the coronal plane.In the horizontal plane,the AUC of T1 stage was 1,AUC of T2 stage was 1,AUC of T3 stage was 1,AUC of T4 stage was 1.In the coronal plane,AUC of T1 stage was 0.96,AUC of T2 stage was 0.97,AUC of T3 stage was 0.97,AUC of T4 stage was 0.97.In the sagittal plane,AUC of T1 stage was 0.95,AUC of T2 stage was 0.99,AUC of T3 stage was 0.96,and AUC of T4 stage was 1.00.Conclusion:Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging.Trial registration:chictr.org.cn:ChiCTR1900023575;http://www.chictr.org.cn/showproj.aspx?proj=39665.展开更多
To the Editor:Due to the highly complex nature of intensity-modulated radiotherapy(IMRT)planning and delivery,patient specific quality assurance(PSQA)should be implemented to assure the reliability of treatment delive...To the Editor:Due to the highly complex nature of intensity-modulated radiotherapy(IMRT)planning and delivery,patient specific quality assurance(PSQA)should be implemented to assure the reliability of treatment delivery and improve the treatment efficacy.展开更多
Purpose:Motion artifacts induced by breathing variations are common in 4D-MRI images.This study aims to reduce the motion artifacts by developing a novel,robust 4D-MRI sorting method based on anatomic feature matching...Purpose:Motion artifacts induced by breathing variations are common in 4D-MRI images.This study aims to reduce the motion artifacts by developing a novel,robust 4D-MRI sorting method based on anatomic feature matching and applicable in both cine and sequential acquisition.Method:The proposed method uses the diaphragm as the anatomic feature to guide the sorting of 4D-MRI images.Initially,both abdominal 2D sagittal cine MRI images and axial MRI images were acquired.The sagittal cine MRI images were divided into 10 phases as ground truth.Next,the phase of each axial MRI image is determined by matching its diaphragm position in the intersection plane to the ground truth cine MRI.Then,those matched phases axial images were sorted into 10-phase bins which were identical to the ground truth cine images.Finally,10-phase 4D-MRI were reconstructed from these sorted axial images.The accuracy of reconstructed 4D-MRI data was evaluated by comparing with the ground truth using the 4D eXtended Cardiac Torso(XCAT)digital phantom.The effects of breathing signal,including both regular(cosine function)and irregular(patient data)in both axial cine and sequential scanning modes,on reconstruction accuracy were investigated by calculating total relative error(TRE)of the 4D volumes,Volume-Percent-Difference(VPD)and Center-of-Mass-Shift(COMS)of the estimated tumor volume,compared with the ground truth XCAT images.Results:In both scanning modes,reconstructed 4D-MRI images matched well with ground truth with minimal motion artifacts.The averaged TRE of the 4D volume,VPD and COMS of the EOE phase in both scanning modes are 0.32%/1.20%/0.05 mm for regular breathing,and 1.13%/4.26%/0.21 mm for patient irregular breathing.Conclusion:The preliminary evaluation results illustrated the feasibility of the robust 4D-MRI sorting method based on anatomic feature matching.This method provides improved image quality with reduced motion artifacts for both cine and sequential scanning modes.展开更多
基金supported by the Natural Science Foundation of Zhejiang Province,China(Grant No.LTGY23H220001).
文摘With advancements in systemic therapy,the incidence of brain metastases(BMs)continues to rise,leading to severe neurological complications.Effective and precise treatment modalities are,therefore,critically important for managing BMs.Radiation therapy(RT),including photon therapy,has been essential in managing BMs.Recent technological advances have significantly enhanced the precision,efficacy,and safety of these treatments.This comprehensive review provides an in-depth examination of the latest advancements in radiation and photon therapy technologies for treating BMs,focusing on innovations such as stereotactic radiosurgery(SRS),whole-brain radiation therapy(WBRT),laser interstitial thermal therapy(LITT),and other radiation-related treatment modalities.Additionally,we discuss clinical outcomes,challenges,and future directions in this rapidly evolving field.While a detailed comparison of techniques is beyond the scope of this paper,this paper provides up-to-date technical information for physicians,medical physicists,patients,and researchers in related fields,potentially enhancing clinical outcomes.Among the treatment modalities,SRS has become a cornerstone of RT for BMs,with its implementation spanning multiple modalities over the past few decades.Given its inherent minimally invasive nature and growing clinical acceptance,SRS is positioned to further evolve as a key therapeutic tool in both neurosurgery and radiotherapy.
基金supported by grants from the Key Research De-velopment Program of Zhejiang Province(2018C03018)Major Science and Technology Projects of Medicine and Health in Zhe-jiang Province(WKJ-ZJ-1923+1 种基金2020383364)National Key R and D Program of China(2017YFCO114102)。
文摘Background:Nonalcoholic fatty liver disease(NAFLD)is closely associated with obesity.However,this association could be influenced by the coexisting metabolic abnormalities.This study aimed to investigate the role of obesity and metabolic abnormalities in NAFLD among elderly Chinese.Methods:A cross-sectional study was performed among elderly residents who took their annual health checkups during 2016 in Keqiao District,Shaoxing,China.Results:A total of 3359 elderly adults were retrospectively included in this study.The overall prevalence of NAFLD was 28.7%.The prevalence of NAFLD were 7.14%,27.92%,34.80%,and 61.02%in participants with metabolically healthy normal weight(MHNW),metabolically abnormal normal weight(MANW),metabolically healthy obese(MHO),and metabolically abnormal obese(MAO),respectively.NAFLD patients in MHO group had more unfavorable metabolic profiles than those in MHNW group.Logistic regression analysis showed that sex,body mass index(BMI),fasting blood glucose,and serum uric acid were the risk factors of NAFLD.Conclusions:Both obesity and metabolic health were significantly associated with NAFLD in elderly Chinese.Screening for obesity and other metabolic abnormalities should be routinely performed for early risk stratification of NAFLD.
基金supported by grants from the Project of Health Commission of Zhejiang province(2014KYA075)Natural Science Foundation of Zhejiang province(2014C33199)
文摘Background:Hepatic radiation injury severely restricts irradiation treatment for liver carcinoma.The purpose of this study was to investigate the clinical application of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)-enhanced MRI(EOB-MRI)in the assessment of liver function after external radiation therapy and to determine the relationship between focal liver reaction(FLR)and liver function.Methods:A total of 47 patients with liver malignancies who underwent external beam radiation therapy were enrolled.EOB-MRI was performed on each patient at approximately one month post-radiotherapy.The hepatobiliary(HPB)phase images from EOB-MRI were fused with the planning CT images,and the isodose lines from the patients’treatment plans were overlaid onto the fused images.The correlation of the EOB-MR image intensity distribution with the isodose lines was studied.We also compared liver function in patients between pre-treatment and post-treatment.Results:Decreased uptake of Gd-EOB-DTPA,which was manifested by well-demarcated focal hypointensity of the liver parenchyma or FLR to high-dose radiation,was observed in the irradiated areas of 38 patients.The radiotherapy isodose line of decreased uptake area of Gd-EOB-DTPA was 30–46 Gy.The median corresponding dose curve of FLR was 34.4 Gy.Nine patients showed the absence of decreased uptake area of Gd-EOB-DTPA in the irradiated areas.Compared to the 38 patients with the presence of decreased uptake area of Gd-EOB-DTPA,9 patients with the absence of decreased uptake area of Gd-EOB-DTPA showed significant higher levels of total bile acid,total bilirubin,direct bilirubin and alpha-fetoprotein(P<0.05).There were no significant differences in alanine transaminase,aspartate aminotransferase,gamma-glutamyl transpeptidase or albumin levels between the two groups(P>0.05).Conclusions:Visible uptake of Gd-EOB-DTPA by the liver parenchyma was significantly associated with liver function parameters.EOB-MRI can be a valuable imaging biomarker for the assessment of liver parenchyma function outside of radiation area.
文摘Tissue-classification-based attenuation correction strategies have been previously proposed to correct for bone attenuation in PET/MR imaging and simulated using computed tomography. However, the complication of voxel averaging uniquely associated with bone has not been considered explicitly in the past. This study investigated the effect of voxel averaging between bone and soft tissue in attenuation images and determined how accurately bone must be detected in MR images in order to perform acceptable attenuation correction of PET data by using CT-simulated attenuation correction. We found out that treating bone as soft tissue caused a mean quantification difference of -9.9% ± 5.5% in all 119 bone lesions. There were no significant differences between lesions in the pelvis and the vertebrae. The nominal difference in lesions in the ribs was significantly lower, likely due to the spatial misregistration between the emission and attenuation images. Interestingly, a non-monotonic relationship between the bone imaging ability and the absolute PET quantification accuracy was observed, with the minimal quantification difference achieved at a BVF around 40% for skull lesions (2.6% ± 2.1%), and 30% for non-skull lesions (1.4% ± 1.1%) and all lesions (1.5% ± 1.3%). This study established that a bone classification sensitivity of approximately 30% BVF is required in order for MR-based attenuation correction methods to achieve optimal quantification in whole-body PET/MR studies. For this purpose, higher bone imaging ability of MR may not be necessary.
文摘Purpose: To develop and test an integrated simulation system based on the digital Extended Cardio Torso (XCAT) phantom for 4-dimensional (4D) radiation therapy of lung cancer. Methods: A computer program was developed to facilitate the characterization and implementation of the XCAT phantom for 4D radiation therapy applications. To verify that patient-specific motion trajectories are reproducible with the XCAT phantom, motion trajectories of the diaphragm and chest were extracted from previously acquired MRI scans of five subjects and were imported into the XCAT phantom. The input versus the measured trajectories was compared. Simulation methods of 4D-CT and 4D-cone-beam CT (CBCT) based on the XCAT phantom were developed and tested for regular and irregular respiratory patterns. Simulation of 4D dose delivery was illustrated in a simulated lung stereotactic-body radiation therapy (SBRT) case based on the XCAT phantom. Dosimetric comparison was performed between the planned dose and simulated delivered dose. Result: The overall mean (±standard deviation) difference in motion amplitude between the input and measured trajectories was 1.19 (±0.79) mm for the XCAT phantoms with voxel size of 2 mm. 4D-CT and 4D-CBCT images simulated based on the XCAT phantom were validated using regular respiratory patterns and tested for irregular respiratory patterns. Comparison between simulated 4D dose delivery and planned dose for the lung SBRT case showed comparable results in all dosimetric matrices: the relative differences were 0.3%, 4.0%, 0%, and 2.8%, respectively, for max cord dose, max esophagus dose, mean heart dose, and V20Gy of the lungs. 97.5% of planning target volume (PTV) received prescription dose in the simulated 4D delivery, as compared to 95% of PTV received prescription dose in the plan. Conclusion: We developed an integrated simulation system based on the XCAT digital phantom and illustrated its utility in 4D radiation therapy of lung cancer. This simulation system is potentially a useful tool for quality control and development of imaging and treatment techniques for 4D radiation therapy of lung cancer.
基金National Natural Science Foundation of China(No.81802888)Key Research and Development Project of Shandong Province(No.2018GSF118206+1 种基金No.2018GSF118088)Natural Science Foundation of Shandong Province(No.ZR2019PF017)。
文摘Background:Colorectal cancer is harmful to the patient’s life.The treatment of patients is determined by accurate preoperative staging.Magnetic resonance imaging(MRI)played an important role in the preoperative examination of patients with rectal cancer,and artificial intelligence(AI)in the learning of images made significant achievements in recent years.Introducing AI into MRI recognition,a stable platform for image recognition and judgment can be established in a short period.This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network.Methods:A total of 183 rectal cancer patients’data were collected retrospectively as research objects.Faster region-based convolutional neural networks(Faster R-CNN)were used to build the platform.And the platform was evaluated according to the receiver operating characteristic(ROC)curve.Results:An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI.The areas under the ROC curve(AUC)were 0.99 in the horizontal plane,0.97 in the sagittal plane,and 0.98 in the coronal plane.In the horizontal plane,the AUC of T1 stage was 1,AUC of T2 stage was 1,AUC of T3 stage was 1,AUC of T4 stage was 1.In the coronal plane,AUC of T1 stage was 0.96,AUC of T2 stage was 0.97,AUC of T3 stage was 0.97,AUC of T4 stage was 0.97.In the sagittal plane,AUC of T1 stage was 0.95,AUC of T2 stage was 0.99,AUC of T3 stage was 0.96,and AUC of T4 stage was 1.00.Conclusion:Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging.Trial registration:chictr.org.cn:ChiCTR1900023575;http://www.chictr.org.cn/showproj.aspx?proj=39665.
基金National Key Research and Development Program of China(Nos.2021YFE0202500 and 2019YFF01014403)Beijing Municipal Commission of Science and Technology Collaborative Innovation Project(No.Z221100003522028)+1 种基金the National Natural Science Foundation of China(Nos.11735003,11975041,and 11961141004)the fundamental Research Funds for the Central Universities.
文摘To the Editor:Due to the highly complex nature of intensity-modulated radiotherapy(IMRT)planning and delivery,patient specific quality assurance(PSQA)should be implemented to assure the reliability of treatment delivery and improve the treatment efficacy.
基金This research was partly supported by research grants(NIH R01 EB028324,NIH R01 CA226899,GRF 151021/18M,GRF 151022/19M and HMRF 06173276).
文摘Purpose:Motion artifacts induced by breathing variations are common in 4D-MRI images.This study aims to reduce the motion artifacts by developing a novel,robust 4D-MRI sorting method based on anatomic feature matching and applicable in both cine and sequential acquisition.Method:The proposed method uses the diaphragm as the anatomic feature to guide the sorting of 4D-MRI images.Initially,both abdominal 2D sagittal cine MRI images and axial MRI images were acquired.The sagittal cine MRI images were divided into 10 phases as ground truth.Next,the phase of each axial MRI image is determined by matching its diaphragm position in the intersection plane to the ground truth cine MRI.Then,those matched phases axial images were sorted into 10-phase bins which were identical to the ground truth cine images.Finally,10-phase 4D-MRI were reconstructed from these sorted axial images.The accuracy of reconstructed 4D-MRI data was evaluated by comparing with the ground truth using the 4D eXtended Cardiac Torso(XCAT)digital phantom.The effects of breathing signal,including both regular(cosine function)and irregular(patient data)in both axial cine and sequential scanning modes,on reconstruction accuracy were investigated by calculating total relative error(TRE)of the 4D volumes,Volume-Percent-Difference(VPD)and Center-of-Mass-Shift(COMS)of the estimated tumor volume,compared with the ground truth XCAT images.Results:In both scanning modes,reconstructed 4D-MRI images matched well with ground truth with minimal motion artifacts.The averaged TRE of the 4D volume,VPD and COMS of the EOE phase in both scanning modes are 0.32%/1.20%/0.05 mm for regular breathing,and 1.13%/4.26%/0.21 mm for patient irregular breathing.Conclusion:The preliminary evaluation results illustrated the feasibility of the robust 4D-MRI sorting method based on anatomic feature matching.This method provides improved image quality with reduced motion artifacts for both cine and sequential scanning modes.
