Background: Tumor invasion risk (TIR) is an important prognostic factor in nasopharyngeal carcinoma (NPC). We propose a novel prognostic analytic method for NPC based on a voxelwise analysis of TIR in a coordinate system of the nasopharynx.Methods: A stable nasopharynx coordinate system was constructed based on anatomical landmarks to obtain an accurate TIR profile for NPC. The coordinate system was validated by image registration of the lateral pterygoid muscle (LPM). The tumors were registered to the coordinate system through shift, scale, and rotation transformations. The voxelwise TIR map for NPC was obtained by superposition of all registered and mirrored tumor regions of interest. The minimum risk (MinR) point of the tumor region was used as an independent prognostic factor for NPC. The cutoff value was calculated with density plot and validated with restricted cubic splines (RCSs), and then the patients were divided into 2 groups for overall survival (OS) analysis. Results:The first voxelwise TIR map of NPC was obtained based on 778 patients. The OS of patients with a low TIR was 76.8% and was 92.6% for patients with a high TIR [P<0.001; hazard ratio (HR) =1/0.45; 95% CI: 0.27-0.77; adjusted P=0.004]. Thus, patients with a low TIR had a poor prognosis, whereas patients with a high TIR had a good prognosis. The MinR may be better at grading the prognosis of patients compared to the American Joint Committee on Cancer (AJCC) staging or tumor/node (T/N) classification systems. Conclusions:The voxelwise TIR map provides a new method for the prognostic analysis of NPC.Potential clinical applications of voxelwise TIR mapping are clinical target volume (CTV) delineation and dose-painting for NPC.
BackgroundImage registration technology has become an important medical image preprocessing step with the wide application of computer‐aided diagnosis technology in various medical image analysis tasks.PurposeWe propose a multiscale feature fusion registration based on deep learning to achieve the accurate registration and fusion of head magnetic resonance imaging (MRI) and solve the problem that general registration methods cannot handle the complex spatial information and position information of head MRI.MethodsOur proposed multiscale feature fusion registration network consists of three sequentially trained modules. The first is an affine registration module that implements affine transformation; the second is to realize non‐rigid transformation, a deformable registration module composed of top‐down and bottom‐up feature fusion subnetworks in parallel; and the third is a deformable registration module that also realizes non‐rigid transformation and is composed of two feature fusion subnetworks in series. The network decomposes the deformation field of large displacement into multiple deformation fields of small displacement by multiscale registration and registration, which reduces the difficulty of registration. Moreover, multiscale information in head MRI is learned in a targeted manner, which improves the registration accuracy, by connecting the two feature fusion subnetworks.ResultsWe used 29 3D head MRIs for training and seven volumes for testing and calculated the values of the registration evaluation metrics for the new algorithm to register anterior and posterior lateral pterygoid muscles. The Dice similarity coefficient was 0.745 ± 0.021, the Hausdorff distance was 3.441 ± 0.935 mm, the Average surface distance was 0.738 ± 0.098 mm, and the Standard deviation of the Jacobian matrix was 0.425 ± 0.043. Our new algorithm achieved a higher registration accuracy compared with state‐of‐the‐art registration methods.ConclusionsOur proposed multiscale feature fusion registration network can realize end‐to‐end deformable registration of 3D head MRI, which can effectively cope with the characteristics of large deformation displacement and the rich details of head images and provide reliable technical support for the diagnosis and analysis of head diseases.
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