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Objectives: To investigate the feasibility of synthetic MRI (syMRI), diffusion-weighted imaging (DWI), and their combination with morphological features for differentiating nasopharyngeal lymphoma (NPL) from nasopharyngeal carcinoma (NPC)., Methods: Sixty-nine patients with nasopharyngeal tumours (NPL, n = 22; NPC, n = 47) who underwent syMRI and DWI were retrospectively enrolled between October 2020 and May 2022. syMRI and DWI quantitative parameters (T1, T2, PD, ADC) and morphological features were obtained. Diagnostic performance was assessed by independent sample t-test, chi-square test, logistic regression analysis, receiver operating characteristic curve (ROC), and DeLong test., Results: NPL has significantly lower T2, PD, and ADC values compared to NPC (all P < .05), whereas no significant difference was found in T1 value between these two entities (P > .05). The morphological features of tumour type, skull-base involvement, Waldeyer ring involvement, and lymph nodes involvement region were significantly different between NPL and NPC (all P < .05). The syMRI (T2 + PD) model has better diagnostic efficacy, with AUC, sensitivity, specificity, and accuracy of 0.875, 77.27%, 89.36%, and 85.51%. Compared with syMRI model, syMRI + Morph (PD + Waldeyer ring involvement + lymph nodes involvement region), syMRI + DWI (T2 + PD + ADC), and syMRI + DWI + Morph (PD + ADC + skull-base involvement + Waldeyer ring involvement) models can further improve the diagnostic efficiency (all P < .05). Furthermore, syMRI + DWI + Morph model has excellent diagnostic performance, with AUC, sensitivity, specificity, and accuracy of 0.986, 95.47%, 97.87%, and 97.10%, respectively., Conclusion: syMRI and DWI quantitative parameters were helpful in discriminating NPL from NPC. syMRI + DWI + Morph model has the excellent diagnostic efficiency in differentiating these two entities., Advances in Knowledge: syMRI + DWI + morphological feature method can differentiate NPL from NPC with excellent diagnostic performance., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: The study explores the application value of three-dimensional arterial spin labeling magnetic resonance imaging (3D pCASL) in early assessment of radiation encephalopathy (REP) in patients with nasopharyngeal carcinoma (NPC)., Methods: A retrospective analysis of 39 cases of NPC was performed. Routine enhanced MRI scan and 3D pCASL imaging were used to examine the apparent diffusion coefficient (ADC) and brain blood flow (CBF) before and after treatment with intensity-modulated radiotherapy (IMRT). Dosimetric analysis of irradiation was performed. Receiver operating characteristic curve (ROC) was used to analyze diagnostic performance of two imaging methods., Results: There was no statistically significant difference between the two methods for the measurement of temporal white matter ADC, but statistically significant difference was found in CBF. 3D pCASL imaging showed more sensitivity, specificity and higher accuracy than conventional MRI enhanced scan in showing REP. The maximum dose of the temporal lobe was at the enhanced area., Conclusion: The present study demonstrates that 3D pCASL scan at month 3 can reflect blood flow perfusion differences in NPC patients after IMRT and can accurately assess the possibility of REP at early stage. Enhanced areas have a higher probability of REP than the surrounding areas., Advances in Knowledge: There is few magnetic resonance angiography studies used to evaluate arterial circulation on its application on potential REP after radiotherapy for NPC. In our study, we evaluate the application value of 3D pCASL in the early assessment of potential REP in patients with NPC after radiotherapy. The study was to provide an improved understanding of the early specific characteristics on MRI imaging and evolution of potential radiation encephalopathy using 3D pCASL technique, which can quantitatively evaluate the changes of blood flow in tissues at early stage and help to diagnose and treat potential radiation encephalopathy as early as possible., Competing Interests: Ethical approval and consent to participate All procedures performed in the current study were approved by the Ethics Committee of Jiangnan University. Written informed consent was obtained from all patients or their families.

Objective: To shorten acquisition time of readout segmentation of long variable echo trains (RESOLVE)-based diffusion kurtosis imaging (DKI) via Readout Partial Fourier (RPF) and b-value combinations., Methods: The RESOLVE-based DKI images of 38 patients with nasopharyngeal carcinoma (NPC) were prospectively enrolled. For RESOLVE-based DKI images with 5/8 RPF and without RPF, objective and subjective evaluations of image quality were performed. A total of nine groups with different b-value combinations were simulated, and the influence of different b-value combinations for RESOLVE-RPF-based DKI sequences was assessed using the intraclass correlation coefficient (ICC)., Results: The mean values of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in DKI images without RPF were higher than those with 5/8 RPF (252.9 ± 77.7 vs 247.3 ± 85.5 and 5.8 ± 2.8 vs 5.4 ± 2.3, respectively), but not significantly ( p = 0.460 and p = 0.180, respectively). In comparing the ICCs between nine groups of different b-value combinations in RESOLVE-RPF-based DKI, group (200, 800, 2000 s/mm 2 ), group (200, 400, 800, 2000 s/mm 2 ) and group (200, 800, 1500, 2000 s/mm 2 ) were not significantly different ( p > 0.001) and showed excellent agreement (0.81-1.00) with that of group (200, 400, 800, 1500, 2000 s/mm 2 ). Using b-value optimization and RPF technology, the group with RPF (200, 400, 800, 2000 s/mm 2 ) showed a 56% reduced scanning compared with the group without RPF (200, 400, 800, 1500, 2000 s/mm 2 ; 3 min 46 s vs 8 min 31 s, respectively)., Conclusion: DKI with RPF did not significantly affect image quality, but both RPF and different b-value combinations can affect the scanning time. The combination of RPF and b-value optimization can ensure the stability of DKI parameters and reduce the scanning time by 56%., Advances in Knowledge: This work is to optimize scan parameters, e.g. RPF and b-value combinations, to reduce acquisition time for RESOLVE-based DKI in NPC. To our knowledge, the effect of RESOLVE-RPF and b-value combinations on DKI has not been reported.

Objectives: To investigate the value of 18 F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) combined with the platelet-lymphocyte ratio (PLR) in predicting the prognosis of nasopharyngeal carcinoma (NPC)., Methods: This was a retrospective analysis of the data of 73 patients with NPC who underwent 18 F-FDG PET/CT before treatment from January 2010 to December 2014. The maximum standard uptake value (SUVmax) of NPC and the PLR within 1 week before treatment were both measured. The Mann-Whitney U-test was used to compare the differences between the SUVmax and PLR among the different clinical characteristics of patients with NPC and the 5-year progression-free survival (PFS) rate; according to the receiver operating characteristic (ROC) curve, the best cutoff values of the SUVmax and PLR were obtained and used to group patients. The Kaplan-Meier method and Log-rank test were used to conduct univariate analysis of 5-year PFS in patients with NPC, and Cox regression was used to conduct multivariate analysis; differences in the 5-year PFS of patients with different SUVmax values combined with the PLR were compared., Results: The SUVmax and PLR of patients with disease progression within 5 years were higher than those of patients without disease progression ( p = 0.006 and p = 0.026). SUVmax = 9.7 and PLR = 132.98 had the best prognostic diagnostic efficiency for patients. Cox multivariate analysis showed that the SUVmax and PLR are independent factors affecting the prognosis of NPC. The 5-year PFS of patients with SUVmax <9.7 was significantly higher than that of patients with SUVmax ≥9.7 in the high PLR group (PLR ≥132.98) and in the low PLR group (PLR <132.98) (59.3% vs  29.4%, p = 0.033 and 90.9% v s  42.9%, p = 0.006, respectively). For patients with SUVmax <9.7, the 5-year PFS of the high PLR group was significantly lower than the low PLR group (59.3% vs  90.9%, p = 0.016 ); for patients with SUVmax ≥9.7, there was no significant difference in 5-year PFS between the high PLR group and the low PLR group (29.4% vs  42.9%, p = 0.406)., Conclusions: Both the SUVmax of the primary tumor and the PLR before treatment have an important influence on the prognosis of NPC. Combining the SUVmax and the PLR can more accurately predict the prognosis of patients with NPC., Advances in Knowledge: In this study, we evaluated the prognostic value of combining pretreatment tumor 18 F-FDG uptake on PET/CT imaging and PLR in NPC patients. We found that both SUVmax and PLR are independent factors for the PFS of NPC patients, and a low SUVmax (SUVmax <9.7) combined with a low PLR (PLR <132.98) revealed significant PFS benefit.

Objective: To establish and substantiate MRI-based radiomic models to predict the treatment response of metastatic cervical lymph node to radiochemotherapy in patients with nasopharyngeal carcinoma (NPC)., Methods: A total of 145 consecutive patients with NPC were enrolled including 102 in primary cohort and 43 in validation cohort. Metastatic lymph nodes were diagnosed according to radiologic criteria and treatment response was evaluated according to the Response Evaluation Criteria in Solid Tumors. A total of 2704 radiomic features were extracted from contrast-enhanced T 1 weighted imaging (CE- T 1 WI) and T 2 weighted imaging ( T 2 WI) for each patient, and were selected to construct radiomic signatures for CE- T 1 WI, T 2 WI, and combined CE- T 1 WI and T 2 WI, respectively. The area under curve (AUC) of receiver operating characteristic, sensitivity, specificity, and accuracy were used to estimate the performance of these radiomic models in predicting treatment response of metastatic lymph node., Results: No significant difference of AUC was found among radiomic signatures of CE- T 1 WI, T 2 WI, and combined CE- T 1 WI and T 2 WI in the primary and validation cohorts (all p > 0.05). For combined CE- T 1 WI and T 2 WI data set, 12 features were selected to develop the radiomic signature. The AUC, sensitivity, specificity, and accuracy were 0.927 (0.878-0.975), 0.911 (0.804-0.970), 0.826 (0.686-0.922), and 0.872 (0.792-0.930) in primary cohort, and were 0.772 (0.624-0.920), 0.792 (0.578-0.929), 0.790 (0.544-0.939), and 0.791 (0.640-0.900) in validation cohort., Conclusion: MRI-based radiomic models were developed to predict the treatment response of metastatic cervical lymph nodes to radiochemotherapy in patients with NPC, which might facilitate individualized therapy for metastatic lymph nodes before treatment., Advances in Knowledge: Predicting the response in patients with NPC before treatment may allow more individualizing therapeutic strategy and avoid unnecessary side-effects and costs. Radiomic features extracted from metastatic cervical lymph nodes showed promising application for predicting the treatment response in NPC.

The prevalence of nasopharyngeal carcinoma is characterized by an unbalanced distribution: the disease is particularly prevalent in East and Southeast Asia. In this article, we review the evolution of the International Union Against Cancer/American Joint Committee on Cancer staging system for nasopharyngeal carcinoma. With the increasing using of newer imaging methods, more advanced radiotherapy techniques and systemic chemotherapy, we also discuss newer clinical features that might affect staging. Finally, we propose the future direction of staging and potential prognostic factors that have a major influence on the treatment outcomes of this disease.

Objective: Radiomics pipelines have been developed to extract novel information from radiological images, which may help in phenotypic profiling of tumours that would correlate to prognosis. Here, we compared two publicly available pipelines for radiomics analyses on head and neck CT and MRI in nasopharynx cancer (NPC)., Methods and Materials: 100 biopsy-proven NPC cases stratified by T- and N-categories were enrolled in this study. Two radiomics pipeline, Moddicom (v. 0.51) and Pyradiomics (v. 2.1.2) were used to extract radiomics features of CT and MRI. Segmentation of primary gross tumour volume was performed using Velocity v. 4.0 by consensus agreement between three radiation oncologists. Intraclass correlation between common features of the two pipelines was analysed by Spearman's rank correlation. Unsupervised hierarchical clustering was used to determine association between radiomics features and clinical parameters., Results: We observed a high proportion of correlated features in the CT data set, but not for MRI; 76.1% (51 of 67 common between Moddicom and Pyradiomics) of CT features and 28.6% (20 of 70 common) of MRI features were significantly correlated. Of these, 100% were shape-related for both CT and MRI, 100 and 23.5% were first-order-related, 61.9 and 19.0% were texture-related, respectively. This interpipeline heterogeneity affected the downstream clustering with known prognostic clinical parameters of cTN-status and GTVp. Nonetheless, shape features were the most reproducible predictors of clinical parameters among the different radiomics modules., Conclusion: Here, we highlighted significant heterogeneity between two publicly available radiomics pipelines that could affect the downstream association with prognostic clinical factors in NPC., Advances in Knowledge: The present study emphasized the broader importance of selecting stable radiomics features for disease phenotyping, and it is necessary prior to any investigation of multicentre imaging datasets to validate the stability of CT-related radiomics features for clinical prognostication.

Objective: The aim of the present study was to evaluate the clinical significance of the post-radiotherapy 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) response for detecting residual disease and predicting survival outcome in patients with nasopharyngeal cancer., Methods: We reviewed 143 patients with nasopharyngeal cancer who underwent 18 F-FDG PET within 6 months after completion of radiotherapy between 2001 and 2012. 18 F-FDG PET findings at the primary tumor (T-) and regional lymph nodes (N-) were separately assessed and considered negative [PET (-)] or positive [PET (+)] depending on the remaining focal increased uptake of 18 F-FDG that was greater than that of the surrounding muscle or blood vessels. The standard of reference was histopathological confirmation or clinical/imaging follow-up. Overall survival (OS), distant metastasis-free survival (DMFS), and locoregional recurrence-free survival (LRRFS) rates were estimated from the date of the start of radiotherapy., Results: The median follow-up period was 73 months (range, 9-182 months). Overall, 83 and 66% of patients achieved T-PET (-) and N-PET (-) responses, and the negative-predictive values (NPVs) for T- and N- were 100 and 99%, respectively. The sensitivity, specificity, and positive-predictive value were 100, 84, and 8% for T-, and 67, 80, and 7% for N-, respectively. The 5-year OS, DMFS, and LRRFS rates were 83, 83, and 87%, respectively, and patients with N-PET (+) with SUV max >2.5 showed significantly inferior 5-year OS and DMFS rates than patients with N-PET (-) or N-PET (+) with SUV max ≤2.5 (44 vs 86%, p = 0.004; 36 vs 85%, p < 0.001)., Conclusion: In patients that have received definitive (chemo)radiotherapy for nasopharyngeal cancer, 18 F-FDG PET within 6 months of completion of treatment has a high NPV for predicting residual disease and is prognostic for long-term treatment outcomes. Patients with remaining focal increased uptake of 18 F-FDG at lymph nodes may benefit from more aggressive treatments, and further studies are needed to validate the clinical significance of post-radiotherapy 18 F-FDG PET., Advances in Knowledge: We found that post-radiotherapy 18 F-FDG PET findings have a high NPV for detecting residual disease and are a significant prognostic factor for treatment outcomes.

Objective: In radiotherapy of nasopharyngeal carcinoma (NPC) patients, the brachial plexus (BP) situated at both sides of the neck is often irradiated to high dose. This study was to evaluate different BP delineation methods and analyse the dosimetric consequences when applying BP dose constraints in radiotherapy planning of NPC., Methods: 15 NPC cases radically treated with helical tomotherapy were recruited. Apart from the original treatment plan (Plan A), two new plans (Plans B and C) with additional BP dose constraints were computed using the same planning CT images, structures and planning parameters. Plan B consisted of BP contours based on Radiation Therapy Oncology Group (RTOG)-endorsed atlas; while those in Plan C were based on MR images registered with the planning CT images., Results: The mean BP volume by RTOG method was 19.04 ± 3.50 cm 3 vs 10.44 ± 2.00 cm 3 by CT/MRI method. The mean BP overlapping volume between the two contouring methods was 1.9 cm 3 (0.38-4.03 cm 3 ). There was significant difference between two methods ( p < 0.001). The average D max , D mean , D 5% , D 10% and D 15% of both sides of BP in Plan A were significantly higher than those in both Plan B and Plan C. There were no significant dose differences in the targets and organs at risk (OARs) after applying dose constraints in Plan B and Plan C., Conclusion: RTOG method was recommended since larger BP volume provided better protection. Applying BP dose constraints during tomotherapy plan optimisation for NPC patients could significantly reduce the BP dose ( p < 0.05) without compromising the doses to the targets and other OARs., Advances in Knowledge: This is the first study comparing the delineation method based on RTOG-endorsed atlas with the conventional CT/MRI delineation method for BP in tomotherapy of NPC patients. Our results showed that BP dose could be significantly reduced after applying the dose constraints without compromising the doses to the target volumes and other OARs. The RTOG method was more favoured as it gave a relatively larger BP volume and therefore offered better organ sparing.