Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.

Multimodality functional imaging using DW-MRI and 18F-FDG-PET/CT during radiation therapy for human papillomavirus negative head and neck squamous cell carcinoma: Meixoeiro Hospital of Vigo Experience

AIMTo noninvasively investigate tumor cellularity measured using diffusion-weighted magnetic resonance imaging (DW-MRI) and glucose metabolism measured by 18F-labeled fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) during radiation therapy (RT) for human papillomavirus negative (HPV-) head and neck squamous cell carcinoma (HNSCC).METHODSIn this prospective study, 6 HPV- HNSCC patients underwent a total of 34 multimodality imaging examinations DW-MRI at 1.5 T Philips MRI scanner [(n = 24) pre-, during- (2-3 wk), and post-treatment (Tx), and 18F-FDG PET/CT pre- and post-Tx (n = 10)]. All patients received RT. Monoexponential modeling of the DW-MRI data yielded the imaging metric apparent diffusion coefficient (ADC) and the mean of standardized uptake value (SUV) was measured from 18F-FDG PET uptake. All patients had a clinical follow-up as the standard of care and survival status was documented at 1 year.RESULTSThere was a strong negative correlation between the mean of pretreatment ADC (ρ = -0.67, P = 0.01) and the pretreatment 18F-FDG PET SUV. The percentage (%) change in delta (∆) ADC for primary tumors and neck nodal metastases between pre- and Wk2-3 Tx were as follows: 75.4% and 61.6%, respectively, for the patient with no evidence of disease, 27.5% and 32.7%, respectively, for those patients who were alive with disease, and 26.9% and 7.31%, respectively, for those who were dead with disease.CONCLUSIONThese results are preliminary in nature and are indicative, and not definitive, trends rendered by the imaging metrics due to the small sample size of HPV- HNSCC patients in a Meixoeiro Hospital of Vigo Experience.

Magnetic resonance imaging evaluation of head and neck involvement in IgG4-related disease

Objective:To evaluate the radiological features of IgG4-related disease(IgG4-RD)in the head and neck region.Methods:In this radiology-based study,radiological features,clinical,laboratory,pathological findings,and prognosis of nine patients with head and neck involvement diagnosed with IgG4-RD were investigated retrospectively.Results:The median age of the patients was 38 years(range:2.5-79 years),and there were six males and three females.The most common symptoms and clinical findings of the patients were eyelid and lacrimal gland swelling,painless exophthalmos,and ophthalmoplegia.The most common site of involvement on MRI was the orbit.Orbital involvement was followed by branches of the trigeminal nerve,sinonasal cavity,cervical lymph nodes,and dural involvement.The most common and remarkable imaging features were T2 hypointensity and diffuse homogeneous contrast enhancement.Conclusions:Head and neck involvement of the IgG4-RD,has specific imaging features that can help with diagnosis.Thus,early diagnosis and better outcomes can be achieved with increasing awareness of these features of this relatively new pathology.

Research Progress in Surgical Management of Head and Neck Tumors Involving the Carotid Artery

The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.

Texture analysis on parametric maps derived from dynamic contrast-enhanced magnetic resonance imaging in head and neck cancer

AIM: To investigate the merits of texture analysis on parametric maps derived from pharmacokinetic modeling with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) as imaging biomarkers for the prediction of treatment response in patients with head and neck squamous cell carcinoma(HNSCC). METHODS: In this retrospective study,19 HNSCC patients underwent pre- and intra-treatment DCEMRI scans at a 1.5T MRI scanner. All patients had chemo-radiation treatment. Pharmacokinetic modeling was performed on the acquired DCE-MRI images,generating maps of volume transfer rate(Ktrans) and volume fraction of the extravascular extracellular space(ve). Image texture analysis was then employed on maps of Ktrans and ve,generating two texture measures: Energy(E) and homogeneity.RESULTS: No significant changes were found for the mean and standard deviation for Ktrans and ve between pre- and intra-treatment(P > 0.09). Texture analysis revealed that the imaging biomarker E of ve was significantly higher in intra-treatment scans,relative to pretreatment scans(P < 0.04). CONCLUSION: Chemo-radiation treatment in HNSCC significantly reduces the heterogeneity of tumors.

Clinical impact of surveillance for head and neck cancer in patients with esophageal squamous cell carcinoma

To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC).METHODSSince 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC before treatment, and each follow-up. The patients with newly diagnosed stage I to III ESCC were enrolled and classified into two groups as follows: Group A (no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up.RESULTSA total 561 patients (group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P = 0.008). During the follow up period, metachronous HNSCC were detected in 10 patients (3.9%) in group A and in 30 patients (9.8%) in group B (P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC.CONCLUSIONSurveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC.

Different imaging techniques in the head and neck:Assets and drawbacks

In this review,the gold standard imaging techniques for the head and neck and the latest upcoming techniques are presented,by comparing computed tomography(CT),magnetic resonance imaging and positron emission tomography-CT,as well as ultrasound,depending on the examined area.The advantages and disadvantages of each examination protocol are presented.This article illustrates the connection between the imaging technique and the examined area.Therefore,the head and neck area is divided into different sections such as bony structures,nervous system,mucous membranes and squamous epithelium,glandular tissue,and lymphatic tissue and vessels.Finally,the latest techniques in the field of head and neck imaging such as multidetector CT,dual-energy CT,flash CT,magnetic resonance angiography,spectroscopy,and diffusion tensor tractography using 3 tesla magnetic resonance are discussed.

Prognostic value of post-treatment ^(18)F-FDG PET/CT for advanced head and neck cancer after combined intra-arterial chemotherapy and radiotherapy

Objective：To clarify the prognostic value of post-treatment 18F-fluorodeoxyglucose （FDG） positron emission tomography （PET）/computed tomography （CT） in patients with advanced head and neck squamous cell carcinoma （HNSCC） after combined intra-arterial chemotherapy and radiotherapy （IACR）.Methods：Thirty-six patients with HNSCC who underwent IACR were recruited.The period from the end of IACR to the last post-treatment 18F-FDG PET/CT examination was 8-12 weeks.Both patient-based and lesion-based analyses were used to evaluate the PET/CT images.For lesion-based analysis,36 regions （12 lesions of recurrences and 24 scars at primary sites） were selected.The Kaplan-Meier method was used to assess the overall survival （OS） stratified by 18F-FDG uptake or visual interpretation results.Results：Twelve patients with recurrence were identified by six months after IACR.The sensitivity and specificity in the patient-based analysis were 67％ （8/12） and 88％ （21/24）,respectively.The mean OS was estimated to be 12.1 months （95％ CI,6.3-18.0 months） for the higher maximum standardized uptake value （SUVmax） group （n=7） and 44.6 months （95％ CI,39.9-49.3 months） for the lower SUVmax group （n=29）.OS in the higher SUVmax group （cut-off point,6.1） or positive visual interpretation group was significantly shorter than that in the lower SUVmax or negative visual interpretation group （P＜0.001 and P＜0.05,respectively）.Conclusions：The SUVmax and visual interpretation of HNSCC on post-IACR 18F-FDG PET/CT can provide prognostic survival estimates.

Monitoring photodynamic therapy of head and neck malignancies with optical spectroscopies

In recent years there has been significant developments in photosensitizers(PSs), light sources and light delivery systems that have allowed decreasing the treatment time and skin phototoxicity resulting in more frequent use of photodynamic therapy(PDT) in the clinical settings. Compared to standard treatment approaches such as chemo-radiation and surgery, PDT has much reduced morbidity for head and neck malignancies and is becoming an alternative treatment option. It can be used as an adjunct therapy to other treatment modalities without any additive cumulative side effects. Surface illumination can be an option for pre-malignant and early-stage malignancies while interstitial treatment is for debulking of thick tumors in the head and neck region. PDT can achieve equivalent or greater efficacy in treating head and neck malignancies, suggesting that it may be considered as a first line therapy in the future. Despite progressive development, clinical PDT needs improvement in several topics for wider acceptance including standardization of protocols that involve the same administrated light and PS doses and establishing quantitative tools for PDT dosimetry planning and response monitoring. Quantitative measures such as optical parameters, PS concentration, tissueoxygenation and blood flow are essential for accurate PDT dosimetry as well as PDT response monitoring and assessing therapy outcome. Unlike conventional imaging modalities like magnetic resonance imaging, novel optical imaging techniques can quantify PDT-related parameters without any contrast agent administration and enable real-time assessment during PDT for providing fast feedback to clinicians. Ongoing developments in optical imaging offer the promise of optimization of PDT protocols with improved outcomes.

THE EFFECT OF INTERNAL AND EXTERNAL CAROTID ARTERIAL INFUSION CHEMOTHERAPY ON 41 ADVANCED HEAD AND NECK CANCER PATIENTS

advanced head and neck cancer patients who couldn't be cured by surgery were treated by internal and external carotid arterial infusion via thyroid superior artery,temporal superficial artery or carotid artery with Fluorocuracil (SFu),Pingyangmycini(PYM),Carmustine (BCNU),Nidran Ampooles (ACNU) and Methotrexate (MTX).The results suggested that, the combining application of different drugs acting at different phases in cell replication cycle might play a coordinated role,before chemotherapy the application of hyperosmotic mannitol and corticoid might open the blood brain barrier temporarily and increase the drug uptake by brain tissue.As compared with ultra-selective internal carotic arterial chemotherapy,the treatment intubating into internal carotid artery via thyroid superior artery and leaving the tube in the artery is much easier, safer and cheaper and has fewer complications,so it is readily accepted by patients.

Usability of Deformable Image Registration for Adaptive Radiotherapy in Head and Neck Cancer and an Automatic Prediction of Replanning

Deformable image registration (DIR) has been an important component in adaptive radiotherapy (ART). Our goal was to examine the accuracy of ART using the dice similarity coefficient (DSC) and to determine the optimal timing of replanning. A total of 22 patients who underwent volume modulated arc therapy (VMAT) for head and neck (H&N) cancers were prospectively analyzed. The planning target volume (PTV) was to receive a total of 70 Gy in 33 fractions. A second planning CT scan (rescan) was performed at the 15th fraction. The DSC was calculated for each structure on both CT scans. The continuous variables to predict the need for replanning were assessed. The optimal cut-off value was determined using receiver operating characteristic (ROC) curve analysis. In the correlation between body weight loss and DSC of each structure, weight loss correlated negatively with DSC of the whole face (rs = -0.45) and the face surface (rs = -0.51). Patients who required replanning tended to have experienced rapid weight loss. The threshold DSC was 0.98 and 0.60 in the whole face and the face surface, respectively. Patients who showed low DSC in the whole face and the face surface required replanning at a significantly high rate (P < 0.05 and P < 0.01). Weight loss correlated with DSC in both the whole face and the face surface (P < 0.05 and P < 0.05). The DSC values in the face predicted the need for replanning. In addition, weight loss tended to correlate with DSC. DIR during ART was found to be a useful tool for replanning.

VISUALIZATION OF HEAD AND NECK CANCER MODELS WITH A TRIPLE FUSION REPORTER GENE

The development of experimental animal models for head and neck tumors generally rely on the biol uminescence imaging to achieve the dynamic monitoring of the tumor growth and metastasis due to the complicated anatomical structures.Since the bioluminescence imaging is largely affected by the intracellular luciferase expression level and external D-luciferin concentrations,its imaging accuracy requires further confirmation.Here,a new triple fusion reportelr gene,which consists of a herpes simplex virus type 1 thymidine kinase(TK)gene for radioactive imaging,a far-red fuorescent protein(mLumin)gene for fuorescent imaging,and a firefly luciferase gene for bioluminescence imaging,was introduced for in vrivo observation of the head and neck tumors through multi-modality imaging.Results show that fuorescence and bioluminescence signals from mLumin and luciferase,respectively,were clearly observed in tumor cells,and TK could activate suicide pathway of the cells in the presence of nucleotide analog-ganciclovir(GCV),demonstrating the effecti veness of individual functions of each gene.Moreover,subcutaneous and metastasis animal models for head and neck tumors using the fusion reporter gene-expressing cell lines were established,allowing multi-modality imaging in vio.Together,the established tumor models of head and neck cancer based on the newly developed triple fusion reporter gene are ideal for monitoring tumor growth,assessing the drug therapeutic efficacy and verifying the effec-tiveness of new treatments.

The Comparison of Diagnostic Significance of Narrow Band Imaging in Contrast of White Light Endoscopy in the Assessment of Nasopharyngeal Cancer

Background: Narrow band imaging (NBI) is reported to improve the diagnostic importance of nasopharyngeal cancer. The purpose of this review was to evaluate the diagnostic significance of NBI in the literature and compare it to the conventional white light endoscopy. The use of narrow band imaging (NBI) and further technological achievements concerning the resolution and magnification of endoscopic images have in the past 15 years. With the use of NBI, superficial mucosal lesions, which may be missed by standard WLI endoscopy, can be identified easily by their neoangiogenic pattern. Objective:?To assess diagnostic value of the narrow band imaging and white light endoscopy in nasopharyngeal carcinoma and compare diagnostic values (sensitivity, specificity, positive predictive value and negative predictive value) with white light endoscopy. Search Methods: From 2010 to 2020, data was searched from electronic databases such as PubMed, web of science. We used narrow band imaging as a key word accordance with diagnostic modalities such as sensitivity, specificity, PPV and NPV and data were collected. Results: We have found mainly 6 studies have discussed about diagnostic value of endoscopy in nasopharyngeal carcinoma in the total of 2746 suspected patients. Among them, 5 studies have compared diagnostic values such as sensitivity, specificity, positive predictive value and negative predictive value between NBI and WLE. Among 5 studies, 4 studies have found higher sensitivity in NBI, 2 studies found higher 1 equal to WLE specificity in NBI. 3 studies have compared PPV and NPV between NBI and WLE. Among them, all the studies found higher PPV and NPV in NBI than WLE. Conclusion: Recently?developed narrow band imaging has a great significance in the diagnosis of nasopharyngeal carcinoma. Although NBI has also encountered some problem such as contact bleeding and darker image. So, further evaluation should be done.

Supraclavicular artery island flap for reconstruction of hypopharynx and upper esophagus defects:A case report and literature review

We report a case of a 74-year-old female with hypopharyngeal cancer who developed a pharyngoesophageal fistula and neck skin defect after total laryngectomy.To reconstruct the hypopharynx,upper esophagus,and neck skin defect,we used a supraclavicular artery island flap(SCAIF)for one-stage reconstruction.SCAIF offered reliable blood supply,minimal donor site morbidity,and excellent cosmetic outcomes.Although a small portion of the flap developed necrosis,it healed without surgical intervention.We also conducted a literature review of previously published articles on SCAIF for head and neck reconstruction.Our review highlights the advantages and limitations of SCAIF as a promising option for one-stage reconstruction of complex hypopharyngeal and upper esophageal defects with neck skin defects in selected patients.This case report provides valuable insights into the use of SCAIF in complex head and neck reconstructions,which can help improve patient outcomes and quality of life.

Primary Cutaneous Apocrine Carcinoma of the Neck Involving the Parotid Gland: A Case Report and Review of the Literature

Introduction: Primary cutaneous apocrine carcinoma (PCAC) is a rare skin malignant tumor that originates from areas with a high concentration of apocrine glands. The incidence of PCAC in the neck is relatively low. The age of onset in PCAC ranges from 5 to 70 years old. Clinically, PCAC typically shows up as painless nodules or lumps. In immunohistochemistry, positive expression of CK-7, GCDFP-15, AR, and myoepithelial markers are helpful in the diagnosis of PCAC. This case report pertains to a 59-year-old male of Asian descent. Five years ago, a painless mass was discovered behind his right ear, which grew slowly. This patient was identified as PCAC based on clinical symptoms, pathology, immunohistochemistry, and imaging characteristics. PCAC involved the parotid gland in this case;it is easy to be misdiagnosed as a primary malignant tumor of the parotid gland on imaging. Furthermore, a thorough set of clinical, imaging, pathological, and immunohistochemical examinations must be performed to make a diagnosis because it is challenging to differentiate PCAC from metastatic breast carcinoma. Conclusion: A well-developed multidisciplinary examination is essential because PCAC can be challenging to diagnose and differentiate.

Malignant proliferative ependymoma of the neck with lymph node metastasis:A case report

BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.

Targeted molecular imaging of head and neck squamous cell carcinoma:a window into precision medicine

Tumor biomarkers play important roles in tumor growth,invasion,and metastasis.Imaging of specific biomarkers will help to understand different biological activities,thereby achieving precise medicine for each head and neck squamous cell carcinoma(HNSCC)patient.Here,we describe various molecular targets and molecular imaging modalities for HNSCC imaging.An extensive search was undertaken in the PubMed database with the keywords including"HNSCC,""molecular imaging,""biomarker,"and"multimodal imaging."Imaging targets in HNSCC consist of the epidermal growth factor receptor,cluster of differentiation 44 variant 6(CD44v6),and mesenchymal-epithelial transition factor and integrins.Targeted molecular imaging modalities in HNSCC include optical imaging,ultrasound,magnetic resonance imaging,positron emission tomography,and single-photon emission computed tomography.Making the most of each single imaging method,targeted multimodal imaging has a great potential in the accurate diagnosis and therapy of HNSCC.By visualizing tumor biomarkers at cellular and molecular levels in vivo,targeted molecular imaging can be used to identify specific genetic and metabolic aberrations,thereby accelerating personalized treatment development for HNSCC patients.

The role of technetium Tc99m-tetrofosmin as head and neck tumor-seeking agent:a preliminary report

Aim:To evaluate the diagnostic value of technetium Tc99m-tetrofosmin(^(99m)Tc-TF)in primary cancers of the head and neck.Methods:Single photon emission computer tomography with planar imaging of the neck for primary site evaluation and whole body scanning for assessment of metastases in 12 patients with newly diagnosed head and neck cancer.Tumor-to-background index(T/Bg)was derived in patients with positive findings(tumor or lymph nodes).Results:The tomographic images showed increased tracer uptake in pathological sites(primary tumor or lymph node)in 9 patients(overall sensitivity 75%).Primary tumor was visualised in 7 patients(sensitivity 58%)and infiltrated lymph nodes in 4 out 7 patients(sensitivity 57%).Mean values for T/Bg index were 5.44±1.28 for primary tumor and 4.25±1.67 for lymph nodes.Mean values for T/Bg index were 4.5±0.71 for patients with in situ and grade I carcinoma and 6.68±0.36 for patients with tumor grade II and III(P=0.034,Mann-Whitney U test).Conclusion:The present study demonstrates that ^(99m)Tc-TF is a valuable radiotracer for head and neck cancer imaging.To determine the potential role of this imaging protocol in clinical practice will require a larger sample size.

Imaging-based diagnosis for extraskeletal Ewing sarcoma in pediatrics: A case report

BACKGROUND Extraskeletal Ewing sarcoma(EES)is a member of the Ewing sarcoma family of tumors which is pathologically known as a small,round,blue cell tumor involving bone and soft tissue.The prevalence of EES is only 15%-25%of all Ewing sarcoma and EES often occurs in patients aged from 20-mo-old to 30-yearsold resulting in an unfavorable prognosis.CASE SUMMARY The present case report described a 7-year-old patient with a palpable EES mass of 33 mm×27 mm×28 mm in the deep neck with symptoms of persistent dyspnea over the past 5 mo.After laboratory examinations,abnormal physiological and biochemical indicators were not found.Ultrasound images presented the mass to be complex,solid and fluid-filled with circumscribed margins and posterior acoustic enhancement.The mass also presented with partial internal vascularity.The contrast-enhanced magnetic resonance imaging scan illustrated the outstanding enhancement with fast perfusion mode in the early arterial phase. CONCLUSIONOur study suggested that a quick-growing mass in the pediatric patient is possibly a malignanttumor whether the mass has well-defined margins or not.

MultiTrans:Multi-scale feature fusion transformer with transfer learning strategy for multiple organs segmentation of head and neck CT images

Radiotherapy with precise segmentation of head and neck organs at risk(OARs)is one of the important treatment methods for head and neck cancer.In routine clinical practice,OARs are manually segmented by doctors to avoid irreversible adverse reactions caused by radiotherapy,which is time-consuming and laborious.To assist doctors in OARs segmentation,a MultiTrans framework with a multi-scale feature fusion module was proposed in this paper.In the multi-scale feature fusion module,the original image and the feature map of CNN were fused together to form a compound feature map for more complete high-resolution global information.In addition,the global information was also fully utilized in MultiTrans by using the feature map restored from the compound feature map in the skip connection.The multi-scale interactive high-resolution information can make full use of medical image information and obtain features more comprehensively,thus improve the segmentation accuracy.Experiments showed that MultiTrans had an average Dice score coefficient(DSC)of 74.01%in all organs,effectively improved segmentation accuracy.In addition,we proposed a transfer learning strategy for small organs by transferring the weight parameters of organs with a large amount of data to organs with a small amount of data to speed up the convergence of MultiTrans and reduce the demand for data volume in the MultiTrans.With this strategy,the average DSC of small organs was obviously increased,making the segmentation of small organs more accurate.The proposed framework and transfer learning strategy have the potential of assisting doctors in OARs delineation.