CT Image Feature Diagnosis on the Basis of Deep Learning Algorithm for Preoperative Patients and Complications of Transcatheter Aortic Valve Implantation

This work was aimed to explore the role of CT angiography information provided by deep learning algorithm in the diagnosis and complications of the disease focusing on congenital aortic valve disease and severe aortic valve stenosis. 120 patients who underwent ultrasound cardiography for aortic stenosis and underwent transcatheter aortic valve implantation (TAVI) in hospital were selected as the research objects. Patients received CT examination of deep learning algorithm within one week. The measurement methods were long and short diameter method, area method, and perimeter method. The deep learning algorithm was used to measure the long and short diameter, area, and perimeter of the target area before CT image processing. The results showed that the average diameter of long and short diameter measurement was 95% CI (0.84, 0.92), the average diameter of perimeter measurement was 95% CI (0.68, 0.87), and the average diameter of area measurement was 95% CI (0.72, 0.91). Among the 52 patients, 35 cases were hypertension (67%), 13 cases were diabetes (25%), 6 cases were chronic renal insufficiency (Cr > 2 mg/dL) (11%) (2 cases were treated with hemodialysis, 3.8%), 11 patients had chronic pulmonary disease (21%), 9 patients had cerebrovascular disease (17.3%) and atrial flutter and atrial fibrillation. Deep learning can achieve excellent results in CT image processing, and it was of great significance for the diagnosis of TAVI patients, improving the success rate of treatment and the prognosis of patients.

Predictive factors affecting percutaneous drainage duration in the percutaneous treatment of common bile duct stones

The duration of percutaneous transhepatic biliary drainage (PTBD) is a critical factor that determines the duration of treatment. This study aimed to evaluate factors affecting the PTBD duration in patients who underwent percutaneous treatment of common bile duct (CBD) stones. This study analyzed data of 169 patients who underwent percutaneous treatment of CBD stones from June 2009 to June 2019. Demographic data, characteristics of stone, procedure-related factors, and laboratory findings before the insertion of PTBD tubes were retrospectively evaluated. To assess the effect of confounding factors on the PTBD duration, multivariate linear regression analysis was applied, incorporating significant predictive factors identified in the univariate regression analysis. In the univariate regression analysis, the predictive factor that showed high correlation with the PTBD duration was the initial total bilirubin level (coefficient = 0.68, P < .001) followed by the short diameter of the largest stone (coefficient = 0.19, P = .056), and previous endoscopic sphincterotomy (coefficient = -2.50, P = .086). The multivariate linear regression analysis showed that the initial total bilirubin level (coefficient = 0.50, P < .001) and short diameter of the largest stone (coefficient = 0.16, P = .025) were significantly related to the PTBD duration. The total bilirubin level before PTBD tube insertion and the short diameter of the largest CBD stone were predictive factors for the PTBD duration in patients who underwent percutaneous CBD stone removal. Careful assessment of these factors might help in predicting the treatment period, thereby improving the quality of patient care.

Endobronchial Ultrasound Elastography Combined With Computed Tomography in Differentiating Benign from Malignant Intrathoracic Lymph Nodes

Objective. This study was to combine endobronchial ultrasound elastography (UE) with computed tomography (CT) to identify benign and malignant thoracic lymph nodes (LNs) more objectively and accurately. Methods. A total of 42 patients with intrathoracic lymphadenopathy required for endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) examination were enrolled. All patients were examined by enhanced chest CT, B-mode ultrasound, and endobronchial ultrasound (EBUS)-guided elastography before EBUS-TBNA. Each lymph node was assessed by describing the characteristics of CT image (short diameter, texture, shape, boundary, and mean CT value), B-mode ultrasound (short diameter, echo characteristic, shape, and boundary), and elastography (image type, grading score, strain rate, and blue area ratio). The pathological results were used as the gold standard. The characteristics were compared alone and in combination between benign and malignant LNs. Results. The blue area ratio of elastography combined with CT had better diagnostic value in differentiating benign and malignant LNs than elastography alone, with the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) being 92%, 96%, 80%, 94%, and 86% vs 81%, 77%, 93%, 97%, and 56%, respectively. Elastography combined with B-mode ultrasound and CT characteristics showed the highest diagnostic value. Accuracy, sensitivity, specificity, PPV, and NPV were all 100%. Conclusions. Endobronchial UE combined with CT and B-mode ultrasound imaging shows a greater diagnostic value in differentiating benign and malignant intrathoracic LNs than either imaging alone.

Dual-Source Dual-Energy Thin-Section CT Combined with Small Field of View Technique for Diagnosing Small Lymph Node in Thyroid Cancer

Background To evaluate the diagnostic performance of quantitative special CT parameters derived from dual-source dual-energy CT at small field of view (FOV) for small lymph node metastasis in thyroid cancer. Methods This was a retrospective study. From 2016 to 2019, 280 patients with thyroid disease underwent thin-section dual-source dual-energy thyroid CT and thyroid surgery. The data of patients with lymph nodes having a short diameter of 2-6 mm were analyzed. The targeted lymph nodes were sketched, their quantitative dual-energy CT parameters were measured, and all parameters between metastatic and nonmetastatic lymph nodes were compared. These parameters were then fitted to univariable and multivariable binary logistic regression models. The diagnostic role of spectral parameters was analyzed by receiver operating characteristic curves and compared with the McNemar test. Small FOV CT images and a mathematical model were used to judge the lymph nodes status respectively and then compared with pathological results.Results Of the 216 lymph nodes investigated in this study, 52.3% and 23.6% had a short diameter of 2-3 mm and 4 mm, respectively. Multiple quantitative CT parameters were found to be significantly different between benign and malignant lymph nodes and binary regression analysis was performed. The mathematical model was: p=ey/(1+ ey), y= = -23.119+0.033×precontrast electron cloud density+0.076×arterial phase normalized iodine concentration+2.156×arterial phase normalized effective atomic number -0.540×venous phase slope of the spectral Hounsfield unit curve +1.676×venous phase iodine concentration. This parameter model has an AUC of 92%, with good discrimination and consistency, and the diagnostic accuracy was 90.3%. The diagnostic accuracy of CT image model was 43.1%, and for lymph nodes with short-diameter 2-3 mm, the diagnostic accuracy was 22.1%.Conclusions Parameter model show higher diagnostic accuracy than CT image model for diagnosing small lymph node metastasis in thyroid cancer, and quantitative dual-energy CT parameters were very useful for small lymph nodes that were difficult to be diagnosed only on conventional CT images.Trial registration This study is retrospectively registered, and we have registered a prospective study (Registration number: ChiCTR2000035195;http://www.chictr.org.cn)

Ureteroscopic lithotripsy combined with stent placement contributed to long-term auto-release of lithangiuria in upper urinary tract after ureterolithotripsy

Background To investigate the clinical efficiency of ureterectasis combined with stent placement in the long-term auto-release of lithangiuria in upper urinary tract after ureterolithotripsy. Methods In this retrospective analysis, we included the patients (male: 314; female: 49; age: 32–78 yrs; median age: 53 yrs) admitted to our hospital between January 2014 and January 2018 underwent ureterolithotripsy (URS group, n = 178) and extracorporeal shock wave lithotripsy (ESWL group, n = 212) for treating lithangiuria in upper urinary tract. All the patients were followed up for 24–59 months after treatment (median: 38 months). Uni-variate and multi-variate Logistic regression analysis was used to analyze the factors that could affect the long-term release of lithangiuria in upper urinary tract. Then we compared the short diameter of the ureter surpassing the stenosis of iliac vessels and the long-term auto-release of lithotripsy between the two groups. Results Logistic regression analysis indicated that the risk of auto-release of the stones in the upper urinary tract in the URS group was significantly higher than that of the ESWL group (OR = 3.357, 95% CI: 1.234–9.137). Stent placement was an independent risk factor for long-term auto-release of lithotripsy (P < 0.01). The short diameter of the ureter surpassing the stenosis of iliac vessels after URS was significantly longer than that of the baseline level (6.06 ± 1.26 mm vs. 3.63 ± 0.98 mm, t = 20.88, P < 0.01). The short diameter of the ureter surpassing the stenosis of iliac vessels after ESWL showed no statistical differences compared with that of the baseline level (3.67 ± 1.02 mm vs. 3.61 ± 0.94 mm, t=-0.798, P = 0.425). Sixteen cases (2.8%) in the URS group showed auto-release of stones during the follow-up, which was significantly higher than that in the ESWL group with 6 cases (13.5%) presented auto-release of stones (χ2 = 6.895, P = 0.09). Conclusions The combination of URS and stent replacement induced obvious ureterctasis, which may contribute to the auto-release of stones in the upper urinary tract in the long-term.

A CT-based radiomics model to detect prostate cancer lymph node metastases in PSMA radioguided surgery patients

Purpose In recurrent prostate carcinoma, determination of the site of recurrence is crucial to guide personalized therapy. In contrast to prostate-specific membrane antigen (PSMA)–positron emission tomography (PET) imaging, computed tomography (CT) has only limited capacity to detect lymph node metastases (LNM). We sought to develop a CT-based radiomic model to predict LNM status using a PSMA radioguided surgery (RGS) cohort with histological confirmation of all suspected lymph nodes (LNs). Methods Eighty patients that received RGS for resection of PSMA PET/CT-positive LNMs were analyzed. Forty-seven patients (87 LNs) that received inhouse imaging were used as training cohort. Thirty-three patients (62 LNs) that received external imaging were used as testing cohort. As gold standard, histological confirmation was available for all LNs. After preprocessing, 156 radiomic features analyzing texture, shape, intensity, and local binary patterns (LBP) were extracted. The least absolute shrinkage and selection operator (radiomic models) and logistic regression (conventional parameters) were used for modeling. Results Texture and shape features were largely correlated to LN volume. A combined radiomic model achieved the best predictive performance with a testing-AUC of 0.95. LBP features showed the highest contribution to model performance. This model significantly outperformed all conventional CT parameters including LN short diameter (AUC 0.84), LN volume (AUC 0.80), and an expert rating (AUC 0.67). In lymph node–specific decision curve analysis, there was a clinical net benefit above LN short diameter. Conclusion The best radiomic model outperformed conventional measures for detection of LNM demonstrating an incremental value of radiomic features.

P152 CLINICAL PREDICTIVE MODEL OF LYMPH NODE METASTASIS AT RIGHT RECURRENT LARYNGEAL NERVE ZONE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Aim The aim of this study is to establish a clinical predictive standard for lymph node metastasis at this location by retrospectively comparing the traditional imaging findings of RRLN lymph nodes in esophageal squamous cell carcinoma with postoperative pathology. Background The right recurrent laryngeal nerve (RRLN) is the zone most prone to lymph node metastasis of esophageal squamous cell carcinoma. Although the survival benefit is large after surgical dissection, however, the postoperative mortality rate is significantly increased if the nerve is injured. How to selectively perform lymph node dissection at this location has always been a clinical problem that needs to be addressed. In the past, clinical evaluations mostly used lymph node short diameter ≥1cm as the diagnostic criteria for metastasis, which significantly underestimated the actual clinical situation. Methods 308 patients with thoracic esophageal squamous cell carcinoma who underwent surgical treatment in Shanghai Chest Hospital from Jan 2018 to Dec 2018 were retrospectively analyzed. According to imaging 1mm layer thickness enhanced CT as a tool, the RRLN lymph node short diameter (ctNd) size was measured. All patients were divided into four groups: (A) CT images without RRLN lymph node, (B) CT images with RRLN lymph node was 0<ctNd<5mm, (C) CT images with RRLN lymph node was 5mm≤ctNd<10mm, (D) CT images with RRLN lymph node was ctNd≥10mm. The RRLN lymph node metastasis of each group was analyzed, and the influencing factors were analyzed to establish a predictive model. Results Among all patients, 87.6% of the patients had lymph nodes detected in the RRLN surgical specimens. The sampling rate was 14.5% (121/832), the RRLN lymph node metastasis rate was 19.48%, and the total lymph node metastasis rate was 48.7%. RRLN lymph nodes (57.1%) (A-132, B-43, C-125, D-9) were seen in the preoperative CT scan of 176 patients. The postoperative pathological RRLN lymph node metastasis rate was 9.1%, 18.6%, 27.2% and 66.7%, respectively (P=0.01). Multivariate analysis showed that ctNd, tumor location and N stage were risk factors for RRLN lymph node metastasis (P<0.05). The risk of upper esophageal cancer metastasis was higher than middle segment esophageal cancer (28.2% vs 18.6%, P<0.05). The higher the risk of right laryngeal lymph node metastasis was detected in the later N stage (cN0-13.2%, cN1-21.5%, cN2-46.7%, P<0.05). The 6.5mm short diameter of RRLN lymph nodes on CT scan is the critical value of metastasis at this position (sensitivity 50%, specificity 83.5%), and the higher the risk of metastasis was seen in the larger the short diameter (P<0.05). Conclusion More than 6.5mm short diameter in the CT scan image should be the clinical predictor of lymph node metastasis of the right recurrent laryngeal nerve. The higher risk of metastasis was seen in the greater short diameter. Upper esophageal cancer and multiple lymph node metastasis increase the risk of RRLN lymph node metastasis. Key words esophageal cancer, lymph node metastasis, recurrent laryngeal nerve, computed tomography

Transtemporal edges and crosslayer edges in incompressible high-order networks

This work presents some outcomes of a theoretical investigation of incompressible high-order networks defined by a generalized graph represen tation. We study some of their network topological properties and how these may be related to real world complex networks. We show that these networks have very short diameter, high k-connectivity, degrees of the order of half of the network size within a strong-asymptotically dominated standard deviation, and rigidity with respect to automorphisms. In addition, we demonstrate that incompressible dynamic (or dynamic multilayered) networks have transtemporal (or crosslayer) edges and, thus, a snapshot-like representation of dynamic networks is inaccurate for capturing the presence of such edges that compose underlying structures of some real-world networks.

Anatomical and Histological Structure of Reproductive Organs in Male Flying Squirrel Hylopetes Lepidus (Horsfield, 1822)

Flying squirrel (Hylopetes lepidus) is an Eutherial mamal (placental mammal), belong to the order Rodentia and belong to the family Sciuridae. Hylopetes lepidus had gray cheek as its unique characteristics. The reproductive organs are the key to success in maintaining the new descendants. Male reproductive organs will produce the male sex cells or spermatozoa. The purpose of the research is to examine the anatomical structure, morphometry, histomorphometry, and histological structure of male reproductive organs (penis, testicle, vas deferens, bulbouretralis gland, prostate and seminal vesicles) of Hylopetes lepidus. The method used in examining histological characteristics is Hematoxyin–Eosin staining method. The histological structure of reproductive organs were observed using optilab microscope. The results of the study showed that the adult male flying squirrel weighed 104.28 ± 0.64 gram. Anatomically, it has oval white reddist testicle. The testicle is located side out of the body cavity in the scrotum. Morphometric observation testicular showed that the right testes has volume 0.35 ± 0.07 ml, and the left has volume 0.35 ± 0.07 ml, weight of the right testicular 0.19 ± 0.01 gram, weight of the left testicular 0.18 ± 0.01 gram, diameter of the right testicular 6.35 ± 0.21 mm, diameter of the left testicular 6.35 0.21 mm, short diameter of the right testicular 3.45 ± 0.21 mm, and short diameter of the left testicular 3.45 ± 0.21 mm. The diameter of tubulus seminiferus 261,4 ± 0.14 μm. The conclusion of this study compared to rodentia other testicular Hylopetes lepidus has a unique testicular bound by the connective tissue in the scrotum so that testicular included in class permanent descending testicular. The rhombus of the prostate gland are blunt, while histologically the sertoli cells in the seminiferus tubule shaped elongated, while in morphometry penis Hylopetes lepidus relatively longer than Mus musculus.

PS02.187: RELATIONSHIP BETWEEN REGIONAL LYMPH NODE SIZE AND PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS

Background Surgery for esophageal cancer, in many cases performed after chemotherapy or chemoradiotherapy. Because treatment policy is determined by pretreatment evaluation, improvement of diagnosis accuracy is important. Commonly, metastatic diagnosis is performed by uniformly defining the size. We examined whether evaluation of N classification reflecting more prognosis can be done by examining lymph node metastasis criteria by area in CT. Methods We surveyed 300 cases of thoracic esophageal cancer (squamous cell carcinoma) who underwent surgery at our hospital from September 2010 to December 2014. We defined lymph node with a minor axis of 5 mm or more from CT (5 mm slice) before treatment as ‘visible node’. We changed the cut off of lymph node short diameter for each area to 5 mm, 10 mm and 15 mm, and those with long diameter/short diameter ratio less than 1.5 were designated as ‘metastasis’. We examined the optimal size of lymph node which reflect prognosis. We compared the correlation with the prognosis based on the N category of the 8th edition UICC TNM classification and the 11th edition Japanese Classification of Esophageal Cancer, using the cutoff of short diameter examined for each area. Results We evaluated the cut off of each area lymph node except paraesophageal, 15 mm in the cervical, 10 mm in the recurrent nerve, 15 mm in the upper trachea, 15 mm in the lower trachea, and 10 mm in the epigastric. Classification based on the N classification of the 8th edition UICC TNM classification, overall survival declined in the order of N categories. Conclusion From this result, it was suggested that diagnosis based on lymph node size in CT reflects prognosis by prescribing cut off for each site. From now on, it would be possible to raise the diagnostic accuracy of N classification further by subdivision of cut off and accumulation of the case. Disclosure All authors have declared no conflicts of interest.