Tumor-to-tumor metastasis: a rare case of breast carcinoma metastasizing to a pheochromocytoma, and a literature review.

BACKGROUND: Tumor-to-tumor metastasis is a well-recognized but uncommon entity. Breast carcinoma is one of the most common metastatic donors. Breast carcinoma metastasizes commonly to adrenal glands. However, the co-existence of a metastatic lesion with an existing adrenal tumor is a rare finding. CASE PRESENTATION: A 35-year-old woman was diagnosed with pheochromocytoma using computed tomography and ultrasound examinations. The tumor was surgically removed. Histological and immunohistochemical staining suggested that there were two components in the tumor: pheochromocytoma and metastatic cancer. CONCLUSION: This is the second published case of pheochromocytoma with tumor-to-tumor metastasis from an invasive ductal carcinoma of the breast. Furthermore, we highlight the importance of awareness of tumor-to-tumor metastasis in pathological diagnosis.

IILS: Intelligent imaging layout system for automatic imaging report standardization and intra-interdisciplinary clinical workflow optimization.

BACKGROUND: To achieve imaging report standardization and improve the quality and efficiency of the intra-interdisciplinary clinical workflow, we proposed an intelligent imaging layout system (IILS) for a clinical decision support system-based ubiquitous healthcare service, which is a lung nodule management system using medical images. METHODS: We created a lung IILS based on deep learning for imaging report standardization and workflow optimization for the identification of nodules. Our IILS utilized a deep learning plus adaptive auto layout tool, which trained and tested a neural network with imaging data from all the main CT manufacturers from 11,205 patients. Model performance was evaluated by the receiver operating characteristic curve (ROC) and calculating the corresponding area under the curve (AUC). The clinical application value for our IILS was assessed by a comprehensive comparison of multiple aspects. FINDINGS: Our IILS is clinically applicable due to the consistency with nodules detected by IILS, with its highest consistency of 0·94 and an AUC of 90·6% for malignant pulmonary nodules versus benign nodules with a sensitivity of 76·5% and specificity of 89·1%. Applying this IILS to a dataset of chest CT images, we demonstrate performance comparable to that of human experts in providing a better layout and aiding in diagnosis in 100% valid images and nodule display. The IILS was superior to the traditional manual system in performance, such as reducing the number of clicks from 14·45 ±â€¯0·38 to 2, time consumed from 16·87 ±â€¯0·38 s to 6·92 ±â€¯0·10 s, number of invalid images from 7·06 ±â€¯0·24 to 0, and missing lung nodules from 46·8% to 0%. INTERPRETATION: This IILS might achieve imaging report standardization, and improve the clinical workflow therefore opening a new window for clinical application of artificial intelligence. FUND: The National Natural Science Foundation of China.

Application of spectral CT imaging in evaluating lymph node metastasis in patients with gastric cancers: initial findings.

BACKGROUND: Traditional computed tomography (CT) can predict the lymph node metastasis of gastric cancers with moderate accuracy; however, investigation of spectral CT imaging in this field is still limited. PURPOSE: To explore the application of spectral CT imaging in evaluating lymph node metastasis in patients with gastric cancers. MATERIAL AND METHODS: Twenty-four patients with gastric cancers prospectively underwent spectral CT imaging in the arterial phase. The short and long diameters, material concentrations, and CT values were measured and compared between lymph nodes with and without metastasis. The diagnostic performance of the CT index in identifying metastatic lymph nodes was analyzed with receiver operating characteristic (ROC) analysis. RESULTS: A total of 102 lymph nodes (77 metastatic, 25 non-metastatic) were detected on spectral CT imaging with the reference of postoperative pathologic exanimation. The short and long diameters, water/fat concentrations, CT value, and ratio between lymph nodes vs. tumors of metastatic lymph nodes were significantly higher than those of non-metastatic ones (all P < 0.05). With a cut-off of 0.785, the CT ratio of lymph node/tumor on 70-keV monochromatic images yielded an accuracy of 81.4% in differentiating lymph nodes with and without metastasis. CONCLUSION: Spectral CT imaging detects lymph nodes more clearly, and the CT ratio of lymph node/tumor on 70-keV monochromatic images holds great potential in differentiating lymph nodes with and without metastasis, which is more accurate than size measurement.

[Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction].

Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,laboratory Results ,and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ2=102.331,P=0.000),American Society of Anesthesiologists(ASA) score≥3 (χ2=69.748,P=0.000),leukocyte count (t=7.453,P=0.000),C-reactive protein (t=2.128,P=0.034),segmental mesenteric fluid (χ2=78.655,P=0.000),thick-walled small bowel (χ2=100.806,P=0.000),intestinal wall of hyperattenuation (χ2=69.068,P=0.000),ascites (χ2=89.299,P=0.000),mesenteric fat stranding (χ2=80.255,P=0.000),bird's beak sign (χ2=84.451,P=0.000),and stranding sign (χ2=98.635,P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576,95%CI:1.043-12.261,P=0.043),ASA score≥3 (OR=3.463,95%CI:1.149-10.441,P=0.027),muscle guarding (OR=3.288,95%CI:1.010-10.707,P=0.048),thick-walled small bowel (OR=3.046,95%CI:1.074-8.638,P=0.036),and increased leukocyte count (OR=1.307,95%CI:1.170-1.458,P=0.000). Conclusion Muscle guarding,ASA score≥3,segmental mesenteric fluid,thick-walled small bowel,and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

Correlation between apparent diffusion coefficients and HER2 status in gastric cancers: pilot study.

BACKGROUND: To evaluate whether apparent diffusion coefficient (ADC) value of gastric cancer obtained from diffusion weighted imaging (DWI) correlates with the HER2 status. METHODS: Forty-five patients, who had been diagnosed with gastric cancer through biopsy, were enrolled in this IRB-approved study. Each patient underwent a DWI (b values: 0 and 1,000 sec/mm(2)) prior to surgery (curative gastrectomy or palliative resection). Postoperative microscopic findings, HER2 status by immunohistochemical analysis and fluorescence in situ hybridization (FISH) were obtained. HER2 status was compared among gastric cancers with various histopathological features using the chi square test. The ADC values of gastric cancers with positive and negative HER2 were compared using the student t test. RESULTS: A weak yet significant correlation was observed between the mean ADC values and HER2 status (r = 0.312, P = 0.037) and scores (r = 0.419, P = 0.004). The mean ADC value of HER2-positive gastric cancers was significantly higher than those of HER2-negative tumors (1.211 vs. 0.984 mm(2)/s, P = 0.020). The minimal ADC value of HER2-positive gastric cancers was significantly higher than those of HER2-negative tumors (1.105 vs. 0.905 × 10(-3) mm(2)/s, P = 0.036). CONCLUSIONS: In this pilot study, we have demonstrated that the ADC values of gastric cancer correlate with the HER2 status. Future research is warranted to see if DWI can predict HER2 status and help in tailoring therapy for gastric cancer.

Preoperative apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: Correlations with postoperative TNM staging.

BACKGROUND: To determine if the apparent diffusion coefficient (ADC) values of gastric cancers on the preoperative diffusion weighted imaging (DWI) correlate with the postoperative TNMs of the lesions. METHODS: In a retrospective clinical study, seventy patients with gastric cancers were enrolled and each underwent a MRI before surgery. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1000 s/mm(2) ). The mean and minimum ADC values of the gastric cancers were calculated and compared among various postoperative TNM staging. RESULTS: Both mean and minimum ADC values of the gastric cancers correlated with the postoperative T staging (r = -0.464, -0.476; both P < 0.001), N staging (r = -0.402, -0.397; P = 0.001, 0.002) and TNM staging (r = -0.446, -0.437; both P < 0.001). The areas under the receiver operating characteristic (ROC) curves for the differentiating lymph node metastasis were 0.788 for the mean ADC values (P = 0.001) and 0.778 for the minimum ADC values (P = 0.001). CONCLUSION: The preoperative ADC values of gastric cancers can help to assess the postoperative TNM staging.

Apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: correlations with the histological differentiation and Lauren classification.

OBJECTIVE: The purpose of this study was to evaluate the correlations between histological differentiation and Lauren classification of gastric cancer and the apparent diffusion coefficient (ADC) value of diffusion weighted imaging (DWI). MATERIALS AND METHODS: Sixty-nine patients with gastric cancer lesions underwent preoperative magnetic resonance imaging (MRI) (3.0T) and surgical resection. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1000s/mm(2)). Mean and minimum ADC values were obtained for each gastric cancer and normal gastric walls by two radiologists, who were blinded to the histological findings. Histological type, degree of differentiation and Lauren classification of each resected specimen were determined by one pathologist. Mean and minimum ADC values of gastric cancers with different histological types, degrees of differentiation and Lauren classifications were compared. Correlations between ADC values and histological differentiation and Lauren classification were analyzed. RESULTS: The mean and minimum ADC values of gastric cancers, as a whole and separately, were significantly lower than those of normal gastric walls (all p values <0.001). There were significant differences in the mean and minimum ADC values among gastric cancers with different histological types, degrees of differentiation and Lauren classifications (p<0.05). Mean and minimum ADC values correlated significantly (all p<0.001) with histological differentiation (r=0.564, 0.578) and Lauren classification (r=-0.493, -0.481). CONCLUSIONS: The ADC values may be helpful as a noninvasive tool for evaluating the histological features of gastric cancer, such as histological type, degree of differentiation and Lauren classification.

Modeling pedestrian's conformity violation behavior: a complex network based approach.

Pedestrian injuries and fatalities present a problem all over the world. Pedestrian conformity violation behaviors, which lead to many pedestrian crashes, are common phenomena at the signalized intersections in China. The concepts and metrics of complex networks are applied to analyze the structural characteristics and evolution rules of pedestrian network about the conformity violation crossings. First, a network of pedestrians crossing the street is established, and the network's degree distributions are analyzed. Then, by using the basic idea of SI model, a spreading model of pedestrian illegal crossing behavior is proposed. Finally, through simulation analysis, pedestrian's illegal crossing behavior trends are obtained in different network structures and different spreading rates. Some conclusions are drawn: as the waiting time increases, more pedestrians will join in the violation crossing once a pedestrian crosses on red firstly. And pedestrian's conformity violation behavior will increase as the spreading rate increases.

[Diagnostic value of magnetic resonance diffusion weighted imaging for metastatic lymph nodes in patients with gastric cancer].

OBJECTIVE: To explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer. METHODS: Between December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis. RESULTS: A total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52). CONCLUSIONS: MR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.

[Preoperative T staging of gastric cancer: comparison between MR including diffusion weighted imaging and contrast enhanced CT scan].

OBJECTIVE: To compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer. METHODS: Forty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated. RESULTS: Overall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively). CONCLUSION: MR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.

Added value of diffusion-weighted MR imaging to T2-weighted and dynamic contrast-enhanced MR imaging in T staging of gastric cancer.

OBJECTIVE: To assess the utilization of diffusion-weighted (DW) magnetic resonance (MR) imaging in T staging of gastric cancer prospectively. METHODS: Fifty-one patients underwent T2-weighted (T2W), contrast-enhanced (CE) and DW MR imaging. Two radiologists independently interpreted the images for T staging of the tumors. RESULTS: The overall accuracy of T staging in pT1-4 gastric cancers by T2W+CE+DW (88.2%) was significantly higher than that by T2W+CE and T2W+DW (both 76.5%, P=.031). CONCLUSION: DW adds useful information to T2W and CE MR imaging in T staging of gastric cancer.

A study on urban road traffic safety based on matter element analysis.

This paper examines a new evaluation of urban road traffic safety based on a matter element analysis, avoiding the difficulties found in other traffic safety evaluations. The issue of urban road traffic safety has been investigated through the matter element analysis theory. The chief aim of the present work is to investigate the features of urban road traffic safety. Emphasis was placed on the construction of a criterion function by which traffic safety achieved a hierarchical system of objectives to be evaluated. The matter element analysis theory was used to create the comprehensive appraisal model of urban road traffic safety. The technique was used to employ a newly developed and versatile matter element analysis algorithm. The matter element matrix solves the uncertainty and incompatibility of the evaluated factors used to assess urban road traffic safety. The application results showed the superiority of the evaluation model and a didactic example was included to illustrate the computational procedure.