Additional file 1 of What we should consider to facilitate recovery of the hematological profile in all patients after pancreaticoduodenectomy: the role of preoperative intravenous iron treatment

Supplementary Material

Initial clinical experience with dual-layer detector spectral CT in patients with acute intracerebral haemorrhage: A single-centre pilot study

<div><p>Purpose</p><p>The purpose of this study was to investigate the clinical feasibility of spectral analyses using dual-layer detector spectral computed tomography (CT) in acute intracerebral haemorrhage (ICH).</p><p>Material and methods</p><p>We retrospectively reviewed patients with acute ICH who underwent CT angiography on a dual-layer detector spectral CT scanner. A spectral data analysis was performed to detect contrast enhancement in or adjacent to acute ICH by using spectral image reconstructions including monoenergetic (MonoE), virtual noncontrast (VNC), and iodine overlay fusion images. We also acquired a spectral plot to assess material differentiation within lesions.</p><p>Results</p><p>Among the 30 patients, the most common cause of acute ICH was chronic hypertension (18/30, 60%) followed by trauma (5/30, 16.7%), brain tumour (3/30, 10%), Moyamoya disease (2/30, 6.7%), and haemorrhagic diathesis from anticoagulation therapy (2/30, 6.7%). Of 30 patients, 13 showed suboptimal iodine suppression in the subcalvarial spaces on VNC images compared with true noncontrast images. The CT angiographic spot sign within the acute ICH was detected in four patients (4/30, 13.3%). All three tumours were metastatic and included lung cancer (n = 2) and hepatocellular carcinoma (n = 1) which showed conspicuous delineation of an enhancing tumour portion in the spectral analysis. Spectral analyses allowed the discrimination of acute haemorrhage and iodine with enhanced lesion visualization on the MonoE images obtained at lower keVs (less than 70 keV) and spectral plot.</p><p>Conclusions</p><p>Even though the image quality of VNC is perceived to be inferior, it is feasible to evaluate acute ICH in clinical settings using dual-layer detector spectral CT. The MonoE images taken at lower keVs were useful for depicting contrast enhancing lesion, and spectral plot might be helpful for material differentiation in patients with acute ICH.</p></div

An 82-year-old man with lung cancer.

<p>(A). A true noncontrast (TNC) image shows a lobular haematoma in the left frontal lobe. (B). An enhanced image also demonstrates strong hyperattenuation but does not provide exact information regarding the enhancing component. (C). A virtual noncontrast image clearly shows a haematoma; however, the image is slightly smoothed and there is incomplete suppression of the intracranial arteries compared with the TNC image. (D). On a spectral plot from a MonoE image at 40 keV, peripheral hyperattenuation shows a gradual decrease in HU values with a steep slope (ROI 1) similar to a tumour vessel (ROI 4), suggesting a contrast-enhancing tumour portion. Two hypoattenuation foci (ROI 2, 3) show constant HU values regardless of the keV value. (E). An iodine overlay fusion image based on 80 keV MonoE image shows the left frontal lesion in red, representing the iodine component. (F, G). A non-enhanced axial T₁-weighted image (F) shows central hyperintensity with peripheral isointensity in the left frontal lesion. An enhanced T₁-weighted image (G) demonstrates strong peripheral enhancement of the lesion, suggesting an underlying brain tumour. This tumour was pathologically confirmed as a haemorrhagic metastasis from lung cancer (adenocarcinoma) by tumorectomy.</p

A 48-year-old man with Moyamoya disease.

<p>(A). A true noncontrast (TNC) image shows a large lobar haematoma in the right fronto-parietal lobe. (B). A virtual noncontrast image clearly shows a haematoma with image quality similar to the TNC image. (C–E). Monoenergetic (MonoE) images at 40 keV (C), 80 keV (D), and 140 keV (E). A small, dot-like enhancement (arrow) is noted in the medial aspect of the haematoma, suggesting active extravasation at 40 keV, and this lesion has similar attenuation to the haematoma as the keV values increase. (F). On a spectral plot from a MonoE image at 40 keV, active extravasation reveals a gradual decrease in HU values with a steep slope (ROI 3), suggesting iodine. (G). An iodine overlay fusion image based on 80 keV MonoE image also shows conspicuous delineation of a small, active extravasation (arrow).</p

A diagram of the image acquisition and post-processing of dual-layer detector spectral CT for analysis in comparison with conventional CT.

<p>A diagram of the image acquisition and post-processing of dual-layer detector spectral CT for analysis in comparison with conventional CT.</p

Clinical characteristics of patient population.

<p>Clinical characteristics of patient population.</p

SLC38A8 mutations result in arrested retinal development with loss of cone photoreceptor specialisation.

Foveal hypoplasia, optic nerve decussation defects and anterior segment dysgenesis is an autosomal recessive disorder arising from SLC38A8 mutations. SLC38A8 is a putative glutamine transporter with strong expression within the photoreceptor layer in the retina. Previous studies have been limited due to lack of quantitative data on retinal development and nystagmus characteristics. In this multi-centre study, a custom-targeted next generation sequencing (NGS) gene panel was used to identify SLC38A8 mutations from a cohort of 511 nystagmus patients. We report 16 novel SLC38A8 mutations. The sixth transmembrane domain is most frequently disrupted by missense SLC38A8 mutations. Ninety percent of our cases were initially misdiagnosed as PAX6-related phenotype or ocular albinism prior to NGS. We characterized the retinal development in vivo in patients with SLC38A8 mutations using high-resolution optical coherence tomography. All patients had severe grades of arrested retinal development with lack of a foveal pit and no cone photoreceptor outer segment lengthening. Loss of foveal specialization features such as outer segment lengthening implies reduced foveal cone density, which contributes to reduced visual acuity. Unlike other disorders (such as albinism or PAX6 mutations) which exhibit a spectrum of foveal hypoplasia, SLC38A8 mutations have arrest of retinal development at an earlier stage resulting in a more under-developed retina and severe phenotype