Decoding pylephlebitis: Tracing the path of infected thrombosis and liver abscesses.

Pylephlebitis, a septic thrombophlebitis of the portal vein, is an uncommon but serious complication following an abdominal site of infection, most frequently diverticulitis or appendicitis. It has a high mortality rate, yet it commonly presents with unspecific abdominal complaints and fever, making diagnosis by clinical and laboratory examinations alone, impossible. This report highlights the extensive computed tomography (CT) findings of pylephlebitis with multiple hepatic abscesses thought to be secondary to diverticulitis, in a patient presenting with septic shock. Radiological characteristics differentiating the liver lesions from malignancy, and showing the ascending pathway of vascular involvement from the inferior mesenteric vein to portal veins is presented, as well as the search for the primary site of infection. Recognizing and understanding the imaging findings in pylephlebitis is crucial for diagnosis and avoiding delay of appropriate treatment for this otherwise often fatal condition.

Effect of CT reconstruction settings on the performance of a deep learning based lung nodule CAD system.

PURPOSE: To study the effect of different reconstruction parameter settings on the performance of a commercially available deep learning based pulmonary nodule CAD system. MATERIALS AND METHODS: We performed a retrospective analysis of 24 chest CT scans, reconstructed at 16 different reconstruction settings for two different iterative reconstruction algorithms (SAFIRE and ADMIRE) varying in slice thickness, kernel size and iterative reconstruction level strength using a commercially available deep learning pulmonary nodule CAD system. The DL-CAD software was evaluated at 25 different sensitivity threshold settings and nodules detected by the DL-CAD software were matched against a reference standard based on the consensus reading of three radiologists. RESULTS: A total of 384 CT reconstructions was analysed from 24 patients, resulting in a total of 5786 found nodules. We matched the detected nodules against the reference standard, defined by a team of thoracic radiologists, and showed a gradual drop in recall, and an improvement in precision when the iterative strength levels were increased for a constant kernel size. The optimal DL-CAD threshold setting for use in our clinical workflow was found to be 0.88 with an F2 of 0.73 ±â€¯0.053. CONCLUSIONS: The DL-CAD system behaves differently on IR data than on FBP data, there is a gradual drop in recall, and growth in precision when the iterative strength levels are increased. As a result, caution should be taken when implementing deep learning software in a hospital with multiple CT scanners and different reconstruction protocols. To the best of our knowledge, this is the first study that demonstrates this result from a DL-CAD system on clinical data.

Computed Tomography Angiography with a 192-slice Dual-source Computed Tomography System: Improvements in Image Quality and Radiation Dose.

PURPOSE: This study aims to compare image quality, radiation dose, and the influence of the heart rate on image quality of high-pitch spiral coronary computed tomography angiography (CCTA) using 128-slice (second generation) dual-source CT (DSCT) and a 192-slice DSCT (third generation) scanner. MATERIALS AND METHODS: Two consecutive cohorts of fifty patients underwent CCTA by high-pitch spiral scan mode using 128 or 192-slice DSCT. The 192-slice DSCT system has a more powerful roentgen tube (2 × 120 kW) that allows CCTA acquisition at lower tube voltages, wider longitudinal coverage for faster table speed (732 m/s), and the use of iterative reconstruction. Objective image quality was measured as the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was evaluated using a Likert scale. RESULTS: While the effective dose was lower with 192-slice DSCT (1.2 ± 0.5 vs. 0.6 ± 0.3 mSv; P < 0.001), the SNR (18.9 ± 4.3 vs. 11.0 ± 2.9; P < 0.001) and CNR (23.5 ± 4.8 vs. 14.3 ± 4.1; P < 0.001) were superior to 128-slice DSCT. Although patients scanned with 192-slice DSCT had a faster heart rate (59 ± 7 vs. 56 ± 6; P = 0.045), subjective image quality was scored higher (4.2 ± 0.8 vs. 3.0 ± 0.7; P < 0.001) compared to 128-slice DSCT. CONCLUSIONS: High-pitch spiral CCTA by 192-slice DSCT provides better image quality, despite a higher average heart rate, at lower radiation doses compared to 128-slice DSCT.

Iron deficiency anemia as initial presentation of a non-small cell lung carcinoma: A case report.

Duodenal metastases secondary to lung cancer are very rare and most of the time asymptomatic. When symptomatic they usually present with bowel obstruction or perforation. We here describe the case of a 68 year-old man with a solitary metastasis in the duodenum from a non-small cell lung carcinoma (NSCLC). The patient presented with reduced exercise tolerance and iron deficiency anemia without clinical gastrointestinal blood loss. Further investigation showed a tumor in the left upper lung lobe and a duodenal metastasis for which he received chemotherapy. To the best of our knowledge this is the first case report of iron deficiency anemia as initial presentation of a duodenal metastasis from a NSCLC.

High-precision genetic mapping of behavioral traits in the diversity outbred mouse population.

Historically our ability to identify genetic variants underlying complex behavioral traits in mice has been limited by low mapping resolution of conventional mouse crosses. The newly developed Diversity Outbred (DO) population promises to deliver improved resolution that will circumvent costly fine-mapping studies. The DO is derived from the same founder strains as the Collaborative Cross (CC), including three wild-derived strains. Thus the DO provides more allelic diversity and greater potential for discovery compared to crosses involving standard mouse strains. We have characterized 283 male and female DO mice using open-field, light-dark box, tail-suspension and visual-cliff avoidance tests to generate 38 behavioral measures. We identified several quantitative trait loci (QTL) for these traits with support intervals ranging from 1 to 3 Mb in size. These intervals contain relatively few genes (ranging from 5 to 96). For a majority of QTL, using the founder allelic effects together with whole genome sequence data, we could further narrow the positional candidates. Several QTL replicate previously published loci. Novel loci were also identified for anxiety- and activity-related traits. Half of the QTLs are associated with wild-derived alleles, confirming the value to behavioral genetics of added genetic diversity in the DO. In the presence of wild-alleles we sometimes observe behaviors that are qualitatively different from the expected response. Our results demonstrate that high-precision mapping of behavioral traits can be achieved with moderate numbers of DO animals, representing a significant advance in our ability to leverage the mouse as a tool for behavioral genetics.

High-throughput behavioral phenotyping in the expanded panel of BXD recombinant inbred strains.

Genetic reference populations, particularly the BXD recombinant inbred (BXD RI) strains derived from C57BL/6J and DBA/2J mice, are a valuable resource for the discovery of the bio-molecular substrates and genetic drivers responsible for trait variation and covariation. This approach can be profitably applied in the analysis of susceptibility and mechanisms of drug and alcohol use disorders for which many predisposing behaviors may predict the occurrence and manifestation of increased preference for these substances. Many of these traits are modeled by common mouse behavioral assays, facilitating the detection of patterns and sources of genetic coregulation of predisposing phenotypes and substance consumption. Members of the Tennessee Mouse Genome Consortium (TMGC) have obtained phenotype data from over 250 measures related to multiple behavioral assays across several batteries: response to, and withdrawal from cocaine, 3,4-methylenedioxymethamphetamine; "ecstasy" (MDMA), morphine and alcohol; novelty seeking; behavioral despair and related neurological phenomena; pain sensitivity; stress sensitivity; anxiety; hyperactivity and sleep/wake cycles. All traits have been measured in both sexes in approximately 70 strains of the recently expanded panel of BXD RI strains. Sex differences and heritability estimates were obtained for each trait, and a comparison of early (N = 32) and recent (N = 37) BXD RI lines was performed. Primary data are publicly available for heritability, sex difference and genetic analyses using the MouseTrack database, and are also available in GeneNetwork.org for quantitative trait locus (QTL) detection and genetic analysis of gene expression. Together with the results of related studies, these data form a public resource for integrative systems genetic analysis of neurobehavioral traits.