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Organization of monkey superior colliculus: enhanced visual response of superficial layer cells.

1. Cells in the superficial layers of monkey superior colliculus respond more vigorously to a spot of light falling in their receptive fields when the monkey uses that spot of light as the target for a saccadic eye movement. Our purpose in these experiments was to investigate the characteristics of this enhancement effect. While monkeys fixated, we determined the response of a cell to a stimulus falling in its receptive field. Then we determined the response of the cell to the same stimulus when the monkey made a saccade to the stimulus or near to it. 2. The enhancement of the visual response is spatially limited. The receptive field of a cell always shows enhancement throughout its extent and frequently shows a slight expansion. Saccades made near to a stimulus in the visual receptive field, but not to it, also lead to an enhancement of that visual stimulus; an area around the excitatory center of the receptive field where such enhancement occurs was referred to as the enhancement field of the cell. An enhanced response in one part of the visual field was not accompanied by depressed responses associated with saccades to other parts of the visual field. 3. The enhancement effect is temporally limited; it begins 200-300 ms before the eye movement, as determined by the increasing response to 50-ms light pulses presented at varying intervals before the eye movement. The degree of enhancement intensifies when the visual stimulus is turned on closer in time to the onset of the saccade. A buildup of the enhancement also occurs on successive trials as does the response of eye movement-related cells in the intermediate layers. 4. The enhancement response is not present in the upper quarter-millimeter of the superficial layers, suggesting that the effect is not present in retinal afferents which terminate primarily in this area of the superficial layers. The enhancement effect is seen throughout the visual field; the foveal area was not tested. 5. In order to determine the relation of the enhancement effect to the monkey's behavioral response, we required the monkey to make a hand response rather than an eye movement-response to the visual stimuli. Cells did not show a clear enhancement with such a hand response. Results of these experiments indicate that the enhancement effect is dependent on the type of response the monkey makes to the stimulus and is probably specifically related to eye movements. Since the enhancement of visual response seems likely to be related specifically to eye movements both on physiological and behavioral grounds, the response-free term "attention" is probably inappropriate for the phenomenon. 6. The hypothesis advanced in the preceding paper that eye movement-related activity from intermediate and deep colliculus layers is directed upward to converge with visually related activity in the superficial layers is extended to include an input from cells in these deeper layers (or their afferents) to the superficial layer cells...

Animals↗

MR diagnosis of hepatic metastases from neuroendocrine tumors versus hemangiomas: relative merits of dynamic gadolinium chelate-enhanced gradient-recalled echo and unenhanced spin-echo images.

OBJECTIVE: Hepatic metastases from neuroendocrine tumors are often markedly hyperintense on unenhanced T2-weighted MR images, making their appearance similar to that of cavernous hemangiomas. In contrast, cavernous hemangiomas show characteristic enhancement on dynamic gadolinium chelate-enhanced gradient-recalled echo MR images. The purpose of this study was to determine the relative merits of dynamic gadolinium chelate-enhanced gradient-recalled echo MR imaging versus MR imaging with unenhanced spin-echo pulse sequences for distinguishing between hepatic metastases from neuroendocrine tumors and cavernous hemangiomas. MATERIALS AND METHODS: The unenhanced spin-echo and dynamic gradient-recalled echo MR images obtained after IV administration of a gadolinium chelate in 28 patients (14 patients with pathologically proven hepatic metastases from neuroendocrine tumors and 14 patients with hepatic cavernous hemangiomas) were reviewed blindly and independently by three interpreters. Unenhanced spin-echo and dynamic gadolinium chelate-enhanced gradient-recalled echo MR images were compared for accuracy in characterizing liver lesions. RESULTS: The most intense enhancement of hepatic metastases from neuroendocrine tumors was observed on early dynamic gadolinium chelate-enhanced gradient-recalled echo MR images; enhancement was peripheral in four patients, global and heterogeneous in seven patients, and global and homogeneous in three patients. On late dynamic gadolinium chelate-enhanced gradient-recalled echo MR images, enhancement of hepatic metastases from neuroendocrine tumors was predominantly peripheral in five patients, global and heterogeneous in five patients, and global and homogeneous in four patients. Differentiation between cavernous hemangiomas and hepatic metastases from neuroendocrine tumors was impossible in five cases with unenhanced spin-echo MR imaging alone, in five cases with dynamic gadolinium chelate-enhanced gradient-recalled echo MR imaging alone, and in no case with the combination of unenhanced spin-echo MR imaging and dynamic gadolinium chelate-enhanced gradient-recalled echo MR imaging. In comparison with unenhanced spin-echo MR imaging alone or dynamic gadolinium chelate-enhanced gradient-recalled echo MR imaging alone, the combination of unenhanced spin-echo MR imaging and dynamic gadolinium chelate-enhanced gradient-recalled echo MR imaging allowed significantly (p < .001) clearer differentiation between hepatic metastases from neuroendocrine tumors and cavernous hemangiomas. CONCLUSIONS: Early enhancement and heterogeneity on dynamic gadolinium chelate-enhanced gradient-recalled echo MR images are the most common features of hepatic metastases from neuroendocrine tumors. The combination of unenhanced spin-echo and dynamic gadolinium chelate-enhanced gradient-recalled echo MR images allows more accurate characterization of hepatic metastases from neuroendocrine tumors and clearer differentiation from cavernous hemangiomas.

Abdominal Neoplasms↗

Characterization of focal hepatic lesions with contrast-enhanced C-cube gray scale ultrasonography.

AIM: To characterize enhancement patterns of focal hepatic lesions using C-cube gray scale sonography with a microbubble contrast agent and to evaluate its usefulness in differential diagnosis of hepatic lesions. METHODS: Fifty-four patients with 58 focal hepatic lesions were examined with Levovist-enhanced C-cube gray scale sonography. The final diagnosis of hepatic lesions was 29 primary liver cancers, 4 metastases, 8 hemangiomas, 12 focal nodular hyperplasias, 2 inflammatory pseudotumors of the liver and 3 angiomyolipomas. The initiation time of enhancement in various lesions and enhancement duration after administration of contrast agent were compared. Vascular findings in lesions were classified as peripheral enhancement, homogenous enhancement, mosaic enhancement and no enhancement depending on microbubble signals in the lesion relative to the liver parenchyma. RESULTS: The initiation time of enhancement in hemangioma (48+/-12 s) was significantly later compared to other lesions (P<0.05). The enhancement duration of malignancies (69+/-33 s in primary liver cancer, 61+/-23 s in metastasis) was significantly shorter compared to benign lesions (P<0.05). Intranodular enhancement appearing at arterial phase and decreasing at portal venous phase was considered characteristic for malignancy. Intranodular enhancement did not appear earlier than the liver parenchyma, and peripheral enhancement pattern was regarded as positive findings for hemangioma. Intranodular enhancement appeared in the arterial phase, and homogenous enhancement pattern sustained in the whole portal venous phase were regarded as positive findings for focal nodular hyperplasia. No microbubble signals appeared in two inflammatory pseudotumors of the liver. CONCLUSION: C-cube gray scale sonography can demonstrate dynamic intranodular enhancement in various focal hepatic lesions. The information provided by this methodology may be useful in the differential diagnosis of hepatic lesions.

Adult↗

Spectral contrast enhancement of speech in noise for listeners with sensorineural hearing impairment: effects on intelligibility, quality, and response times.

This paper describes a series of experiments evaluating the effects of digital processing of speech in noise so as to enhance spectral contrast, using subjects with cochlear hearing loss. The enhancement was carried out on a frequency scale related to the equivalent rectangular bandwidths (ERBs) of auditory filters in normally hearing subjects. The aim was to enhance major spectral prominences without enhancing fine-grain spectral features that would not be resolved by a normal ear. In experiment 1, the amount of enhancement and the bandwidth (in ERBs) of the enhancement processing were systematically varied. Large amounts of enhancement produced decreases in the intelligibility of speech in noise. Performance for moderate degrees of enhancement was generally similar to that for the control conditions, possibly because subjects did not have sufficient experience with the processed speech. In experiment 2, subjects judged the relative quality and intelligibility of speech in noise processed using a subset of the conditions of experiment 1. Generally, processing with a moderate degree of enhancement was preferred over the control condition, for both quality and intelligibility. Subjects varied in their preferences for high degrees of enhancement. Experiment 3 used a modified processing algorithm, with a moderate degree of spectral enhancement, and examined the effects of combining the enhancement with dynamic range compression. The intelligibility of speech in noise improved with practice, and, after a small amount of practice, scores for the condition combining enhancement with a moderate degree of compression were found to be significantly higher than for the control condition. Experiment 4 used a subset of conditions from experiment 3, but performance was assessed using a sentence verification test that measured both intelligibility and response times. Scores on both measures were improved by spectral enhancement, and improved still more by enhancement combined with compression. The effects were statistically more robust for the response times. When expressed as equivalent changes in speech-to-noise ratio, the improvements were about twice as large for the response times as for the intelligibility scores. The overall effect of spectral enhancement combined with compression was equivalent to an improvement of speech-to-noise ratio by 4.2 dB.

Adult↗

Magnetic resonance imaging of normal meningeal enhancement at 1.5 T.

RATIONALE AND OBJECTIVES: We examined patterns of intracranial meningeal enhancement on gadolinium chelate contrast media-enhanced 1.5-T spin-echo magnetic resonance (MR) imaging and developed criteria that might be useful for distinguishing between normal and abnormal meningeal enhancement. METHODS: The convexity, falx cerebri, tentorium cerebelli, and suprasellar cistern regions of 204 patients were prospectively evaluated for contrast enhancement with a grading system ranging from 0 (no enhancement) to 5 (diffuse, irregular, thickened enhancement). Meningeal findings were correlated with other MR abnormalities and pertinent clinical histories that have been associated previously with meningeal enhancement. RESULTS: Short-segment convexity meningeal enhancement was commonly seen and most likely represents intravascular contrast material in normal meningeal vessels. Such enhancement did not correlate with the presence of other MR abnormalities. Long-segment (> 3 cm) or diffuse convexity meningeal enhancement did correlate with other significant MR abnormalities and pertinent clinical history. Fine linear falcine and tentorial meningeal enhancement, as an isolated finding, did not correlate with other MR or clinical abnormalities. The suprasellar cistern and ventricular walls were rarely enhanced. CONCLUSION: Short-segment convexity meningeal contrast enhancement is a normal finding representing normal vascular structures. More extensive convexity meningeal enhancement is abnormal and should prompt careful examination of the remainder of an MR image as well as the patient's clinical history for an etiology of the enhancement.

Adolescent↗

Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement.

PURPOSE: We sought to evaluate the potential of dynamic contrast enhancement after the intravenous administration of an iodine-based contrast medium in full-field digital mammography. MATERIAL AND METHODS: A protocol for image acquisition was established for contrast-enhanced mammography and the mammography unit (Senographe 2000D, GE Healthcare, Buc, France) changed as required. The effect of the protocol parameters on imaging was investigated. Subsequently, 21 patients with 25 suspicious lesions of the breast (10 benign, 1 borderline, and 14 malignant) underwent mammography with administration of an iodine-based contrast medium (Ultravist 370, Schering AG, Berlin, Germany), after approval of ethical committee as well as permission of German federal office for Radiation protection, and informed consent from each patient was obtained. Three sequential digital mammographic images of the respective breast were acquired after administration of the contrast medium at a dose of 1 mL/kg body weight and a flow of 4 mL/s. The postcontrast images were acquired 60, 120, and 180 seconds after administration. Subsequently, the precontrast image was logarithmically subtracted from the postcontrast images. Enhancement of the lesions was measured in absolute terms as well as relative to the enhancement of the glandular tissue. The subtracted images were evaluated for lesion depiction and dynamic contrast enhancement. Lesion-enhancement kinetics were compared with the histologic findings. RESULTS: All malignant lesions were identified on the contrast-enhanced images of digital mammography. Three of the tumors (2 malignant, 1 benign) were detected only by contrast-enhanced mammography and not by standard mammography. Dynamic enhancement curves of benign and malignant tumors in contrast-enhanced mammography look similar to the curves known from gadolinium-enhanced magnetic resonance imaging. Nevertheless differentiation between malignant and benign tumors based on the enhancement patterns cannot be directly taken over from magnetic resonance imaging, as suggested by our initial results. The results are somewhat better when tumor enhancement relative to surrounding glandular tissue is used instead of absolute enhancement. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography is a potentially useful tool for the detection and the differentiation of benign and malignant breast lesions.

Animals↗

CT depiction of experimental liver tumors: contrast enhancement with hepatocyte-selective iodinated triglyceride versus conventional techniques.

PURPOSE: To compare findings at computed tomography (CT) enhanced with a hepatocyte-selective contrast agent (iodinated triglyceride) and/or iohexol and at CT during arterial portography (CTAP). MATERIALS AND METHODS: Rabbit livers were directly inoculated with VX2 carcinoma. Results were compared for five helical CT examinations: unenhanced CT, iohexol-enhanced CT (600 mg iodine per kilogram of body weight [mg I/kg]), CTAP (with iohexol [600 mg I/kg]), triglyceride-enhanced CT (126 mg I/kg), and dual-contrast-enhanced CT (triglyceride plus iohexol [425 mg I/kg]). Attenuation of normal liver and tumor were compared with analysis of variance techniques and blinded reader evaluations. RESULTS: Normal liver attenuation was greatest at CTAP (127.3 HU +/- 5.3 [mean +/- standard error of the mean]), followed by dual-contrast-enhanced CT (112.4 HU +/- 1.2), iohexol-enhanced CT (97.9 HU +/- 2.2), triglyceride-enhanced CT (82.3 HU +/- 1.1), and unenhanced CT (54.9 HU +/- 1.8). Liver-to-lesion attenuation difference at triglyceride-enhanced CT was significantly greater than at iohexol-enhanced CT (P < .05), and attenuation differences at dual-contrast-enhanced CT were comparable to those at CTAP. Tumors did not enhance at triglyceride-enhanced CT, which increased conspicuity. Sensitivity values for lesion detection at dual-contrast-enhanced CT were greater than those at iohexol-enhanced CT or at CTAP (P < .05). CONCLUSION: At CT enhanced with triglyceride (especially when combined with iohexol), sensitivity values and liver-to-lesion attenuation differences were greater with lower iodine doses than with iohexol or at CTAP.

Animals↗

Hepatic cavernous hemangioma: temporal peritumoral enhancement during multiphase dynamic MR imaging.

PURPOSE: To determine whether temporal parenchymal enhancement around hepatic cavernous hemangiomas can be correlated with the rapidity of intratumoral contrast material enhancement and/or tumor volume at dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Dynamic MR images obtained in 94 patients with 167 hemangiomas were retrospectively reviewed for peritumoral enhancement. Tumor volume was estimated by using the longest dimension on nonenhanced images. Speed of intratumoral contrast material enhancement was determined with early nonequilibrium phase images and was categorized as rapid (>75% of tumor volume), intermediate (25%-75% of tumor volume), or slow (<25% of tumor volume). RESULTS: Thirty-two of the 167 hemangiomas (19%) had temporal peritumoral enhancement, which was more common in hemangiomas with rapid enhancement (20 of 49 [41%]) than in those with intermediate (12 of 62 [19%]) and slow (0 of 56 [0%]) enhancement (P: <.001). The mean diameter of the hemangiomas with peritumoral enhancement was not significantly different from that of hemangiomas without peritumoral enhancement (P: >.05). Hemangiomas with rapid enhancement (mean diameter, 16 mm +/- 8), however, were significantly smaller than those with intermediate enhancement (mean diameter, 33 mm +/- 34) (P: <.001). CONCLUSION: Temporal peritumoral enhancement on dynamic MR images of hepatic hemangiomas correlates well with the speed of intratumoral contrast material enhancement and was most commonly encountered in rapidly enhancing small lesions. There was no statistically significant relationship, however, between peritumoral enhancement and tumor volume.

Adult↗

Virtually identical enhancers containing a segment of homology to murine 3'IgH-E(hs1,2) lie downstream of human Ig C alpha 1 and C alpha 2 genes.

We have isolated sequences downstream of human Ig C alpha 1 and C alpha 2 genes and have identified two enhancers in these regions. One enhancer is located approximately 9 kb downstream of C alpha 1, and the second enhancer is located approximately 11 kb downstream of C alpha 2. These approximately 1.6-kb enhancers are virtually identical to each other except for varying numbers of a approximately 53-bp motif. The C alpha 2-associated enhancer contains four copies of this motif in tandem, whereas the C alpha 1-associated enhancer has only a single copy. Within the human enhancers is a 177-bp segment that is homologous to a 191-bp segment of one of four enhancers from the 3' regulatory region of murine (and rat) DNA, namely 3'IgH-E(hs1,2). Like the murine and rat enhancers, both human enhancers are flanked by inverted repeats; furthermore, the human enhancers generally appear to be inverted with respect to each other. The evolutionarily conserved region of homology has substantial core enhancer activity. Contained within this region are the single octamer and one copy of the approximately 53-bp motif, both of which contribute to the activity of the full-length enhancer. A comparison of the DNA sequences and the results of transient transfection assays imply that the human C alpha-associated enhancers may be regulated (in part) differently than the murine enhancer 3'IgH-E(hs1,2).

Animals↗

Mangafodipir trisodium (MnDPDP)-enhanced magnetic resonance imaging of the liver and pancreas.

Contrast-enhanced magnetic resonance imaging (MRI) of the liver and pancreas is frequently performed to improve the sensitivity and specificity of lesion detection in these organs. The concept of using tissue-specific contrast media is to selectively enhance the normal parenchyma, but not lesions, so that the contrast between tumorous and normal tissue is increased, and lesion detectability improved. Mangafodipir trisodium (MnDPDP) has been developed as a hepatocellular-specific contrast agent, but uptake has also been found in pancreatic tissue. In this study the safety and diagnostic efficacy of MnDPDP were investigated in both healthy volunteers and in patients with liver and pancreatic tumors. In healthy volunteers (n = 8), dose-dependent enhancement in T1-weighted images was observed in the normal liver and pancreatic parenchyma after infusion of MnDPDP at doses of 5 and 10 mumol/kg. The maximal enhancement in the two dose groups was 77 and 110% in the liver, and 57 and 84% in the pancreas, respectively. The enhancement-over-time profiles demonstrated that the effective imaging window was about 2 h for the liver, and over 4 h for the pancreas. There was no measurable enhancement in brain structures protected by intact blood-brain barrier, and no changes of clinical importance were found in vital signs or in blood and urinary chemistry variables. Compared with unenhanced images (including T2-weighted images), significantly more lesions were detected on MnDPDP-enhanced T1 images in 82 patients with liver tumors (mostly metastases). Features such as rim enhancement and the enhancement in hepatocellular carcinomas can provide information for differential diagnosis. In a study on patients with pancreatic tumors, mainly adenocarcinomas (n = 21) and islet cell tumors (n = 19), two additional lesions were found in the MnDPDP-enhanced images. The contrast enhancement in the pancreatic parenchyma can vary greatly, depending on the site of the enhancing part of the organ in relation to a large tumor. The tumors of both origins were also enhanced post-contrast, but to a lesser degree than the normal pancreatic tissue. MnDPDP enhancement was investigated in 30 liver metastases from endocrine tumors in 13 patients. These lesions showed a signal increase of about 49% post-contrast, which lasted longer than that in the normal liver tissue. The findings may help to distinguish these tumors from other metastatic tumors. T1-weighted sequences of four types, including a spin-echo and three variants of fast gradient-echo sequences, and various parameter combinations, were investigated in healthy volunteers (n = 6), with the aim of finding the optimal sequence for MnDPDP-enhanced MRI of the liver and pancreas. The fat-and-water out-of-phase, fast field (gradient)-echo sequence was the best for imaging of both the liver and pancreas. The studies have shown that MnDPDP is safe when given as an infusion, and is effective as a liver- and pancreas-specific contrast medium, with improved lesion detection in MRI of these organs. It is also useful for the characterization of liver tumors.

Adenocarcinoma↗

Pyogenic hepatic abscesses: MRI findings on T1- and T2-weighted and serial gadolinium-enhanced gradient-echo images.

The purpose of this study was to determine the magnetic resonance imaging (MRI) features of pyogenic hepatic abscesses on T1-weighted, T2-weighted, and serial gadolinium (Gd)-enhanced T1-weighted spoiled gradient-echo (SGE) images including images acquired in the immediate, intermediate, and late phases of enhancement. The MRI studies of 20 patients with pyogenic liver abscesses were retrospectively reviewed. All patients were examined on 1.5 (n = 19) and 1.0 (n = 1) T MR scanners. MR studies included T1-weighted, T2-weighted, and serial Gd-enhanced SGE images. The following determinations were made: signal intensity of the abscess cavity and perilesional liver tissue, and the presence of internal septations, layering material, or air in the abscess cavity. The pattern of enhancement of the abscess wall, internal septae and peri-abscess liver were evaluated on serial Gd-enhanced SGE images. A total of 53 abscesses were observed in the 20 patients. Fortyeight abscesses were hypointense on T1-weighted and hyperintense on T2-weighted images. Internal septations were present in four abscesses. Lower signal intensity material was observed in a dependent location on T2-weighted images in one abscess. Signal void foci of air located on the nondependent surface was observed in two abscesses. Two other abscesses contained signal void air that occupied the entire abscess cavity, observed on all imaging sequences. On serial gadolinium-enhanced images, all abscesses revealed early enhancement of the wall, which persisted with negligible change in degree of enhancement or thickness on delayed images. Abscess walls ranged in thickness from 2 to 5 mm. Internal septations ranged in thickness from 2 to 3 mm. Abscess walls and septations were relatively uniform in thickness with no evidence of focal nodularity. Periabscess liver tissue was mildly hypointense on T1-weighted and mildly hyperintense on T2-weighted images in 20 lesions, which were either circumferential (n = 12) or wedge-shaped (n = 8). All these regions enhanced more than the remainder of the liver on immediate post-gadolinium images and remained relatively hyperintense on late phase images. Periabscess liver parenchyma was isointense on both T1- and T2-weighted images in 18 lesions, and in these lesions wedge-shaped subsegmental (n = 6) or segmental (n = 12) enhancement was observed on immediate gadolinium-enhanced images, which faded to isointensity on intermediate phase images. No perilesional signal changes and enhancement difference was observed in 15 lesions. Characteristic features of abscesses include: intense mural enhancement on early gadolinium-enhanced images, which persists with negligible change in thickness and intensity on later post-gadolinium images, and the presence of periabscess increased enhancement on immediate post-gadolinium images. These MRI features may help to distinguish abscesses from other focal liver lesions during differential diagnosis.

Contrast Media↗

Post-radiotherapy contrast enhancement changes in fast dynamic MRI of cervical carcinoma.

This pilot study determines fast dynamic gadolinium enhanced MRI contrast enhancement parameters (onset of enhancement and time to peak enhancement) before and after radiotherapy in 10 cervical carcinoma patients. Before radiotherapy, onset of enhancement and time to peak enhancement were early, with a median of 4.5 and 5.2 seconds, respectively. High-grade tumors showed early enhancement, compared with low-grade. After radiotherapy, contrast enhancement patterns differed. In survivors, onset of enhancement after radiotherapy was later than before radiotherapy. In non-survivors, onset of enhancement after radiotherapy was still early. The median difference in onset of enhancement before and after radiotherapy in survivors and non-survivors was an increase of 3.2 and a decrease of 1.1 seconds, respectively. Early onset of enhancement after radiotherapy was a better predictor for survival than a high-signal intensity zone on post radiotherapy unenhanced T1/T2-weighted MRI. It is concluded that enhancement parameters from fast dynamic Gd-enhanced MR images can provide additional functional information with regard to tumor vascularization, and may have prognostic significance. It complements clinical examination and unenhanced MRI in determining the effectiveness of radiotherapy treatment in cervical carcinoma. Future studies will focus on the clinical utility and improvements of the estimation of contrast-enhanced parameters with this new technique.

Contrast Media↗

Flap and stromal bed thickness in laser in situ keratomileusis enhancement.

PURPOSE: To evaluate whether flap thickness changes after the primary laser in situ keratomileusis (LASIK) procedure and to assess the accuracy of intraoperative pachymetry and ablation depth measurements in predicting stromal bed thickness before enhancement in eyes that have had primary myopic LASIK. SETTING: Bascom Palmer Eye Institute, Miami, Florida, USA. METHODS: This retrospective noncomparative interventional case series comprised 57 eyes of 42 patients who had LASIK enhancement between June 2001 and September 2002. Exclusion criteria included previous ocular surgery or complications during the first LASIK procedure. Only patients who had had LASIK and enhancement by the same surgeon at our institution and had intraoperative pachymetry readings for both procedures were included. The original flap was relifted in all enhancement procedures. Corneal thickness was routinely measured intraoperatively by ultrasound pachymetry. The age, eye, refraction, date of primary LASIK, central corneal thickness (CCT) and central stromal bed thickness at primary LASIK, depth of ablation, flap thickness (subtraction pachymetry), date of enhancement, CCT and central stromal bed thickness at enhancement, and flap thickness at enhancement were recorded. RESULTS: Thirty-one eyes of 26 patients were myopic and 26 eyes of 16 patients were hyperopic before primary LASIK. The mean time between LASIK and enhancement was 218 days +/- 115 (SD) (193 +/- 88 days in myopic eyes and 248 +/- 136 days in hyperopic eyes [P = .068]). The flap tended to be thicker at enhancement than in the primary LASIK procedure by 9.3 +/- 25.7 microm in myopic eyes (P = .054) and 10.5 +/- 16.6 microm in hyperopic eyes (P = .004). A strong correlation was found between flap thickness in the first and second procedures in myopic and hyperopic eyes (r = 0.6). In myopic eyes, the mean difference between the estimated stromal bed thickness after the first procedure (central bed thickness- ablation depth) and the stromal bed thickness measured directly at enhancement was not statistically significant (3 +/- 29 microm; P = .54, paired t test). A strong correlation was found between the 2 measurements (r = 0.8, P<.001). Another strong correlation was found in myopic eyes between the estimated corneal thickness after the primary LASIK and the corneal thickness measured at enhancement (r = 0.81, P<.001). No correlation was found between the difference in flap thickness and the time to enhancement (r = 0.09 in myopic eyes and r = 0.01 in hyperopic eyes). CONCLUSIONS: Flap thickness tended to be thicker at enhancement than at primary LASIK. Intraoperative pachymetry and ablation depth measurements proved to be precise tools to predict stromal bed thickness before enhancement in eyes that had had primary myopic LASIK. This information may help in planning LASIK enhancements.

Adult↗

Conditioned medium from activated rat macrophages and the recombinant factors, IL-1 beta and GM-CSF, enhance the accessory activity of dendritic cells.

Low density lymph node cells (LD-LNC; 5% of total unfractionated LNC) contain 95% of the accessory activity required for responses of T lymphocytes to mitogens. Significantly greater responses to mitogens occur when T lymphocytes are added to LD-LNC that have been exposed overnight to silica, in comparison to responses occurring with LD-LNC incubated without silica. Conditioned medium (CM) from silica-treated LD-LNC is itself able to mediate enhanced responses; i.e., when LD-LNC are exposed overnight to CM alone and mitogen-treated T lymphocytes added the next day. The enhancing activity found in CM from LD-LNC exposed to silica is produced by macrophages; however, their low accessory activity is not enhanced by CM. In contrast, dendritic cells isolated from LD-LNC exposed to silica or to CM show significantly increased accessory activity, but dendritic cells do not produce the enhancing activity found in CM. CM lacks IL-2 activity and does not have any effect on the responses of untreated or mitogen-treated T lymphocytes alone. Thus, macrophages produce the enhancing activity and dendritic cells respond to it. Maximum enhancement of dendritic cell accessory activity requires overnight exposure to CM; once induced, accessory activity is not further modulated after continued incubation in the presence or absence of CM. LD-LNC, adherent peritoneal exudate cells, and adherent thioglycollate-induced peritoneal exudate cells produce enhancing activity after exposure to silica, LPS, and silica plus LPS. After gel filtration of a CM produced by silica plus LPS, enhancing activity shows a broad molecular weight distribution between 20 and 55 kD. IL-1 is present in CM and shows a more narrow molecular weight distribution that falls within the lower molecular weight range for enhancing activity. Silica treatment by itself produces CM containing little IL-1, but abundant enhancing activity; gel filtration of this CM shows that the distribution of enhancing activity is confined more narrowly to the higher molecular weight range, suggesting that IL-1 is one of several factors that enhances the accessory activity of dendritic cells. Recombinant human IL-1 beta does have enhancing activity, but of the other recombinant factors tested only mouse GM-CSF also has enhancing activity. Human IL-1 alpha, tumor necrosis factor alpha, IL-4, rat IL-3 and rat IFN-gamma, as well as L cell-conditioned medium containing M-CSF, lack enhancing activity.

Animals↗

Screening of cationic compounds as an absorption enhancer for nasal drug delivery.

Several cationic compounds were screened as potential nasal absorption enhancers to increase intranasal absorption of a model drug, fluorescein isothiocyanate labeled dextran (MW 4.4 kDa, FD-4), without nasal membrane damage in rats. Their effects were compared with those of classical enhancers. Various cationic compounds (poly-L-arginines with different molecular weights (MW 8.9, 45.5 and 92.0 kDa, poly-L-Arg (10), (50) and (100), respectively), L-arginine (L-Arg), L-lysine (L-Lys), and cetylpyridinium chloride (CPCL) were evaluated. Of the cationic compounds, poly-L-Arg and CPCL greatly enhanced the intranasal absorption of FD-4, as did chitosan, a cationic polysaccharide which has been reported to show a great effect on the transnasal delivery of peptide and protein drugs. The enhancing intensity by poly-L-Arg was dependent on its molecular weight. Rank order of the enhancing ratio, calculated from the AUC ratio for the enhancer treatment against the untreatment, was 0.5% poly-L-Arg (100) congruent with0.5% sodium dodecylsulfate congruent with0.5% CPCL?0.5% poly-L-Arg (50)?0.5% sodium deoxycholate congruent with0.5% sodium taurodihydrofusidate?0.5% polyoxyethylene-9-lauryl ether congruent with0.5% lysophosphatidylcholine?0.5% chitosan congruent with0.5% poly-L-Arg (10)>/=10% L-Arg congruent with10% L-Lys?0.5% sodium glycocholate congruent with0.5% sodium taurocholate congruent with0.5% EDTA. Only the poly-L-Args represented almost the same degree of hemolysis of cationic compounds compared with pH 7.0 phosphate buffered saline in the rat erythrocyte lysis experiment. The enhancing ratio by classical enhancers correlated with leaching of protein, phospholipids and LDH from isolated rabbit nasal mucosa. CPCL also fell on the regression lines between the enhancing ratio and their degree of leaching from classical enhancers. In contrast, the enhancing intensities by poly-L-Arg (10), (50) and (100) were greatly shifted from the regression line: the amount of leaching was markedly low in spite of a great enhancement of FD-4 absorption. These findings suggest that of the assessed enhancers only the poly-L-Args enhance the transnasal delivery of high molecular substances without severe damage to the nasal mucosal membrane. Poly-L-Arg is therefore a promising candidate having a good balance between enhancing activity and safety for nasal peptide and protein delivery.

Absorption↗

Characteristics and pitfalls of contrast-enhanced, T1-weighted magnetization transfer images of the brain.

RATIONALE AND OBJECTIVES: This study was undertaken to clarify the difference in signal pattern on contrast material-enhanced T1-weighted magnetic resonance (MR) magnetization transfer (MT) images between enhancing and nonenhancing lesions in various intracranial diseases and to determine the necessity of nonenhanced MT images for evaluating lesional contrast enhancement. MATERIALS AND METHODS: MR images of 116 patients who underwent nonenhanced T1-weighted imaging, nonenhanced MT imaging, and contrast-enhanced MT imaging were reviewed. The increase in signal intensity of lesions relative to normal brain was compared between nonenhanced T1-weighted images and contrast-enhanced MT images. Signal intensity of lesions was compared with that of the striate nucleus and white matter on contrast-enhanced MT images. True enhancement was determined by comparison with nonenhanced MT images. RESULTS: In all, 143 lesions, including 86 enhancing and 57 nonenhancing lesions, were identified among 63 patients. Almost all (99%) of the enhancing lesions were hyperintense to striate nucleus on contrast-enhanced MT images, and most (>87%) showed moderate to marked signal intensity increase from nonenhanced T1-weighted images to contrast-enhanced MT images. Most (>95%) of the nonenhancing lesions showed mild or no increase in relative signal intensity, and most (75%) were iso- or hypointense to striate nucleus on contrast-enhanced MT images. A few nonenhancing lesions (4%-6%), however, showed increase in signal intensity that was indistinguishable from true enhancement without comparison to non-enhanced MT images. CONCLUSION: Nonenhanced MT images should be obtained to assess pathologic enhancement accurately.

Adolescent↗

Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience.

OBJECTIVE: The purpose of this study was to compare the detection rate of injury and characterize imaging findings of contrast-enhanced sonography and non-contrast-enhanced sonography in the setting of confirmed solid organ injury. SUBJECTS AND METHODS: This prospective study involved identifying hepatic, splenic, and renal injuries on contrast-enhanced CT. After injury identification, both non-contrast-enhanced sonography and contrast-enhanced sonography were performed to identify the possible injury and to analyze the appearance of the injury. The sonographic appearance of hepatic, splenic, and renal injuries was then analyzed, and the conspicuity of the injuries was graded on a scale from 0 (nonvisualization) to 3 (high visualization). RESULTS: Non-contrast-enhanced sonography revealed 11 (50%) of 22 injuries, whereas contrast-enhanced sonography depicted 20 (91%) of 22 injuries. The average grade for conspicuity of injuries was increased from 0.67 to 2.33 for spleen injuries and from 1.0 to 2.2 for liver injuries comparing non-contrast-enhanced with contrast-enhanced sonography, respectively, on a scale from 0, being nonvisualization, to 3, being high visualization. The splenic injuries appeared hypoechoic with occasional areas of normal enhancing splenic tissue within the laceration with contrast-enhanced sonography. Different patterns were observed in liver injuries including a central hypoechoic region. In some liver injuries there was a surrounding hyperechoic region. CONCLUSION: Contrast-enhanced sonography greatly enhances visualization of liver and spleen injuries compared with non-contrast-enhanced sonography. Solid organ injuries usually appeared hypoechoic on contrast-enhanced sonography, but often a hyperechoic region surrounding the injury also was identified with liver injuries.

Abdominal Injuries↗

Aortic enhancement during abdominal CT angiography: correlation with test injections, flow rates, and patient demographics.

OBJECTIVE: The goal of our study was to determine the effect of contrast material injection rate and patient demographic variables on vascular enhancement for abdominal CT angiography and compare test injection results with actual patterns of vascular enhancement. SUBJECTS AND METHODS: One hundred twenty-five patients underwent abdominal CT angiography. For each patient, CT attenuation values (Hounsfield units) of the aorta were determined before and after IV contrast administration, every 3 sec between 21 and 60 sec. A peak aortic enhancement value and the time needed to reach peak and aortic enhancement thresholds of 150 and 200 H were determined. All patients received 150 ml of nonionic contrast material at 3 ml/sec in 25 patients and 4 ml/sec in 100 patients. A test injection of 15 ml was used to compute a scan delay in 46 patients. Patient age, sex, weight, injection rate, and test injection results were compared with vascular enhancement patterns. RESULTS: For the 125 patients, the mean aortic enhancement at each time point was greater than 150 H. Patient weight was inversely correlated (r2 = -.62) with aortic enhancement. The test injection did not accurately predict actual aortic enhancement peak value or time. Test injection delay time was significantly correlated with time to reach aortic enhancement thresholds of 150 and 200 H. The 4 ml/sec rate resulted in a higher peak aortic enhancement (320+/-58 H versus 281+/-49 H) (mean +/- SD, p < .01) that was reached quicker than with the 3 ml/sec injection rate (45+/-5 sec versus 52+/-5 sec) (p < .01). Injecting at 4 ml/sec resulted in greater aortic enhancement values at 24-45 sec, whereas 3 ml/sec produced significantly better aortic enhancement at 54-60 sec. CONCLUSION: The test injection correlated better with time to reach specific aortic enhancement thresholds than with time to peak aortic enhancement. For a given amount of contrast material, faster injection rates resulted in greater vascular enhancement that occurred earlier.

Aorta, Abdominal↗