PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Enhancer”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,189 records · Page 66Linked to original sources

The upstream ectoderm enhancer in Pax6 has an important role in lens induction.

The Pax6 gene has a central role in development of the eye. We show, through targeted deletion in the mouse, that an ectoderm enhancer in the Pax6 gene is required for normal lens formation. Ectoderm enhancer-deficient embryos exhibit distinctive defects at every stage of lens development. These include a thinner lens placode, reduced placodal cell proliferation, and a small lens pit and lens vesicle. In addition, the lens vesicle fails to separate from the surface ectoderm and the maturing lens is smaller and shows a delay in fiber cell differentiation. Interestingly, deletion of the ectoderm enhancer does not eliminate Pax6 production in the lens placode but results in a diminished level that, in central sections, is apparent primarily on the nasal side. This argues that Pax6 expression in the lens placode is controlled by the ectoderm enhancer and at least one other transcriptional control element. It also suggests that Pax6 enhancers active in the lens placode drive expression in distinct subdomains, an assertion that is supported by the expression pattern of a lacZ reporter transgene driven by the ectoderm enhancer. Interestingly, deletion of the ectoderm enhancer causes loss of expression of Foxe3, a transcription factor gene mutated in the dysgenetic lens mouse. When combined, these data and previously published work allow us to assemble a more complete genetic pathway describing lens induction. This pathway features (1) a pre-placodal phase of Pax6 expression that is required for the activity of multiple, downstream Pax6 enhancers; (2) a later, placodal phase of Pax6 expression regulated by multiple enhancers; and (3) the Foxe3 gene in a downstream position. This pathway forms a basis for future analysis of lens induction mechanism.

Animals↗

Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound.

Non-invasive differentiation of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) is difficult. The aim of this study was to assess the accuracy of contrast-enhanced phase inversion ultrasound to differentiate between histologically proven FNH and HCA, analysing the arterial and (early) portal venous phase. 32 patients with histological proven FNH (n=24) or HCA (n=8) have been included in this prospective study. Examination technique: Siemens Elegra, phase inversion harmonic imaging (PIHI) with low mechanical index (MI)<0.2-0.3 using SonoVue (BR 1). The contrast enhancing tumour characteristics were evaluated during the hepatic arterial (starting 8-22 s) and early portal venous phase (starting 12-30 s). The image analysis was performed by three examiners. In 23 of 24 patients with FNH the contrast pattern revealed pronounced arterial and (early) portal venous enhancement. Homogeneous enhancement was detected during the hepatic arterial phase in all eight patients with HCA. In contrast to patients with FNH, no enhancement was seen during the portal venous phase. In conclusion, contrast-enhanced phase inversion ultrasound demonstrated pronounced arterial and portal venous enhancement in patients with focal nodular hyperplasia. In contrast, after homogeneous enhancement during hepatic arterial phase, no enhancement during hepatic portal venous phase was detected in patients with hepatocellular adenoma. Therefore, this technique might improve the functional characterization of benign hypervascular focal liver lesions.

Adenoma, Liver Cell↗

Prospective multicenter trial evaluating a novel method of characterizing focal liver lesions using contrast-enhanced sonography.

OBJECTIVE: The purpose of this study was to assess the clinical value and potential impact of SonoVue-enhanced sonography in the characterization of focal liver lesions. SUBJECTS AND METHODS: This study included 127 patients with 82 malignant and 52 benign lesions in the liver. Contrast-enhanced sonography was performed using nonlinear imaging modes at low mechanical index (0.1-0.3) to enable real-time visualization of arterial, portal, and late-phase enhancement. Digital recordings of unenhanced sonography and contrast-enhanced sonography were reviewed by on-site investigators and two off-site blinded interpreters. The final diagnosis was based on consensus interpreting of all examinations by another two expert observers with access to CT, MRI, and histologic data; the diagnostic accuracy of contrast-enhanced sonography in identifying the lesion as benign, malignant, or indeterminate and as actual tumor type was compared with baseline sonography. RESULTS: For on-site investigators, contrast-enhanced sonography reduced the number of indeterminate diagnoses by 67% and improved the sensitivity and specificity to 90.2% and 80.8%, respectively (p < 0.001). For off-site interpreters, contrast-enhanced sonography reduced the number of indeterminate diagnoses by 51-56% (p < 0.001); significantly improved sensitivity and specificity to 90.8-95.4% and 83.7-89.8%, respectively (p < 0.001); eliminated observers' variability (kappa coefficient: 0.66-0.77); and showed no significant difference in all comparisons in the analysis of lesions measuring less than 1.5 cm, 1.5-2.5 cm, and all sizes combined. Contrast-enhanced sonography did not rely on availability of clinical history to enable the diagnoses, and it reduced the need for further imaging investigations 23.7% to 90.4%. CONCLUSION: Contrast-enhanced sonography improves the characterization of focal liver lesions and may limit the need for further investigations.

Contrast Media↗

MR imaging of peritoneal disease: comparison of contrast-enhanced fast multiplanar spoiled gradient-recalled and spin-echo imaging.

OBJECTIVE: We performed this study to compare contrast-enhanced fast multiplanar spoiled gradient-recalled (SPGR) MR imaging with unenhanced spin-echo imaging for the detection of benign and malignant peritoneal abnormalities. MATERIALS AND METHODS: We retrospectively reviewed abdominal MR images of 34 patients with proved peritoneal abnormalities, including 21 patients with malignant and 13 patients with benign peritoneal disease. Six additional patients had false-positive interpretations of their MR examinations because of diaphragmatic thickening and enhancement. Unenhanced T1-weighted images, fast spin-echo T2-weighted images, and breath-hold fast multiplanar SPGR images obtained immediately and 10-15 min after IV injection of gadopentetate dimeglumine were available. Images were reviewed for evidence of peritoneal disease by two observers who had no knowledge of the clinical findings. The four types of images were separately evaluated for peritoneal thickening, masses, and abnormal enhancement. The anatomic location, thickness, and pattern of thickening of the peritoneum were noted. Results were correlated with surgical findings or results of percutaneous biopsy. RESULTS: Immediate and delayed contrast-enhanced fast multiplanar SPGR images showed malignant peritoneal tumor in all 21 cases, compared with T1-weighted images, which showed tumor in 11 cases (p < .01), and fast spin-echo T2-weighted images, which showed tumor in 13 cases (p < .01). Enhancement of the peritoneal tumor increased the tumor's conspicuity, particularly on delayed fast multiplanar SPGR images, which were selected as the best sequence for detection of peritoneal tumor in 18 of the 21 cases. The MR findings varied widely from moderately and regularly thickened, enhancing peritoneum to very thick (> 1 cm) and lobular or masslike peritoneal thickening with enhancement. Delayed fast multiplanar SPGR images showed evidence of benign peritoneal disease in all 13 cases compared with immediate fast multiplanar SPGR images, which showed disease in 12 cases (p > .05); T1-weighted images, which showed disease in four cases (p < .05); and fast spin-echo T2-weighted images, which showed disease in only one case (p < .01). In the benign forms of peritoneal disease, the peritoneum was often regular in contour and tended to be thinner than in the cases of malignant peritoneal tumor, in which the peritoneum was generally thicker and more lobular or masslike. However, significant overlap was seen between the MR findings in benign and malignant forms of peritoneal disease. CONCLUSION: Detection of peritoneal abnormalities with MR imaging can be improved by using contrast-enhanced fast multiplanar SPGR imaging. The findings of peritoneal thickening and enhancement are best depicted on delayed images.

Adult↗

Gadolinium-enhanced MR imaging of pediatric patients after reduction of dysplastic hips: assessment of femoral head position, factors impeding reduction, and femoral head ischemia.

OBJECTIVE: We describe gadolinium-enhanced MR imaging of position and vascular enhancement of the femoral head in pediatric patients who have undergone reduction of hip dislocation. SUBJECTS AND METHODS: Within 24 hr of hip reduction and spica casting, we performed 25 gadolinium-enhanced MR studies in 18 infants and young children (15 girls, three boys) with 23 dysplastic hips. All but two patients underwent closed reductions. We evaluated intraoperative arthrograms for obstacles to reduction and subsequent radiographs for avascular necrosis. RESULTS: MR images showed that all femoral heads were in their respective acetabula, but several structures interfered with concentric reduction. Obstacles to reduction included a pulvinar (n = 16), infolding of the capsule (n = 9), interposition of the labrum (n = 2), and a hypertrophied ligamentum teres and transverse ligament (n = 2). All 50 femoral heads showed enhancement: 35 normally, 10 homogeneously but less than on the contralateral femoral head or the ipsilateral greater trochanter, and five with areas of focally decreased enhancement. Hips that showed decreased enhancement had undergone greater degrees of abduction (r = .38, p < .01). CONCLUSION: Gadolinium-enhanced MR imaging can reveal abnormalities of hip position and proximal femoral epiphyseal and physeal vascularity that can occur after hip reduction. Abnormalities of enhancement were more frequent in patients who had greater femoral abduction. The effect of decreased epiphyseal vascular enhancement is still uncertain.

Arthrography↗

Comparing the performance of mammographic enhancement algorithms: a preference study.

OBJECTIVE: The objective of this study was to compare the performance of four image enhancement algorithms on secondarily digitized (i.e., digitized from film) mammograms containing masses and microcalcifications of known pathology in a clinical soft-copy display setting. MATERIALS AND METHODS: Four different image processing algorithms (adaptive unsharp masking, contrast-limited adaptive histogram equalization, adaptive neighborhood contrast enhancement, and wavelet-based enhancement) were applied to one image of secondarily digitized mammograms of forty cases (10 each of benign and malignant masses and 10 each of benign and malignant microcalcifications). The four enhanced images and the one unenhanced image were displayed randomly across three high-resolution monitors. Four expert mammographers ranked the unenhanced and the four enhanced images from 1 (best) to 5 (worst). RESULTS: For microcalcifications, the adaptive neighborhood contrast enhancement algorithm was the most preferred in 49% of the interpretations, the wavelet-based enhancement in 28%, and the unenhanced image in 13%. For masses, the unenhanced image was the most preferred in 58% of cases, followed by the unsharp masking algorithm (28%). CONCLUSION: Appropriate image enhancement improves the visibility of microcalcifications. Among the different algorithms, the adaptive neighborhood contrast enhancement algorithm was preferred most often. For masses, no significant improvement was observed with any of these image processing approaches compared with the unenhanced image. Different image processing approaches may need to be used, depending on the type of lesion. This study has implications for the practice of digital mammography.

Aged↗

Takayasu's arteritis: assessment of disease activity with contrast-enhanced MR imaging.

OBJECTIVE: The purpose of this study was to evaluate the role of contrast-enhanced MR imaging in the determination of disease activity in patients with Takayasu's arteritis. SUBJECTS AND METHODS: High-resolution contrast-enhanced T1-weighted spinecho MR imaging using small fields of view (14-20 cm) and thin slices (4-5 mm) was performed in 26 patients with Takayasu's arteritis and 16 healthy subjects. The degree of aortic mural enhancement was assessed by measuring signal intensity and by visually estimating it in comparison with that of the myocardium. RESULTS: Contrast-enhanced MR imaging showed more enhancement of thickened aortic wall compared with myocardium, thus suggesting active Takayasu's arteritis on MR imaging in 16 patients. Determination of disease activity using contrast-enhanced MR imaging was concordant with clinical findings in 23 patients (88.5%). Contrast-enhanced MR findings were concordant with laboratory findings in most patients (erythrocyte sedimentation rate in 92.3% [24/26] and C-reactive protein in 84.6% [22/26]). The measured signal intensity of the aortic wall relative to that of myocardium during the early phase of contrast-enhanced MR imaging correlated well with the erythrocyte sedimentation rate (r = 0.78, p < 0.005) and with the C-reactive protein level (r = 0.63, p < 0.005). CONCLUSION: Contrast-enhanced MR imaging provides information about disease activity of Takayasu's arteritis, which may be useful in the diagnosis and treatment of Takayasu's arteritis.

Adolescent↗

Delayed enhanced CT of lipid-poor adrenal adenomas.

OBJECTIVE: Although representing a minority of adrenal adenomas, the lipid-poor variety cannot be accurately identified on unenhanced CT or chemical shift MR imaging. We compared the delayed contrast-enhanced CT features of lipid-poor adenomas with those of lipid-rich adenomas and of adrenal nonadenomas to determine whether there were differences in the washout features between these groups of lesions. SUBJECTS AND METHODS: Eighteen proven lipid-poor adenomas, 56 lipid-rich adenomas, and 40 adrenal nonadenomas underwent CT before, immediately after, and 15 min delay after IV contrast injection. Region-of-interest measurements were made of all adrenal lesions at the three time points. The degree of enhancement, enhancement washout, percentage enhancement washout, and relative percentage enhancement washout were calculated for each adrenal mass. Pooled data were analyzed statistically. Optimal threshold values for diagnosing adrenal adenomas were also determined. RESULTS: The mean CT attenuation of lipid-poor adenomas was significantly higher than that of lipid-rich adenomas at all three phases but not significantly different from that of nonadenomas. The mean percentage enhancement washout on images obtained 15 min after administration of contrast material was similar for lipid-rich and lipid-poor adenomas but was significantly higher than that of nonadenomas. The mean relative percentage enhancement washout was significantly different among all three groups. CONCLUSION: Lipid-poor adenomas cannot be differentiated from adrenal nonadenomas on the basis of a single mean attenuation value. However, lipid-poor adrenal adenomas show enhancement and enhancement washout features nearly identical to lipid-rich adenomas and can be distinguished from nonadenomas on the basis of a percentage washout threshold value of 60% and a relative percentage washout of 40%.

Adenoma↗

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.

Aged↗

A multiprotein complex consisting of the cellular coactivator p300, AP-1/ATF, as well as NF-kappaB is responsible for the activation of the mouse major histocompatibility class I (H-2K(b)) enhancer A.

Major histocompatibility complex (MHC) class I genes encode highly polymorphic antigens that play an essential role in a number of immunological processes. Their expression is activated in response to a variety of signals and is mediated through several promoter elements among which the enhancer A is one of the key control regions. It contains binding sites for several transcription factors, for example: (i) a well-characterized binding site for rel/NF-kappaB transcription factors in its 3'-end (the H2TF1 or kappaB1 element), (ii) a second kappaB site (the kappaB2 element), which is located immediately adjacent 5' to the H2TF1 element and which is recognized by p65/relA in the human HLA system, and (iii) an AP-1/ATF recognition sequence in the 5' end (EnA-TRE). Here we demonstrate that latter element is bound by at least two distinct heterodimers of the AP-1/ATF transcription factor family, namely c-Jun/ATF-2 and c-Jun/Fra2. Moreover, our data reveal that the enhancer A is simultaneously bound by AP-1/ATF and rel/NF-kappaB transcription factors and that the cellular coactivator p300, which enhances enhancer A-driven reporter gene expression if cotransfected, is recruited to the enhancer A through this multiprotein complex. In contrast to the complete enhancer A, neither the EnA-TRE nor the H2TF1 element on their own are able to confer activation on a heterologous promoter in response to the phorbol ester tumor promoter TPA or the cytokine TNFalpha. Moreover, deletion of any one of the enhancer A control elements results in a dramatic loss of its inducibility by TNFalpha, and point mutations in either the EnA-TRE or the H2TF1 element lead to the loss of AP-1/ATF or NF-kappaB binding, respectively, and to the loss of enhancer A inducibility. Therefore, we conclude that the enhancer A is synergistically activated through a multiprotein complex containing AP-1/ATF, NF-kappaB transcription factors as well as the cellular coactivator p300.

Activating Transcription Factors↗

[Differential diagnosis of pulmonary nodules by using enhanced CT with iodinated contrast material].

OBJECTIVE: To evaluate pulmonary nodules by using enhanced CT. METHODS: 89 patients with pulmonary nodules included 63 pulmonary carcinomas and 26 benign pulmonary nodules. Thin-slice CT was performed before injection, 35 s, 2 min and 5 min after injection of 100 ml of contrast material at 2 ml/s. The maximum level of enhancement and the enhanced patterns were recorded. RESULTS: Lung carcinomas enhanced significantly more than benign nodules. 27 lung carcinomas showed the sign of enhanced spots and twigs; 51 lung carcinomas and 4 benign nodules showed inhomogeneous enhancement; 3 lung carcinomas and 4 benign nodules had homogeneous enhancement; 5 tuberculomas and 1 inflammatory pseudotuma appeared ring enhancement; 12 tuberculomas showed nonenhancement. CONCLUSION: Enhanced CT is a valuable method to differentiate pulmonary carcinomas from benign pulmonary nodules.

Adult↗

Protein-DNA interactions at a dioxin-responsive enhancer. Mutational analysis of the DNA-binding site for the liganded Ah receptor.

The liganded Ah receptor activates transcription by binding to a specific DNA-recognition motif within a dioxin-responsive enhancer upstream of the CYP1A1 gene. Analyses of mutant enhancers by gel retardation reveal that each base pair within the domain 5'CGTG(GCAC)3' is essential to the receptor-enhancer interaction. The three base pairs immediately flanking each end of the essential domain contribute less strongly to receptor binding. Analyses of enhancer function by transfection reveal that a mutation in the essential domain, which abolishes receptor-DNA binding, obliterates enhancer function. Mutations outside the essential domain, which diminish, but do not abolish, receptor-DNA binding, also obliterate enhancer function. Additionally, one mutation adjacent to the essential binding motif does not affect receptor-DNA binding, but destroys enhancer activity. These findings imply that transcriptional enhancement by the dioxin-responsive system cannot be predicted solely by the strength of the receptor-enhancer interaction.

Base Sequence↗

Differentiation of benign and malignant lymph nodes with contrast-enhanced echolymphography using endoscopic ultrasound-guided puncture.

BACKGROUND/AIMS: Although endoscopic ultrasonography is considered the most useful diagnostic modality for the regional staging, the capability of diagnosing lymph node metastasis based on endoscopic ultrasonography images alone is not sufficient. To improve the capability of differential diagnosis of lymph node enlargement, contrast-enhanced echolymphography was performed using endoscopic ultrasonography-guided puncture. METHODOLOGY: Contrast-enhanced echolymphography was performed in 8 metastatic lymph nodes surgically resected from patients with gastrointestinal cancers (in vitro study) and also in 55 patients in whom abdominal lymph node swelling was indicated by endoscopic ultrasonography (in vivo study). Lymph nodes were punctured under real-time endoscopic ultrasonography guidance, and carbon dioxide microbubbles were injected to evaluate echo features before and after microbubbles injection. RESULTS: Contrast-enhanced echolymphography of freshly resected metastatic lymph nodes showed nonhomogeneous echo patterns. In regions demonstrating filling defects detected by contrast-enhanced echolymphography, neoplastic infiltration was pathologically observed. In almost all of the malignant lymph nodes studied in vivo, filling defects and heterogeneous enhancements were observed by contrast-enhanced echolymphography. However, contrast-enhanced echolymphography demonstrated uniform patterns in most of the benign group. The sensitivity, specificity, positive and negative predictive value, and accuracy of differential diagnosis by contrast-enhanced echolymphography were 95.8%, 90.3%, 88.5%, 96.6%, and 92.7%, respectively. CONCLUSIONS: Contrast-enhanced echolymphography is a useful method for help in the differentiation between reactive and malignant alterations of lymph nodes.

Adult↗

Glial tumor grading and outcome prediction using dynamic spin-echo MR susceptibility mapping compared with conventional contrast-enhanced MR: confounding effect of elevated rCBV of oligodendrogliomas [corrected].

BACKGROUND AND PURPOSE: The MR imaging characteristics of oligodendrogliomas and astrocytomas on spin-echo (SE), echo-planar relative cerebral blood volume (rCBV) maps, to our knowledge, have not previously been emphasized. We compared the specificity of SE rCBV mapping with that of conventional, contrast material-enhanced MR imaging in differentiating high- from low-grade glial tumors and in predicting survival of patients with these lesions. METHODS: Thirty consecutive adult patients with suspected gliomas underwent conventional and rCBV MR imaging. Representative maximal rCBV regions of interest were chosen from each lesion. Resultant values were normalized to those of corresponding, contralateral, uninvolved regions. These normalized CBV (nCBV) values were correlated with degree of contrast enhancement, histopathologic tumor grade, and survival. RESULTS: Twenty-two patients had astroctyomas and eight had oligodendrogliomas. With an nCBV cutoff ratio of 1.5, 13 of 13 high-grade astrocytomas were correctly categorized, three of which did not enhance. Seven of nine low-grade astrocytomas were correctly classified by their nCBV values, including one enhancing lesion. Of eight oligodendrogliomas, four of four high-grade and two of four low-grade tumors had elevated nCBV values; two low-grade oligodendrogliomas enhanced, one with nCBV greater than 1.5 and one with nCBV less than 1.5. In 19 patients with astrocytoma for whom survival data were available, correlation with survival was better for nCBV (mean survival 91 +/- 14 months for nCBV < 1.5 versus 24 +/- 27 months for nCBV > 1.5, P <.0001) than for enhancement (mean survival 61 +/- 35 months without enhancement versus 22 +/- 29 months with enhancement, P =.03). CONCLUSION: Elevated SE rCBV was a sensitive, but not specific, marker for high-grade histopathology: all high-grade tumors had nCBV foci values greater than 1.5. No tumor with nCBV region of interest less than 1.5 was high grade (100% predictive value for excluding high grade). Degree of nCBV elevation was a stronger predictor of both tumor grade and survival than was degree of enhancement. A significant proportion of low-grade glial neoplasms, most notably oligodendrogliomas, may display high rCBV foci not reflective of high-grade histopathology.

Adolescent↗

Enhanced sonography using carbon dioxide gas for small hepatocellular carcinoma: a comparison study between pure carbon dioxide gas and carbon dioxide microbubbles.

PURPOSE: To evaluate the feasibility of enhanced sonography using arterial injection of pure carbon dioxide gas (CO(2)) for detecting small hepatocellular carcinoma (HCC) nodules. MATERIALS AND METHODS: We performed enhanced sonography on 51 HCC nodules of 35 patients with HCC. The patients underwent enhanced sonography with two methods: injection of pure CO(2) (26 nodules), or injection of CO(2) microbubbles (25 nodules) using CO(2) and soy bean oil. We observed the enhancement effect of HCC on enhanced sonography, and measured the accumulation time of CO(2) in the nodules. RESULTS: Twenty-three nodules appeared hyperechoic on enhanced sonography, and 12 of the nodules could be found on enhanced sonography only. Sixteen of the hyperechoic nodules on baseline sonography revealed no enhancement. Multiple regression analysis with regard to the method of injection of CO(2), nodule location, and nodule size revealed that method (p<0.0001) and nodule size (p=0.02) remained significant. The accumulation time of CO(2) microbubbles in the nodules was 4.4+/-0.8 minutes, whereas pure CO(2) accumulation time was 14.7+/-1.5 minutes, significantly longer than the CO(2) microbubbles regardless of nodule size and location. CONCLUSION: Enhanced sonography of arterial injection of pure CO(2) is a feasible technique for detecting small HCC nodules.

Adult↗

Optimal scan timing for coronal enhancement of hypervascular hepatocellular carcinomas and correlation with tumor size: evaluation with four-phase CT hepatic arteriography.

PURPOSE: Our aim was to evaluate coronal enhancement of hypervascular hepatocellular carcinomas (HCCs) on four-phase CT hepatic arteriography (CTHA). MATERIALS AND METHODS: This study included a total of 86 hypervascular HCCs. Four-phase CTHA images were acquired at 10 sec, 35 sec, 60 sec, and 85 sec after the initiation of contrast medium injection. The rate of coronal enhancement on each phase of CTHA of HCCs was analyzed. The rate of coronal enhancement on each phase of CTHA of HCC was also compared with nodule size. RESULTS: All HCCs showed tumor enhancement on phase-one CTHA. The appearance rates of coronal enhancement on phases-two, -three, and -four CTHA were 87.2%, 67.4%, and 53.4%, respectively. The appearance rates of coronal enhancement of small HCCs on phases-two, -three, and -four CTHA were 91.1%, 53.6%, and 30.5%, respectively; those of non-small HCCs were 80.0%, 93.3%, and 96.7%, respectively. On phase-two CTHA, the presence of coronal enhancement was higher in small HCCs than in non-small HCCs. On phases-three and -four CTHA, the presence of coronal enhancement was significantly higher in non-small HCCs than in small HCCs. CONCLUSION: The optimal phase for achieving coronal enhancement depended on tumor size.

Aged↗

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI.

BACKGROUND: Contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI) has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrast-enhanced T1-weighted MRI (CE T1WI). However, currently there are no studies showing the potential value of clinical applications of contrast-enhanced FLAIR (CE FLAIR) sequence in diagnosing intracranial tumors in a larger group of patients. The purpose of this study was to evaluate the diagnostic value of CE FLAIR in comparison with CE T1WI for intracranial tumors and to provide more information for clinical diagnosis and therapy. METHODS: One hundred and four consecutive cases of intracranial tumors referred for CE brain MRI were analyzed with regard to FLAIR and T1WI pre- and post-administration of Gd-DTPA. The CE FLAIR and CE T1WI were evaluated independently by two radiologists for the number of examinations with one or more enhanced lesions, the number and location of enhanced lesions per examination, signal-to-noise ratio (SNR) and contrast-enhancement ratio (CER) of lesions, as well as the size and extent of the enhanced lesions. RESULTS: In 98 of 104 cases, enhanced lesions were seen both on the FLAIR and T1W images. More lesions were seen on CE T1WI (n = 120) than those on CE FLAIR sequence (n = 117), but no differences of statistical significance were found between the two sequences (P > 0.05). Four lesions were revealed only on the CE FLAIR images whereas 7 lesions were only found on CE T1WI. Enhanced lesions located in the cerebral hemisphere or the forth ventricle were revealed much more on CE T1WI than on CE FLAIR images. However, CE FLAIR images may be useful in showing superficial abnormalities and those located in the sulcus or lateral ventricle. The CER and contrast-to-noise ratio (CNR) on CE T1WI was significantly higher (t = 7.10, P = 0.00; t = 9.67, P = 0.00, respectively), but grey matter/white matter contrast was lower (t = 2.46, P = 0.02) than those on CE FLAIR images. The SNR did not show any statistically significant difference between the two sequences (t = 1.1, P = 0.27). The size and extent of lesions on the CE FLAIR images were significantly larger than those on CE T1WI (t = 4.13, P = 0.00). CONCLUSIONS: CE FLAIR and CE T1WI may complement each other in showing intracranial tumors and the CE FLAIR sequence should be selected as a routine MRI sequence.

Adolescent↗

Characterization of a novel liver-specific enhancer in the human prothrombin gene.

The 5'-flanking sequence of the human prothrombin gene was isolated by screening a human liver phage library with a human prothrombin cDNA as a hybridization probe. A phage was identified that contained 3 kilobase pairs of DNA upstream of the initiator methionine codon. Primer extension studies showed that the major transcription initiation sites were located 23 and 36 base pairs upstream of the initiator codon. DNA sequences in the 5'-flanking region of the human prothrombin gene were then analyzed for cis-activating transcriptional activity by a transient expression system using the human growth hormone gene as the reporter gene. The chimeric expression vector was introduced into HepG2 cells, and secreted human growth hormone was monitored by using a radio-immunoassay. These studies showed that the 3-kilo-base pair fragment contained sequences that were sufficient for the initiation of transcription in HepG2 cells. Subsequent deletion studies showed that the 3-kilobase pair fragment contained two elements: a weak promoter in the region immediately upstream of the mRNA coding sequence and an enhancer located between nucleotides -860 and -940. The enhancer element was active at a distance and in either orientation. In addition, the enhancer was liver cell-specific and acted on heterologous promoters including the herpes simplex virus thymidine kinase promoter and the mouse metallothionein I promoter. Comparison of the nucleotide sequence of the enhancer with a DNA sequence data base showed the enhancer sequence to be unique. The enhancer sequence is flanked by an inverted repeat 5' CCTCCC 3' and contains a putative binding site for hepatic nuclear factor 1. Deoxyribonuclease I footprint analysis and linker scanning mutagenesis showed that the enhancer contains multiple protein binding motifs. Mutagenesis of the 3' boundary CCTCCC sequence eliminated the enhancer activity. Comparison with other liver genes showed the presence of the CCTCCC sequence in the hepatitis B virus enhancer, the alpha 1-antitrypsin promoter, and the fibrinogen beta-chain promoter, suggesting a functional role for this motif.

Base Composition↗