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PubMed1999

Simultaneous use of sodium deoxycholate and dipotassium glycyrrhizinate enhances the cellular transport of poorly absorbed compounds across Caco-2 cell monolayers.

The absorption-enhancing effect of a combination of sodium deoxycholate and dipotassium glycyrrhizinate in Caco-2 cell monolayers has been compared with that of the enhancers when used alone, and the mechanism of the enhancement was partially elucidated. The effect of the combined compounds was evaluated by measurement of transepithelial electrical resistance (TEER) and the cellular permeability of the water-soluble model compounds sodium fluorescein (MW 376.3) and fluorescein isothiocyanate dextran (MW 4400). The TEER of the monolayers decreased with increasing concentrations of dipotassium glycyrrhizinate in combination with 0.02% (w/v) sodium deoxycholate for 20 min, and reached a minimum at 1% (w/v) dipotassium glycyrrhizinate. Although a combination of 0.02% (w/v) sodium deoxycholate and 1% (w/v) dipotassium glycyrrhizinate enhanced the cellular permeability of sodium fluorescein and fluorescein isothiocyanate dextran, 0.02% (w/v) sodium deoxycholate and 1% (w/v) dipotassium glycyrrhizinate alone had no effect on either the TEER of the monolayers or the cellular transport of the water-soluble compounds. Sequential and separate exposure of the monolayers to each enhancer for 10 min had no effect on the TEER, but a marked decrease in TEER was observed when both compounds were used in combination. The enhancing effect of the combination of sodium deoxycholate and dipotassium glycyrrhizinate was inhibited by H7, a protein kinase C (PKC) inhibitor, suggesting that dipotassium glycyrrhizinate might enhance the activation of PKC via sodium deoxycholate. The combined use of these two enhancers had no toxic effects. These results provide useful, basic information on the action of these absorption enhancers on drugs for which absorption is limited owing to polarity or molecular size, or both.

Absorption↗

PubMed1990

Serial study of gadolinium-DTPA MRI enhancement in multiple sclerosis.

We performed serial baseline and gadolinium (Gd)-DTPA-enhanced MRI in 4 patients with definite multiple sclerosis. Studies were performed every month for a total of 4 scans. We obtained short TR/short TE sequences at 10 and 60 minutes after Gd-DTPA injection. All patients had multiple hyperintense lesions seen on baseline MRI with long TR/short and long TE. There was Gd-DTPA enhancement in new, enlarging, and preexisting lesions that were unchanged in size. The enhancing lesions were always seen on T2-weighted images. There was no difference in enhancement between the 10- and 60-minute studies. Six of 85 preexisting lesions enhanced whereas all new or enlarging lesions enhanced. Enhancement persisted in only 1/3 of the new or enlarging lesions, suggesting that MR enhancement is a transient phenomenon due to local temporary blood-brain barrier breakdown. Our data indicate that Gd-DTPA enhancement monitoring is more sensitive than unenhanced MRI for detecting disease activity in MS.

Adult↗

PubMed2003

Characterization of the passive component of force enhancement following active stretching of skeletal muscle.

The mechanisms causing the steady-state force enhancement following active skeletal muscle stretching are not well understood. Recently, we found direct evidence that part of the force enhancement is associated with the engagement of a passive component. In this study, we reproduced the conditions that give consistent passive force enhancement and evaluated the mechanical properties of this passive force enhancement so as to gain insight into its source. The three primary results were that (1). the passive force enhancement is long lasting (>25 s), (2). passive force enhancement was reduced in a dose-dependent manner by the amount of shortening preceding active muscle stretching, and (3). passive force enhancement could be abolished 'instantaneously' by shortening-stretching the passive muscle by an amount equivalent to the active stretch magnitude. Together with the remaining results, we conclude that the source of the passive force enhancement must be arranged in parallel with the contractile force, it must consist of a viscoelastic molecular spring whose stiffness characteristic can be reset by shortening, and it must have a characteristic length that is governed by the length of the contractile components, possibly the sarcomeres. Based on these results, the molecular spring titin emerges as a possible candidate for the passive component of the steady-state force enhancement observed in this and previous studies.

Animals↗

PubMed2005

Sublingual delivery of insulin: effects of enhancers on the mucosal lipid fluidity and protein conformation, transport, and in vivo hypoglycemic activity.

The purposes of this study were to evaluate effects of enhancers for sublingual delivering insulin on the mucosal lipid fluidity and protein conformation, transport, and in vivo hypoglycemic activity in normal rats. The effects on sublingual mucosa, and aggregation states of insulin were estimated using fluorescence polarization, and circular dichroism method, respectively. The human immortalized oral epithelial cell monolayer was used for evaluating transport of insulin. Hydroxylpropyl-beta-cyclodextrin (HP-beta-CD), chitosan, polyethylene-polypropylene glycol, polyoxyethylene lauryl ether, polysorbate 80, egg lecithin, or oleic acid, was used as a penetration enhancer, respectively. The fluidity of sublingual mucosal lipid was markedly reduced by these enhancers excluding polysorbate 80, and the secondary structure of the mucosal proteins was also influenced by these enhancers. The hexamers of insulin were dissociated to monomers only by chitosan, polyoxyethylene lauryl ether, and egg lecithin. Nonetheless, plasma glucose levels in normal rats were significantly lowered after sublingual administration of insulin with an enhancer compared with those without an enhancer at the same time-point. The enhancing effects may be due to one or multiple factors: increasing the mucosal lipid fluidity, directly loosing the tight junction of epithelia, and dissociating the hexamers of insulin to monomers. Among these, the opened tight junction may correlate most with the enhancing effect in the mucosal permeability. Because the aggregates of insulin exist, the dissociation of the aggregates by an enhancer would benefit the permeability.

Administration, Sublingual↗

PubMed2003

The upper airway response to pollen is enhanced by exposure to combustion particulates: a pilot human experimental challenge study.

Although human experimental studies have shown that gaseous pollutants enhance the inflammatory response to allergens, human data on whether combustion particulates enhance the inflammatory response to allergen are limited. Therefore, we conducted a human experimental study to investigate whether combustion particulates enhance the inflammatory response to aeroallergens. "Enhancement" refers to a greater-than-additive response when combustion particulates are delivered with allergen, compared with the responses when particulates and allergen are delivered alone. Eight subjects, five atopic and three nonatopic, participated in three randomized exposure-challenge sessions at least 2 weeks apart (i.e., clean air followed by allergen, particles followed by no allergen, or particles followed by allergen). Each session consisted of nasal exposure to combustion particles (target concentration of 1.0 mg/m3) or clean air for 1 hr, followed 3 hr later by challenge with whole pollen grains or placebo. Nasal lavage was performed immediately before particle or clean air exposure, immediately after exposure, and 4, 18 and 42 hr after pollen challenge. Cell counts, differentials, and measurement of cytokines were performed on each nasal lavage. In atopic but not in nonatopic subjects, when allergen was preceded by particulates, there was a significant enhancement immediately after pollen challenge in nasal lavage leukocytes and neutrophils (29.7 X 10(3) cells/mL and 25.4 X 10(3) cells/mL, respectively). This represents a 143% and 130% enhancement, respectively. The enhanced response for interleukin-4 was 3.23 pg/mL (p = 0.06), a 395% enhancement. In atopic subjects there was evidence of an enhanced response when particulates, as compared to clean air, preceded the allergen challenge.

Adult↗

PubMed2002

DNA-PK and ATM are required for radiation-enhanced integration.

Ionizing radiation is known to improve transfection of exogenous DNA, a process we have termed radiation-enhanced integration. Previous observations have demonstrated that Ku proteins are critical for radiation-enhanced integration. Since Ku proteins form the DNA-binding domain of DNA-PK and since DNA-PK is important in nonhomologous DNA end joining, it was hypothesized that DNA-PK function might be important for radiation-enhanced integration. The ATM protein has been shown to be important in the recognition of a variety of types of DNA damage and to associate with DNA-PK under certain conditions. It was thus hypothesized that ATM might also play a role in radiation-enhanced integration. To test these hypotheses, radiation-enhanced integration was measured in hamster cells that are defective in the catalytic subunit of DNA-PK and in human cells containing mutant ATM. Radiation-enhanced integration was not detected in any of the cell lines with mutant PRKDC (also known as DNA-PKcs), but it was present in cells of the same lineage with wild-type PRKDC. Radiation-enhanced integration was defective in cells lacking kinase activation. ATM-deficient cell lines also showed defective radiation-enhanced integration. These data demonstrate that DNA-PK and ATM must both be active for radiation-enhanced integration to be observed.

Animals↗

PubMed2003

Wortmannin-enhanced X-ray-induced apoptosis of human T-cell leukemia MOLT-4 cells possibly through the JNK/SAPK pathway.

We demonstrated that enhancement of X-ray-induced apoptosis/rapid cell death by wortmannin accompanied by increased activation of JNK/SAPK in human leukemia MOLT-4 cells. Rapid cell death/apoptosis was determined either by the dye exclusion test or by the appearance of Annexin V-positive cells and cleaved PARP fragments. Enhancement was observed only at higher concentrations of wortmannin, i.e. 1 microM or more. At these high concentrations, both DNA-PK and ATM were inhibited. X-ray-induced phosphorylation of Ser 15 of p53/TP53, accumulation of both p53/TP53 and p21/WAF1/CDKN1A, and phosphorylation of XRCC4 were all suppressed. The enhancement of apoptosis/rapid cell death by wortmannin was prevented by addition of caspase inhibitors, Z-VAD-FMK or Ac-DEVD-CHO, or by transfection and overexpression of mouse Bcl2, which is known as an anti-apoptosis protein. The requirement for a high concentration of wortmannin, i.e. 1 microM or more, indicates that inhibition of both DNA-PK and ATM was necessary for the enhanced apoptosis/rapid cell death. Phosphorylation of AKT/PKB was completely suppressed at a much lower concentration, i.e. 0.1 microM wortmannin, where no enhancement of X-ray-induced apoptosis/rapid cell death was observed. On the other hand, X-ray-induced phosphorylation of JNK and its kinase activity as well as apoptosis/rapid cell death were all significantly enhanced only at high concentrations of wortmannin, i.e. 1 microM or more. Furthermore, the extent of enhancement of both JNK phosphorylation and of apoptosis/rapid cell death by wortmannin was less in Rh1a cells, which are ceramide- and radiation-resistant variant cells compared to the parental MOLT-4 cells. Therefore, activation of the JNK pathway was considered important for the enhancement of X-ray-induced apoptosis/rapid cell death of MOLT-4 cells by wortmannin, because of the requirement for a higher concentration of wortmannin than that required for inhibition of AKT phosphorylation. The suppression of the AKT-dependent pathway by wortmannin may have some underlying role in activating the JNK pathway toward the enhancement of cell death in the current system.

Androstadienes↗

PubMed2006

Clinical significance of poor CT enhancement of the thickened small-bowel wall in patients with acute abdominal pain.

OBJECTIVE: Our purpose was to compare clinical outcomes in patients with acute abdominal pain and inner-layer enhancement of a thickened small-bowel wall, as shown on CT, with outcomes in similar patients without such enhancement. MATERIALS AND METHODS: We retrospectively studied outcomes in 126 patients with acute abdominal pain and small-bowel wall thickening on CT: 84 with inner-layer enhancement and 42 without this enhancement. We compared the surgical, small-bowel resection, small-bowel necrosis, and mortality rates between the two groups using the chi-square test. RESULTS: Among the 42 patients without inner-layer enhancement, 32 (76%) underwent an operation, 27 (64%) received segmental small-bowel resection, 26 (62%) had small-bowel necrosis, and seven (17%) died. All of these proportions were significantly higher (p < 0.01) than the corresponding rates-34 (40%), nine (11%), five (6%), and two (2%), respectively-in the 84 patients with inner-layer enhancement. All 31 patients with necrotic small bowel had pathologic evidence of ischemic necrosis involving the mucosa. CONCLUSION: Among patients with acute abdominal pain, those whose CT scans did not show inner-layer enhancement of a thickened small-bowel wall were more prone to undergo surgery and small-bowel resection and were more likely to have small-bowel necrosis than those with such enhancement. Poor inner-layer enhancement on CT might be consistent with sloughed or necrotic mucosa, as observed on pathology.

Abdomen, Acute↗

PubMed2005

Comparison of IV contrast-enhanced sonography and histopathology of pancreatic cancer.

OBJECTIVE: We compared contrast-enhanced sonography findings with pathologic findings in pancreatic cancer to evaluate the ability of contrast-enhanced sonography to depict the pathologic changes associated with pancreatic cancer. SUBJECTS AND METHODS: Thirty-four patients with pancreatic cancer who underwent surgery were investigated. Sonography was performed with contrast material (Levovist) for all patients before surgery. Pathologic findings were evaluated on the basis of the resected cancer specimens. We compared contrast-enhanced sonography findings with pathologic findings. RESULTS: All tumors that were hyperechoic on contrast-enhanced sonography were papillary adenocarcinoma, and all tumors that were hypoechoic on contrast-enhanced sonography were ductal adenocarcinoma. Among ductal adenocarcinomas, five (71.4%) of seven tumors for which the size of the hypoechoic area was unchanged on contrast-enhanced sonography had clear tumor margins with no infiltration or inflammation in the margin. In contrast, all tumors for which the size of the hypoechoic area was reduced on contrast-enhanced sonography had unclear tumor margins with infiltration of cancerous cells and inflammation. Nine (90%) of 10 tumors that showed partial contrast enhancement or a vascular shadow in a hypoechoic area had large or medium-sized vessels within a tumor at pathology. In contrast, only one (4.8%) of 21 tumors that did not show the vascular shadow in a hypoechoic area had no large or medium-sized vessels in a tumor. CONCLUSION: Contrast-enhanced sonography well reflects the pathologic changes of pancreatic cancer and will provide useful information in a pretreatment evaluation. Further studies with a large number of patients will be required to confirm this finding.

Adenocarcinoma↗

PubMed2006

Opacification of the genitourinary collecting system during MDCT urography with enhanced CT digital radiography: nonsaline versus saline bolus.

OBJECTIVE: The purpose of this study was to determine whether a saline bolus during CT urography improves urinary collecting system opacification and whether the addition of enhanced CT digital radiography (CTDR) improves urinary collecting system visualization with or without a saline bolus. MATERIALS AND METHODS: One hundred eight CT urography and enhanced CTDR examinations were reviewed. Fifty-four patients were given a saline bolus during CT urography, and 54 patients underwent CT urography without a saline bolus. Urinary collecting system opacification was evaluated by group (saline vs nonsaline), imaging technique (CT urography alone vs CT urography plus enhanced CTDR), number of enhanced CTDR images, and site of nonopacified urinary segments. Using a multivariate logistic regression model, we determined significance of variables and odds of complete opacification. RESULTS: In the saline group, 248 nonopacified sites were identified on CT urography alone and 95 sites with CT urography plus enhanced CTDR. In the nonsaline group, 185 nonopacified sites were identified on CT urography alone and 59 sites with CT urography plus enhanced CTDR. Combining both groups, 433 nonopacified sites were identified with CT urography alone and 154 sites with CT urography plus enhanced CTDR. Multivariate logistic regression showed significance for group (p = 0.010), imaging method (p < 0.0001), number of enhanced CTDR images (p = 0.048), and site of segment opacification (p < 0.0001). The renal pelvis shows the greatest odds and the distal ureter the lowest odds for complete opacification by group or imaging method. CONCLUSION: The addition of a saline bolus offers no improvement, whereas the addition of enhanced CTDR offers significant improvement in collecting system opacification during CT urography.

Adult↗

PubMed1986

CT of hepatic masses: significance of prolonged and delayed enhancement.

Hepatic masses showing higher density than that of liver after 3 min (prolonged enhancement) and/or having prominent enhancement after the arterial-dominant phase (delayed enhancement) of dynamic CT (bolus enhancement followed by serial scans) were reviewed. Prolonged enhancement was noted in any hepatic masses, but mainly in cavernous hemangioma and capsule of hepatocellular carcinoma, whereas delayed enhancement occurred in capsule of hepatocellular carcinoma and occasionally in metastatic tumor. The volume of arterial and portal blood supply, turnover rate of blood, extent of the interstitial space, and diffusion rate between the vascular and interstitial space, as well as dose and speed of contrast agent administered, seemed to be important factors in such contrast enhancement. Prolonged enhancement and delayed enhancement are nonspecific but still are of some value in the differentiation of hepatic masses on dynamic CT.

Biliary Tract Neoplasms↗

PubMed1989

IV injection of air-filled human albumin microspheres to enhance arterial Doppler signal: a preliminary study in rabbits.

When air-filled human albumin microspheres are injected IV, they have been shown to traverse the pulmonary circulation and markedly influence the echogenicity of the left atrium and ventricle. We studied the possibility that the microspheres can be used to enhance the Doppler signal from systemic arteries and the portal vein. Doppler sonography of the aorta, renal artery, intrarenal branch, and portal vein was performed after the IV injection of saline or microspheres in doses of 1.0, 0.5, 0.3, and 0.1 ml in four rabbits. With appropriate blinding of the observers, subjective estimates of enhancement of the Doppler signal were made in each case. All injections of saline had no detectable effect. All four doses of microspheres enhanced the Doppler signal in the aorta in all rabbits. Signals from the renal artery enhanced in all rabbits after injections of 0.3 ml or greater, but in only two rabbits after 0.1 ml. Although the 1.0-ml dose enhanced the Doppler signal from the intrarenal arterial branch in all rabbits, the 0.5- and 0.3-ml doses enhanced signals in two and the 0.1-ml dose in one. The effect was typical for bolus IV injections. The mean time from injection to onset of enhancement was 5 sec and the effect lasted for 12 sec. Portal venous signals were evaluated in three rabbits. Ten injections were made, four at 1.0 ml and two at each of the lesser doses. Portal vein signals enhanced after all four injections of 1.0 ml of microspheres but after only one of the six injections of lower doses. Our results show that the IV injection of air-filled human albumin microspheres enhances the Doppler signal from systemic arteries and the portal vein and that the microspheres have the potential to serve as a contrast agent for Doppler sonography in humans.

Albumins↗

PubMed1996

Ring enhancement in ultrasmall superparamagnetic iron oxide MR imaging: a potential new sign for characterization of liver lesions.

OBJECTIVE: We performed this study to evaluate the incidence and significance of ring enhancement after i.v. administration of an ultrasmall superparamagnetic iron oxide (USPIO) particle (Code 7227), a reticuloendothelial contrast agent with potential use as a blood-pool agent, for characterizing focal hepatic lesions. SUBJECTS AND METHODS: Conventional T1-weighed imaging, fat-suppressed T1-weighted imaging, conventional T2-weighted imaging, and fast T2-weighted imaging of the liver were obtained in 27 patients with 43 liver lesions before and after i.v. administration of a USPIO preparation. All lesions were larger than 1 cm; 29 were malignant and 14 were benign. Diagnosis was confirmed in all cases, either pathologically (19 patients) or by follow-up examination (eight patients). Two readers independently evaluated each pulse sequence for the presence of ring enhancement of hepatic lesions. RESULTS: Ring enhancement was noted only on T1-weighted images, with no ring enhancement evident on T2-weighted images. Twenty of 43 (47%) lesions showed ring enhancement, including 18 of 29 (62%) malignant lesions and two of 14 (14%) benign lesions (p < .011); Wilcoxon signed rank test). Fat-suppressed T1-weighted imaging showed ring enhancement better than or equal to conventional T1-weighted imaging in all cases, with ring enhancement of 15 of 18 (83%) malignant lesions and two of two benign lesions better demonstrated on fat-suppressed T1-weighted imaging sequences (p < or = .025). CONCLUSION: Ring enhancement after i.v. administration of Code 7227 is a frequent finding seen more often with malignant than benign lesions, potentially identifying a new MR imaging feature for the characterization of liver lesions. The identification of ring enhancement on T1-weighted images attests to the significant blood-pool effects of USPIO particles.

Contrast Media↗

PubMed1997

Normal gadolinium-enhanced MR images of the developing appendicular skeleton: Part I. Cartilaginous epiphysis and physis.

OBJECTIVE: We have used gadolinium-enhanced MR imaging to define the expected normal appearance of the developing cartilaginous epiphyses and physes in neonates, infants, and children and to define the changes with maturity in epiphyseal vascular pattern. MATERIALS AND METHODS: We analyzed gadolinium-enhanced MR images of 80 normal epiphyses in 48 neonates, infants, and children who were 1 month to 15.5 years old. We studied the differences in enhancement ratios for the epiphyses and physes and the epiphyseal vascular pattern at various development stages. We correlated the MR imaging findings with histologic and injection studies of immature epiphyses. RESULTS: Gadolinium enhancement allowed differentiation between physeal and epiphyseal cartilage and revealed epiphyseal vascular canals. Enhancement proved to be greater in the physeal than in the epiphyseal cartilage (p < .001). In the unossified epiphysis, the vascular canals were mainly parallel. After the development of the secondary ossification center, these canals came to have a radial pattern (p < .0001). Comparison with cadaveric specimens confirmed how, with age, the arrangement of these canals changed. Also, physeal enhancement decreased with physeal closure. CONCLUSION: Gadolinium-enhanced MR imaging reveals differential enhancement of the physis, epiphyseal vascular canals, and epiphyseal cartilage. The pattern of epiphyseal vessels and degree of enhancement of the physis change with maturity.

Adolescent↗

PubMed1999

Contrast enhancement of small hepatocellular carcinoma: usefulness of three successive early image acquisitions during multiphase dynamic MR imaging.

OBJECTIVE: The purpose of this study was to document the usefulness of early triphasic image acquisition during gadolinium-enhanced multiphase dynamic MR imaging for the detection of contrast enhancement in small hepatocellular carcinoma. SUBJECTS AND METHODS: Dynamic MR imaging was performed in 332 patients at 1.5 T using a T1-weighted fast low-angle shot sequence (TR range/TE, 113-130/4.1; flip angle, 80 degrees). With the start of bolus injection of gadolinium dimeglumine (0.1 mmol/kg) into the antecubital vein, three sets of contrast-enhanced images of the entire liver were obtained serially at 10, 35, and 60 sec. Contrast enhancement of the tumor detected on each phase was evaluated in conjunction with the unenhanced T1-weighted images for 52 patients with small hepatocellular carcinomas up to 2 cm in diameter (n = 79). RESULTS: The first phase images depicted a larger number (n = 57) of contrast enhancement of small hepatocellular carcinoma tumors than the second (n = 44) or third phase images (n = 14). Twenty-six lesions were enhanced only during the first phase, and nine, during the second phase. The detection rate of contrast enhancement in the combination of first and second phases was the same as the overall detection rate for all three phases (70/79, 89%) and significantly higher than those of each phase. CONCLUSION: Early multiple image acquisition is helpful for the assessment of small hepatocellular carcinoma and is enabled by the high detection rate of contrast enhancement regardless of individual variations in the timing of enhancement.

Carcinoma, Hepatocellular↗

PubMed2001

Nonresectable hepatocellular carcinoma: improved percutaneous ethanol injection therapy guided by CO(2)-enhanced sonography.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of percutaneous ethanol installation using CO(2)-enhanced sonography for patients with nonresectable hepatocellular carcinoma (HCC). SUBJECTS AND METHODS: Forty-six patients with 65 HCC lesions were examined with contrast-enhanced sonography with direct injection of CO(2) into the proper hepatic artery during arteriography. We performed percutaneous ethanol injection guided by CO(2)-enhanced sonography for the treatment of hypervascular HCC lesions that could not be treated with conventional percutaneous ethanol injection or with transcatheter arterial embolization. RESULTS: CO(2)-enhanced sonography detected five additional small HCC lesions before treatment (p<0.05) and 14 new lesions during follow-up (p<0.01), than conventional sonography detected. CO(2)-enhanced sonography showed positive enhancement of residual lesions after initial treatment (n = 3) and incomplete local treatment (n = 5) that were not detected on conventional sonography. These 27 lesions were successfully treated with percutaneous ethanol injection using a mixture of iodized oil and ethanol and guided by CO(2)-enhanced sonography. CONCLUSION: CO(2)-enhanced sonography is a sensitive method for detecting residual viable lesions and small new HCC lesions that cannot be detected with conventional sonography. Percutaneous ethanol injection guided by CO(2)-enhanced sonography can treat hypervascular HCC lesions that cannot be treated with conventional percutaneous ethanol injection or transcatheter arterial embolization.

Adult↗

PubMed2002

Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma.

OBJECTIVE: Contrast-enhanced CT colonography has the potential to detect local recurrence, metachronous disease, and distant metastases in patients with a history of invasive colorectal cancer. The purpose of our study was to determine whether colonic anastomoses prohibit adequate colonic distention on contrast-enhanced CT colonography and to estimate the performance of contrast-enhanced CT colonography in detecting recurrent colorectal carcinoma. MATERIALS AND METHODS: Fifty patients with a history of resected invasive colorectal carcinoma underwent contrast-enhanced CT colonography and colonoscopy. Colonic distention was graded for different colonic segments. Two radiologists evaluated for the presence of local recurrence, metachronous disease, and metastatic disease. Results were compared with colonoscopy, histology, and clinical follow-up. RESULTS: Most patients had adequate colonic inflation (37/50, 74%). Eleven of 13 patients with inadequate distention had collapse in the sigmoid colon, usually associated with ileocolic anastomoses. Contrast-enhanced CT colonography detected local recurrences with an accuracy of 94% (95% confidence interval, 83-99%). The accuracy of contrast-enhanced CT colonography for metachronous lesions greater than or equal to 1 cm was 92% (95% confidence interval, 80-98%), but there was only one such lesion, which was missed on initial colonoscopy. Stool, granulation tissue, and inflammation can mimic the CT appearance of local recurrence or metachronous disease and account for false-positive examinations. Contrast-enhanced CT colonography identified five patients with metastatic disease. CONCLUSION: Suboptimal sigmoid distention can be seen on contrast-enhanced CT colonography, predominantly in patients with right hemicolectomies. Contrast-enhanced CT colonography is a promising method for detecting local recurrence, metachronous disease, and distant metastases in patients with prior invasive colorectal carcinoma. The technique can also serve as a useful adjunct to colonoscopy by detecting local recurrences or metachronous disease that are endoscopically obscure or by serving as a full structural colonic examination when endoscopy is incomplete.

Adult↗

PubMed2003

Radiofrequency ablation of hepatocellular carcinoma: therapeutic response using contrast-enhanced coded phase-inversion harmonic sonography.

OBJECTIVE: This study was performed to evaluate the usefulness of contrast-enhanced coded phase-inversion harmonic sonography in assessing the therapeutic response of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma. SUBJECTS AND METHODS: Sixty-seven patients with a total of 107 examinations on 91 hepatocellular carcinoma nodules underwent coded harmonic angio, a technique of coded phase-inversion harmonic sonography, using the IV microbubble contrast agent Levovist before and after percutaneous radiofrequency ablation. The intratumoral blood vessels and tumor parenchymal stain were detected in the early arterial phase and the late vascular phase, respectively. The results of contrast-enhanced imaging with coded harmonic angio were compared with those of three-phase dynamic CT. RESULTS: Before treatment, all examined 107 hepatocellular carcinoma nodules were found to be hypervascular on contrast-enhanced imaging with coded harmonic angio. After radiofrequency ablation, contrast-enhanced coded harmonic angio detected persistent signal enhancement in 41 examined nodules (38.3%), whereas this technique showed no intratumoral enhancement in the remaining 66 (61.7%) examined nodules. Compared with dynamic CT, the sensitivity, specificity, and diagnostic accuracy of contrast-enhanced coded harmonic angio were 95.3%, 100%, and 98.1%, respectively. With contrast-enhanced coded harmonic angio, we found that it was difficult to identify the safety margin that can be detected on dynamic CT. CONCLUSION: Contrast-enhanced imaging with coded harmonic angio may provide an alternative approach that has high diagnostic agreement with dynamic CT in assessing the therapeutic effect of radiofrequency ablation in hypervascular hepatocellular carcinomas, in spite of having limitations in identifying the safety margin.

Aged↗