Long-term Outcomes of Antiviral Therapy in Patients With Advanced Chronic HBV Infection.

Hepatitis B virus (HBV) suppression with nucleot(s)ide analogue therapy reduces the risk of hepatic decompensation and hepatocellular carcinoma (HCC) in patients with advanced liver disease.1 In the present era of potent antiviral therapies, the prognostic significance of the serum HBV DNA level as a biological gradient has substantially diminished; the majority of treated patients achieve virologic suppression.2,3 After control of viremia, a higher baseline fibrosis level is a useful predictor for disease progression.4 Few "prospective" studies on the effects of antiviral agents, especially in chronic hepatitis B (CHB) patients with advanced liver disease, have been reported.

Improvement of Liver Fibrosis after Long-Term Antiviral Therapy Assessed by Fibroscan in Chronic Hepatitis B Patients With Advanced Fibrosis.

OBJECTIVES: Performing repeated liver biopsies to assess the improvement of liver fibrosis is impractical. The purpose of this prospective cohort study was to assess the improvement of liver fibrosis during antiviral treatment by serial liver stiffness (LS) measurement using Fibroscan in chronic hepatitis B (CHB) patients with advanced fibrosis. METHODS: Nucleos(t)ide analog-naive CHB patients with advanced fibrosis in histological findings (stage ≥F3), high viral load (hepatitis B virus DNA ≥2,000 IU/ml), and normal liver enzyme levels (<2 × upper normal limit) before starting antiviral treatment were included in this study. LS measurement was performed at baseline and annually for 5 years during antiviral treatment. Five-year fibrosis improvement was defined as LS value <7.2 kPa (

MRI-detected extramural vascular invasion is an independent prognostic factor for synchronous metastasis in patients with rectal cancer.

OBJECTIVES: To determine whether magnetic resonance imaging (MRI)-detected extramural vascular invasion (EMVI) could predict synchronous distant metastases in rectal cancer. METHODS: Patients who underwent rectal MRI between July 2011 and December 2012 were screened. This study included 447 patients with pathologically confirmed rectal adenocarcinoma who had undergone MRI without previous treatment. Distant metastases were recorded at the initial work-up and over a 6-month follow-up. Univariate/multivariate logistic regression models were used to determine the risk of metastasis. The diagnostic performance was calculated using pathologic lymphovascular invasion (LVI) as a gold standard. RESULTS: Among 447 patients, 79 patients (17.7 %) were confirmed to have distant metastases. Three MRI features are significantly associated with a high risk of distant metastasis: positive EMVI (odds ratio 3.02), high T stage (odds ratio 2.10) and positive regional lymph node metastasis (odds ratio 6.01). EMVI in a large vessel (≥3 mm) had a higher risk for metastasis than EMVI in a small vessel (<3 mm). Sensitivity, specificity and accuracy of MRI-detected EMVI were 28.2 %, 94.0 % and 80.3 %, respectively. CONCLUSIONS: MRI-detected EMVI is an independent risk factor for synchronous metastasis in rectal cancer. EMVI in large vessels is a stronger risk factor for distant metastasis than EMVI in small vessels. KEY POINTS: • EMVI, LN metastasis and T staging on MRI are risk factors for metastasis. • EMVI in large vessels has greater risk for metastasis than in small vessels. • Regional LN metastasis on MRI has highest risk for predicting metastasis. • MR findings could be helpful for selecting patients at high risk for metastasis.

Perfusion MRI for the prediction of treatment response after preoperative chemoradiotherapy in locally advanced rectal cancer.

OBJECTIVES: To evaluate the utility of perfusion MRI as a potential biomarker for predicting response to chemoradiotherapy (CRT) in locally advanced rectal cancer. METHODS: Thirty-nine patients with primary rectal carcinoma who were scheduled for preoperative CRT were prospectively recruited. Perfusion MRI was performed with a 3.0-T MRI system in all patients before therapy, at the end of the 2nd week of therapy, and before surgery. The K (trans) (volume transfer constant) and V (e) (extracellular extravascular space fraction) were calculated. RESULTS: Before CRT, the mean tumour K (trans) in the downstaged group was significantly higher than that in the non-downstaged group (P = 0.0178), but there was no significant difference between tumour regression grade (TRG) responders and TRG non-responders (P = 0.1392). Repeated-measures analysis of variance (ANOVA) showed significant differences for evolution of K (trans) values both between downstaged and non-downstaged groups (P = 0.0215) and between TRG responders and TRG non-responders (P = 0.0001). Regarding V (e), no significant differences were observed both between downstaged and non-downstaged groups (P = 0.689) or between TRG responders and TRG non-responders (P = 0.887). CONCLUSION: Perfusion MRI of rectal cancer can be useful for assessing tumoural K (trans) changes by CRT. Tumours with high pre-CRT K (trans) values tended to respond favourably to CRT, particularly in terms of downstaging criteria. KEY POINTS: • Perfusion MRI can now assess therapeutic response of tumours to therapy. • Tumours with high initial K ( trans ) values responded favourably to chemoradiotherapy. • Perfusion MRI of rectal cancer may help with decisions about management.

Coexistence of Moderate-to-Severe Obstructive Sleep Apnea and Inflammation Accelerates the Risk of Progression of Arterial Stiffness: A Prospective 6-Year Study.

Both obstructive sleep apnea (OSA) and inflammation have now been recognized as imposing substantial cardiometabolic risk. However, no prospective study has reported whether the coexistence of OSA and inflammation exacerbates the progressive arterial stiffening. Thus, the purpose of this study is to examine whether these conditions increase the risk of the progression of arterial stiffening. A total of 1945 participants were randomly selected for the study. Subjects with elevated inflammation were divided by high-sensitivity C-reactive protein (hsCRP) levels. A polysomnography and brachial-ankle pulse wave velocity (baPWV) were performed. The elevation of the baPWV was defined as the levels in the highest quartile of the baPWV. The percentage of the elevated baPWV and the change in the baPWV (ΔbaPWV) were higher in individuals with OSA and higher hsCRP levels. After adjusting for confounders, the participants with OSA and inflammation in the groups not treated with antihypertensive medication had a higher risk of an elevated ΔbaPWV in contrast to those with neither variable. Particularly, the alteration in the baPWV differed significantly based on the existence of moderate-to-severe OSA and inflammation at the 6-year follow-up. In combination, these conditions are associated with an accelerated risk of a future burden of the progression of the arterial stiffness, suggesting a potential important role in the increased risk of CVD.

Nypa fruticans Wurmb inhibits melanogenesis in isobutylmethylxanthine­treated melanoma via the PI3K/AKT/mTOR/CREB and MAPK signaling pathways.

Malignant melanoma is responsible for 3.0 and 1.7% of cases of tumor incidence and tumor-associated mortality, respectively, in the Caucasian population. Melanoma is a type of skin cancer that occurs when melanocytes mutate and divide uncontrollably. Nypa fruticans Wurmb (NF) is abundant in phytochemicals (polyphenols and flavonoids) and is traditionally used to treat diseases of the respiratory tract. The present study investigated the inhibitory effect of the ethyl acetate fraction of NF (ENF) on melanogenesis-related factors in isobutylmethylxanthine-treated B16F10 melanoma cells. Phenolics and flavonoids (caffeic acid, catechin, epicatechin and hirsutine) in ENF were analyzed via liquid chromatography-mass spectrometry. In addition, the main factors involved in melanogenesis were identified using immunoblotting, reverse transcription-polymerase chain reaction (RT-PCR), RT-quantitative PCR and immunofluorescence. ENF significantly suppressed the expression of tyrosinase (TYR) and TYR-related proteins 1 and 2 (TYRP-1/2), which are the main factors involved in melanogenesis. ENF also inhibited the expression of microphthalmia-associated transcription factor (MITF) by phosphorylating the related cell signaling proteins (protein kinase B, mammalian target of rapamycin, phosphoinositide 3-kinase and cAMP response element-binding protein). Furthermore, ENF inhibited the phosphorylation of extracellular signal-regulated kinase and thereby downregulated melanogenesis. In conclusion, ENF inhibited melanogenesis by suppressing MITF, which controls TYRP-1/2 and TYR. These results suggested that ENF may be a natural resource that can inhibit excessive melanin expression by regulating various melanogenesis pathways.

Comparison of diffusion-weighted MRI and MR volumetry in the evaluation of early treatment outcomes after preoperative chemoradiotherapy for locally advanced rectal cancer.

PURPOSE: To compare diffusion-weighted imaging (DWI) and magnetic resonance (MR) volumetry for predicting treatment outcomes of locally advanced rectal cancers with preoperative chemoradiotherapy (CRT). MATERIALS AND METHODS: This prospective study was approved by our Institutional Review Board. Thirty-four patients underwent three MR examinations: pre-CRT (before CRT), early CRT (2 weeks after CRT initiation), and post-CRT (before surgery). The tumor apparent diffusion coefficient (ADC), ADC increase rate, and volume reduction rate were compared between responders and nonresponders using three reference standards: downstaging, modified Response Evaluation Criteria in Solid Tumors (mRECIST), and tumor regression grade (TRG). For DWI and volumetry, differences between responders and nonresponders were assessed by receiver operating characteristic analysis. RESULTS: The median early tumor volume reduction rate of responders, subgrouped by downstaging and mRECIST (47.97% and 53.97%, respectively), was significantly higher than that of nonresponders (20.94% and 20.36%; P = 0.0024 and 0.0001, respectively), but there were no significant differences in pre-CRT ADC and early ADC increase rate using all references. When using the downstaging and mRECIST, the diagnostic performance of early tumor volume reduction rate (Az = 0.81 and 0.94, respectively) was higher than that of pre-CRT ADC (Az = 0.55 and 0.62; P = 0.033 and 0.007) and early ADC increase rate (Az = 0.58 and 0.64; P = 0.055 and 0.01) for predicting the treatment outcome. For TRG, there were no significant differences between DWI and volumetry. CONCLUSION: Early tumor volume reduction rate at the second week after CRT initiation may be a better indicator than DWI based on the mean ADC measurements for predicting CRT treatment outcome.

Influence of the insertion time and number of polyps on miss rate in colonoscopy.

OBJECTIVE: Colorectal polyps can be missed even during a meticulous colonoscopy by an experienced colonoscopist. The aim of this study was to investigate patient-, procedure-, and polyp-related factors affecting the miss rate of polyps on colonoscopy. MATERIAL AND METHODS: From March 2001 to February 2006, a total of 285 patients undergoing screening colonoscopy followed within 2 months by colonoscopy for polypectomy were enrolled. The main outcome measurements were factors associated with miss rates of polyp and the conditions for reducing missed polyps on colonoscopy. RESULTS: From the 285 colonoscopy pairs, a total of 1326 polyps were found. Overall, 350 of the 1326 polyps were missed (26.4%). Among those, 59 polyps (4.4%) were only seen on the first colonoscopy and 291 polyps (21.9%) were found only at the second colonoscopy. Patient-related factors were male sex (Odds Ratio (OR) 2.11, 95% Confidence Interval (CI) 1.21-3.70) and older age (OR 2.51, 95% CI 1.48-4.30). Procedure-related factors were colonoscopy by clinical fellows (OR 2.20, 95% CI 1.02-4.84) and delayed insertion time (OR 4.10, 95% CI 2.14-7.86). Polyp-related factors were more than four numbers of polyps (OR 4.48, 95% CI 1.91-10.5). However, a large polyp was less frequently missed on colonoscopy (OR 0.10, 95% CI 0.05-0.19). CONCLUSIONS: In usual clinical practice, colon polyps were frequently missed on colonoscopy. Comprehensive analysis of patient should be required to reduce the miss rates.

MR cholangiography for evaluation of hilar branching anatomy in transplantation of the right hepatic lobe from a living donor.

OBJECTIVE: Our objective was to determine the utility of 3D T2 MR cholangiography (MRC) for biliary visualization and predicting the number of ductal orifices during right lobe harvesting for ductal anastomosis in liver donors for right lobe transplantation. MATERIALS AND METHODS: This study was composed of 33 donors who underwent right lobectomy for transplantation. Preoperative MRC techniques included 2D T2 MRC, 3D T2 MRC, and 3D contrast-enhanced T1 MRC. Qualitative analyses were performed for ductal visualization in each technique. The accuracies for predicting the numbers of orifices during right lobe harvesting were evaluated for 2D T2 MRC alone and for various other combined sets. MRI definitions of the predicted number of ductal orifices were compared with surgical findings. RESULTS: Mean visualization scores of all ducts for 3D T2 MRC were significantly higher than for 2D T2 MRC and 3D contrast-enhanced T1 MRC. In predicting the number of orifices, all combined sets showed significantly higher accuracy than 2D T2 MRC. No significant difference in mean accuracies was observed within the comparison of the combined sets. CONCLUSION: Three-dimensional T2 MRC provided superior biliary visualization than 2D T2 MRC and 3D contrast-enhanced T1 MRC. For predicting the number of orifices, the combined set of 2D and 3D T2 MRC enabled better accuracy than 2D T2 MRC alone and produced comparable results to other combined sets.

Comorbidity Study of Attention-deficit Hyperactivity Disorder (ADHD) in Children: Applying Association Rule Mining (ARM) to Korean National Health Insurance Data.

BACKGROUND: The aim of this study was to explore the comorbidity of Attention-Deficit Hyperactivity Disorder (ADHD) for the Korean national health insurance data (NHID) by using association rule mining (ARM). METHODS: We used data categorized mental disorder according to the international classification of disease, 10th revision (ICD-10) diagnosis system from NHID from 2011 to 2013 in youths aged 18 yr or younger. Overall, 211420 subjects, comorbid cases with ADHD were present in 105784. ARM was applied to the Apriori algorithm to examine the strengths of associations among those diagnosed, and logistic regression was used to evaluate the relations among rules. RESULTS: The most prevalent comorbid psychiatric disorder of ADHD youths was mood/affective disorders. From results of ARM, nine association rules (support≥1%, confidnce≥50%) were produced. The highest association was found between specific developmental disorders of scholastic skills and ADHD. Among association of three comorbid diseases, tic disorder was an important role in the association between ADHD and other comorbid diseases through results of ARM and logistic regression. CONCLUSION: The practical application of ARM for discovering the comorbidity of ADHD in large amount real-data such as the Korean NHID was mostly confirmed by past studies. The results of this study will be helpful to researchers evaluating the stability of their diagnosis in ADHD.

The level of 2-h post-challenge glucose is an independent risk factor of carotid intima-media thickness progression in Korean type 2 diabetic patients.

OBJECTIVE: To evaluate the relationship between the metabolic abnormalities commonly associated with diabetes and the changes in carotid intima-media thickness (IMT) in Korean type 2 diabetic patients who do not have clinically manifest cardiovascular disease (CVD). DESIGN: In a prospective study, a total of 152 type 2 diabetic patients were recruited from a group of outpatients at the Yonsei University Hospital. MATERIALS AND METHODS: The carotid IMTs of 152 subjects with type 2 diabetes (mean age 63.5+/-7.0 years) were determined at baseline and after a mean follow-up time of 23.7+/-3.7 months. Fasting plasma glucose, serum total cholesterol (TC), serum triglyceride, high-density lipoprotein cholesterol (HDL-C), HbA1c, oral glucose tolerance test (OGTT) results for 2-h post-challenge glucose (2hPG), and blood pressure measurements were collected every 3 months and averaged. RESULTS: The highest quartiles of baseline C-peptide and homeostatic model assessment (HOMA) index showed more IMT progression than the lowest quartiles. The change in the mean IMT correlated with average values of HbA1c (r=.219, P=.007), the 2-h post-challenge glucose (r=.239, P=.003), HDL-C (r=-.228, P=.005), LDL-C (r=.175, P=.033), and non-HDL-C (r=.194, P=.016). Multiple regression analysis demonstrated that the independent risk factor for the mean IMT change in diabetic patients was the average 2hPG level (P=.004). The change in the mean IMT of those in the lowest quartile of average 2hPG (<11.1 mmol/l) was 823+/-176 to 841+/-146 microm (P=.276). In the highest quartile (2hPG >15.3 mmol/l), however, the mean IMT increased from 794+/-127 to 882+/-153 microm (P<.001). CONCLUSION: The 2hPG parameter among the various metabolic parameters exerts the greatest influence upon the prevention of carotid IMT progression in type 2 diabetic subjects. The level of 2hPG is an independent risk factor for the progression of carotid IMT in Korean type 2 diabetic patients.

MRI Risk Stratification for Tumor Relapse in Rectal Cancer Achieving Pathological Complete Remission after Neoadjuvant Chemoradiation Therapy and Curative Resection.

PURPOSE: Rectal cancer patients achieving pCR are known to have an excellent prognosis, yet no widely accepted consensus on risk stratification and post-operative management (e.g., adjuvant therapy) has been established. This study aimed to identify magnetic resonance imaging (MRI) high-risk factors for tumor relapse in pathological complete remission (pCR) achieved by rectal cancer patients who have undergone neoadjuvant concurrent chemoradiation therapy (CRT) and curative resection. MATERIALS AND METHODS: We analyzed 88 (male/female = 55/33, median age, 59.5 years [range 34-78]) pCR-proven rectal cancer patients who had undergone pre-CRT MRI, CRT, post-CRT MRI and curative surgery between July 2005 and December 2012. Patients were observed for post-operative tumor relapse. We analyzed the pre/post-CRT MRIs for parameters including mrT stage, mesorectal fascia (mrMRF) status, tumor volume, tumor regression grade (mrTRG), nodal status (mrN), and extramural vessel invasion (mrEMVI). We performed univariate analysis and Kaplan-Meier survival analysis. RESULTS: Post-operative tumor relapse occurred in seven patients (8.0%, n = 7/88) between 5.7 and 50.7 (median 16.8) months. No significant relevance was observed between tumor volume, volume reduction rate, mrTRG, mrT, or mrN status. Meanwhile, positive mrMRF (Ppre-CRT = 0.018, Ppre/post-CRT = 0.006) and mrEMVI (Ppre-CRT = 0.026, Ppre-/post-CRT = 0.008) were associated with higher incidence of post-operative tumor relapse. Kaplan-Meier survival analysis revealed a higher risk of tumor relapse in patients with positive mrMRF (Ppre-CRT = 0.029, Ppre-/post-CRT = 0.009) or mrEMVI (Ppre-CRT = 0.024, Ppre-/post-CRT = 0.003). CONCLUSION: Positive mrMRF and mrEMVI status was associated with a higher risk of post-operative tumor relapse of pCR achieved by rectal cancer patients, and therefore, can be applied for risk stratification and to individualize treatment plans.

Modified mixture of experts for the diagnosis of perfusion magnetic resonance imaging measures in locally rectal cancer patients.

OBJECTIVES: This study demonstrates the feasibility of using a modified mixture of experts (ME) model with repeated measured tumoural K(trans) value to perform an automatic diagnosis of responder based on perfusion magnetic resonance imaging (MRI) of rectal cancer. METHODS: The data used in this study was obtained from 39 patients with primary rectal carcinoma who were scheduled for preoperative chemoradiotherapy. The modified ME model is a joint modeling of the ME model via the linear mixed effect model. First, we considered two local experts and a gating network, and the modified expert network as a liner mixed effect model. Afterward, the finding estimates were obtained via the expectation-maximization algorithm. All computation was performed by R-2.15.2. RESULTS: We found that two experts have different patterns. The feature of expert 1 (n = 10) had a higher baseline value and a lower slope than expert 2 (n = 29). A comparison of the estimated experts and responder/non-responder groups according to T-downstaging criteria showed that expert 1 had a more effect treatment responder than expert 2. CONCLUSIONS: A novel feature of this study is that it is an extension of classical ME models in case of repeatedly measured data. The proposed model has the advantages of flexibility and adaptability for identifying distinct subgroups with various time patterns, and it can be applied to biomedical data which is measured repeatedly, such as time-course microarray data or cohort data. This method can assist physicians as important diagnostic decision making mechanism.

Perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging in patients with rectal cancer: correlation with microvascular density and vascular endothelial growth factor expression.

OBJECTIVE: To determine whether quantitative perfusion parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) correlate with immunohistochemical markers of angiogenesis in rectal cancer. MATERIALS AND METHODS: Preoperative DCE-MRI was performed in 63 patients with rectal adenocarcinoma. Transendothelial volume transfer (K(trans) ) and fractional volume of the extravascular-extracellular space (Ve) were measured by Interactive Data Language software in rectal cancer. After surgery, microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression scores were determined using immunohistochemical staining of rectal cancer specimens. Perfusion parameters (K(trans) , Ve) of DCE-MRI in rectal cancer were found to be correlated with MVD and VEGF expression scores by Spearman's rank coefficient analysis. T stage and N stage (negative or positive) were correlated with perfusion parameters and MVD. RESULTS: Significant correlation was not found between any DCE-MRI perfusion parameters and MVD (rs = -0.056 and p = 0.662 for K(trans) ; rs = -0.103 and p = 0.416 for Ve), or between any DCE-MRI perfusion parameters and the VEGF expression score (rs = -0.042, p = 0.741 for K(trans) ; r = 0.086, p = 0.497 for Ve) in rectal cancer. TN stage showed no significant correlation with perfusion parameters or MVD (p > 0.05 for all). CONCLUSION: DCE-MRI perfusion parameters, K(trans) and Ve, correlated poorly with MVD and VEGF expression scores in rectal cancer, suggesting that these parameters do not simply denote static histological vascular properties.

A mixture of experts model for the diagnosis of liver cirrhosis by measuring the liver stiffness.

OBJECTIVES: The mixture-of-experts (ME) network uses a modular type of neural network architecture optimized for supervised learning. This model has been applied to a variety of areas related to pattern classification and regression. In this research, we applied a ME model to classify hidden subgroups and test its significance by measuring the stiffness of the liver as associated with the development of liver cirrhosis. METHODS: The data used in this study was based on transient elastography (Fibroscan) by Kim et al. We enrolled 228 HBsAg-positive patients whose liver stiffness was measured by the Fibroscan system during six months. Statistical analysis was performed by R-2.13.0. RESULTS: A classical logistic regression model together with an expert model was used to describe and classify hidden subgroups. The performance of the proposed model was evaluated in terms of the classification accuracy, and the results confirmed that the proposed ME model has some potential in detecting liver cirrhosis. CONCLUSIONS: This method can be used as an important diagnostic decision support mechanism to assist physicians in the diagnosis of liver cirrhosis in patients.

Feasibility of interstitial CT lymphography using optimized iodized oil emulsion in rats.

OBJECTIVES: To formulate an iodine-based contrast agent with an oil-in-water emulsion and to evaluate the feasibility of the agent for use as an interstitial computed tomographic (CT) lymphographic agent in a normal rat model. MATERIALS AND METHODS: The effect of iodized oil (lipiodol) content and the type of surfactant/cosurfactant on the resultant emulsion size and polydispersity was investigated to obtain an optimized lipiodol emulsion for CT lymphography. Optimized emulsions (144 mg/mL) were injected in the hind paws of 6 rats, using 0.5 mL per paw. As control groups, iopamidol solution and lipiodol diluted with squalene to adjust the injection volume with iodine concentration equivalent to the emulsions were used. Precontrast and postcontrast CT images up to 1 week after contrast agent injection were obtained. Time-enhancement curves of the popliteal lymph nodes were obtained. Analysis of variance and post hoc analysis with the Dunn procedure were used for comparing mean peak enhancement, time to peak enhancement, and sustained duration of contrast enhancement. RESULTS: Optimized emulsion formulations composed of 30% lipiodol and 282 mg/mL of 9:1 surfactant mixture (Tween 80:TPGS [alpha-tocopheryl polyethylene glycol succinate], Tween 80:Kollidon 12 PF, or Tween 80:Span 85) exhibited mean particle size less than 120 nm, and they were stable without significant particle size change up to 1 month. Targeted lymph nodes in all emulsion groups showed continuously increasing enhancement until 4 or 8 hours after injection, followed by continuous washout. Peak enhancement (time to peak enhancement) was 172.4 +/- 54.5 HU (Hounsfield unit) (384.0 +/- 131.5 minutes) for Tween 80:TPGS; 172.8 +/- 28.0 HU (432.0 +/- 107.3 minutes) for Tween 80:Kollidon 12 PF, and 177.2 +/- 68.9 HU (294.0 +/- 190.2 minutes) for Tween 80:Span 85. For iopamidol, peak enhancement of 153.0 +/- 46.1 HU (0.5 +/- 0.5 minutes) occurred early with rapid washout. For lipiodol as a reference agent, contrast enhancement continuously increased even 1 week after injection without washout (peak enhancement, 486.0 +/- 97.4 HU). Peak enhancement among the emulsion groups and the iopamidol group was not statistically different (P = 0.95). All emulsion groups showed more prolonged enhancement than the iopamidol group; enhancement duration for the emulsion groups was 534.0 +/- 481.1 minutes for Tween 80:TPGS; 957.0 +/- 524.8 minutes for Tween 80:Kollidon 12 PF; and 750.0 +/- 566.0 minutes for Tween 80:Span 85, and enhancement duration for iopamidol was 8.2 +/- 12.3 minutes (all P < 0.05 in multiple comparisons). However, there was no significant difference in enhancement duration among the 3 emulsion groups (P > 0.05). CONCLUSIONS: Iodized oil emulsion made with a surfactant mixture (Tween 80 as the main surfactant and TPGS, Kollidon 12 PF, or Span 85 as the cosurfactant) provided sufficient and sustained contrast enhancement on CT of targeted lymph nodes with washout on delayed phase.