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Paprottka KJ, Todica A, Ilhan H, Rübenthaler J, Schoeppe F, Michl M, Heinemann V, Bartenstein P, Reiser MF, Paprottka PM. Evaluation of Visualization Using a 50/50 (Contrast Media/Glucose 5% Solution) Technique for Radioembolization as an Alternative to a Standard Sandwich Technique. Cardiovasc Intervent Radiol 2017; 40:1740-1747. [PMID: 28584948 DOI: 10.1007/s00270-017-1712-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 05/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Radioembolization (RE) with 90yttrium (90Y) resin microspheres generally employs a sandwich technique with separate sequential administration of contrast medium (CM), followed by vehicle (e.g., glucose 5% [G5] solution), then 90Y resin microspheres (in G5), then G5, and then CM again to avoid contact of CM and microspheres under fluoroscopic guidance. This study evaluates the visualization quality and safety of a modified sandwich technique with a 50/50-mixture of CM (Imeron 300) and G5 for administration of 90Y resin microspheres. MATERIALS AND METHODS A retrospective analysis of 81 RE procedures in patients with primary or secondary liver tumors was performed. The quality of angiographic visualization of the hepatic vessels was assessed before the first injection and immediately before the whole dose has been injected. Visualization and flow rate were graded on a 5-point scale: 1 = very good to 5 = not visible/no antegrade flow. Univariate logistic regression models and multiple linear regression models were used to evaluate the prognostic variables associated with visualization and flow scores. RESULTS Visualization quality was inversely related to flow rate, the lower the flow rate the better the grade of the visualization. Visualization quality was also inversely related to body-mass-index (BMI). Performing RE with the 50/50-CM/G5 mixture resulted in a mean injection time for 1 GBq of 15 min. No clinically significant adverse events, including radiation-induced liver disease were reported. CONCLUSION RE with a 50/50-mixture of CM and G5 for administration of 90Y resin microspheres in a modified sandwich technique is a safe administration alternative and provides good visualization of hepatic vessels, which is inversely dependent on flow rate and BMI. Injection time was reduced compared with our experience with the standard sandwich technique.
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Affiliation(s)
- Karolin J Paprottka
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany.
| | - Andrei Todica
- Department of Nuclear Medicine, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Johannes Rübenthaler
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Franziska Schoeppe
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Marlies Michl
- Department of Oncology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Volker Heinemann
- Department of Oncology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Maximilian F Reiser
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Philipp M Paprottka
- Department of Clinical Radiology, LMU - University of Munich, Marchioninistrasse. 15, 81377, Munich, Germany
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