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Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, Ahmar MA, Lefevre-Colau MM, Nguyen C, Daste C, Lacroix M, Laredo JD, Sabatier B, Martelli N, Chatellier G, Déan C, Rannou F. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial. Diagn Interv Imaging 2024; 105:144-150. [PMID: 38102013 DOI: 10.1016/j.diii.2023.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of transient genicular artery embolization (GAE) using an ethiodized oil-based emulsion for the treatment of knee osteoarthritis (KOA). MATERIALS AND METHODS This prospective, single-arm, open-label, multicenter, first-in-human cohort trial was registered on ClinicalTrials.gov (NCT04733092). The main inclusion criterion was diagnosis of KOA according to a visual analogue scale (VAS) pain score ≥ 40 mm (score range: 0-100 mm), despite conservative treatment for at least three months. Treatment efficacy was assessed using changes in VAS pain score, Mean Western Ontario & McMaster Universities osteoarthritis (WOMAC) function score (normalized to 100; score ranging from 0 to100) and outcome measures in rheumatoid arthritis clinical trials (OMERACT)-Osteoarthritis Research Society (OARSI) set of responder criteria. RESULTS Twenty-two consecutive participants (13 women; mean age, 66 ± 9 [standard deviation (SD)]) were included and underwent GAE. Emulsion consisted in a mixture of ioversol and ethiodized oil (ratio 1:3, respectively) prepared extemporaneously. The rate of serious adverse events attributed to GAE within one month was 5% (1/22), corresponding to reversible worsening of renal function. Immediate technical success rate was 100%. Mean VAS pain score dropped from 74.4 ± 16.5 (SD) mm at baseline to 37.2 ± 26.7 (SD) mm at three months (P < 0.001). Mean WOMAC function score (normalized to 100: score ranging from 0 to 100) decreased from 57.3 ± 17.1 (SD) at baseline to 33.5 ± 25.9 (SD) at three months (P < 0.001). At three months, 16 out of 22 participants (73%) were considered responders according to the OMERACT-OARSI set of responder criteria, including high improvement in either pain or WOMAC function, or improvement in both pain and WOMAC function. CONCLUSION GAE using an ethiodized oil-based emulsion is safe and improves pain and function in participants with KOA for at least three months.
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Affiliation(s)
- Marc Sapoval
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; Université Paris Cité, PARCC - INSERM Unité-970, 75015 Paris, France.
| | - Charles Querub
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Helena Pereira
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Clinical Research Unit, 75015 Paris, France
| | - Olivier Pellerin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; Université Paris Cité, PARCC - INSERM Unité-970, 75015 Paris, France
| | - Tom Boeken
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; HeKA team, INRIA, 75012 Paris, France
| | - Alessandro Di Gaeta
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Marc Al Ahmar
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Marie-Martine Lefevre-Colau
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université de Paris Cité, INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Christelle Nguyen
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Camille Daste
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université de Paris Cité, INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Maxime Lacroix
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'imagerie, 75015 Paris, France
| | - Jean-Denis Laredo
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Chirurgie Orthopédique Et Traumatologique, 75010 Paris, France
| | - Brigitte Sabatier
- HeKA team, INRIA, 75012 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Pharmacie, 75015 Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Pharmacie Clinique, 91400 Orsay, France
| | - Nicolas Martelli
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Pharmacie, 75015 Paris, France; Université Paris-Saclay, Faculté de Pharmacie, GRADES, 91400 Orsay, France
| | - Gilles Chatellier
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Clinical Research Unit, 75015 Paris, France
| | - Carole Déan
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - François Rannou
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
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Langenbach MC, Vogl TJ, Said G, Scholtz JE, Hammerstingl R, Gruber-Rouh T. Lipiodol as a Predictive Indicator for Therapy Response to Transarterial Chemoembolization of Hepatocellular Carcinoma. Cancer Biother Radiopharm 2024; 39:196-202. [PMID: 33481646 DOI: 10.1089/cbr.2020.4137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The predictive value of Lipiodol was evaluated for response evaluation of hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE) by analysis of the enhancement pattern during angiography and in postinterventional computed tomography (CT). Materials and Methods: This retrospective study included 30 patients (mean age 63 years, range: 36 to 82 years, 22 males) with HCC. Patients received three Lipiodol-based cTACE sessions, each followed by an unenhanced CT within 24-h. Contrast-enhanced magnetic resonance imaging (MRI) was acquired before and after the treatment to determine tumor response. Lipiodol enhancement pattern, tumor vascularization, and density were evaluated by angiography and CT. Initial tumor size and response to cTACE were analyzed by MRI according to modified response evaluation criteria in solid tumors (mRECIST) in a 4-week follow-up. Results: Analysis of HCC lesions (68 lesions in 30 patients) during cTACE revealed clear visibility and hypervascularization in angiography as a potential independent parameter able to predict tumor response. A significant correlation was found for response measurements by volume (p = 0.012), diameter (p = 0.006), and according to mRECIST (p = 0.039). The amount of Lipiodol and enhancement pattern in postinterventional CT did not correlate with therapy response. Measurements of Hounsfield unit values after cTACE do not allow sufficient prediction of the tumor response. Conclusion: Hypervascularized HCC lesions with clear visibility after Lipiodol administration in the angiography respond significantly better to cTACE compared to hypo- or nonvascularized lesions.
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Affiliation(s)
- Marcel C Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Gulia Said
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Renate Hammerstingl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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Chen P, Xiao Q, Guo Z, Liang W, Liu O, Lin L, Huang Y, Zhu K, Ye G. Synthesis and characterization of 3-in-1 multifunctional lipiodol-doped Fe 3O 4@Poly (diallyl isophthalate) microspheres for arterial embolization, chemotherapy, and imaging. Biomed Mater 2024; 19:035011. [PMID: 38387046 DOI: 10.1088/1748-605x/ad2c1a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
Transcatheter arterial embolization plays a pivotal role in treating various diseases. However, the efficacy of embolization therapy in cancer treatment can be limited by several factors, such as inevitable incomplete or non-target embolization, and the tumor recurrence and metastasis caused by the hypoxic microenvironment. Moreover, it is essential to explore simpler, more economical, and efficient methods for microsphere synthesis. Herein, we achieved one-step photocatalytic synthesis of lipiodol-doped Fe3O4@Poly (diallyliso-phthalate) multifunctional microspheres (IFeD MS) for arterial embolization, chemotherapy, and imaging. The prepared microspheres are in the shape of dried plums, with a particle size of 100-300 μm. Lipiodol demonstrates a certain degree of chemotherapeutic activity, and the incorporation of Fe3O4enables the microspheres to exhibit magnetothermal response and magnetic resonance imaging capabilities. Furthermore, the radiopaque characteristics of both agents provide the microspheres with promising potential for computed tomography and digital radiography imaging. The renal embolization experiment in rabbits demonstrated that IFeD MS achieved significant embolization and chemotherapeutic effects. Biocompatibility experiments revealed that this embolic agent did not induce tissue damage or inflammation beyond the treatment area. Additionally, IFeD MS exhibited promising imaging potential. The results of this study imply that the developed multifunctional embolic agent IFeD MS may have significant potential in transforming tumors previously only suitable for palliative cares into resectable radical treatments.
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Affiliation(s)
- Piaoyi Chen
- The Fifth Affiliated Hospital, Guangdong Province NMPA and State Key Laboratory, The School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, People's Republic of China
| | - Qinglin Xiao
- The Fifth Affiliated Hospital, Guangdong Province NMPA and State Key Laboratory, The School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, People's Republic of China
| | - Zhaoxiong Guo
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
| | - Wei Liang
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
| | - Ou Liu
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
| | - Liteng Lin
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
| | - Yugang Huang
- The Fifth Affiliated Hospital, Guangdong Province NMPA and State Key Laboratory, The School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, People's Republic of China
| | - Kangshun Zhu
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
| | - Guodong Ye
- The Fifth Affiliated Hospital, Guangdong Province NMPA and State Key Laboratory, The School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, People's Republic of China
- Laboratory of Interventional Radiology, Department of Minimally Invasive Interventional Radiology and Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, 250 East Changgang Road, Guangzhou 510260, Guangdong Province, People's Republic of China
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Ushijima Y, Okamoto D, Fujita N, Ishimatsu K, Wada N, Takao S, Murayama R, Itoyama M, Ishigami K. Effect of lipiodol marking before CT-guided cryoablation on the outcome of sporadic renal cell carcinoma. Diagn Interv Radiol 2024; 30:117-123. [PMID: 38164892 PMCID: PMC10916531 DOI: 10.4274/dir.2023.232381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE This retrospective study evaluates the impact of preoperative lipiodol marking on the outcomes of computed tomography (CT)-guided cryoablation for histologically diagnosed sporadic renal cell carcinoma (RCC). METHODS This study analyzed the data of 173 patients who underwent CT-guided cryoablation for histologically proven sporadic RCC at a single institution between April 2014 and December 2020. The local control rate (LCR), recurrence-free survival rate (RFSR), overall survival rate (OSR), changes in renal function, and complications in patients with (n = 85) and without (n = 88) preoperative lipiodol marking were compared. RESULTS The 5-year LCR and 5-year RFSR were significantly higher in patients with lipiodol marking (97.51% and 93.84%, respectively) than in those without (72.38% and 68.10%, respectively) (P value <0.01, log-rank test). There were no significant differences between the two groups regarding the 5-year OSR (97.50% vs. 86.82%) or the deterioration in chronic kidney disease stage (12.70% vs. 16.43%). Grade ≥3 complications occurred in patients with lipiodol marking (n = 2, retroperitoneal hematoma and cerebral infarction in 1 patient each) and without (n = 5; urinary fistula in 2, colonic perforation in 2, urinary infection in 1). CONCLUSION Lipiodol marking before CT-guided cryoablation for sporadic RCC is a feasible approach to improving local control and RFS while mitigating the decline in renal function. Additionally, it may help reduce complications.
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Affiliation(s)
- Yasuhiro Ushijima
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Daisuke Okamoto
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Nobuhiro Fujita
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Noriaki Wada
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Seiichiro Takao
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Ryo Murayama
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Masahiro Itoyama
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
| | - Kousei Ishigami
- Kyushu University, Graduate School of Medical Sciences, Department of Clinical Radiology, Fukuoka, Japan
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Okuhira R, Higashino N, Sonomura T, Fukuda K, Koike M, Kamisako A, Tanaka R, Koyama T, Sato H, Ikoma A, Minamiguchi H. Balloon-Assisted Portal Vein Embolization Using n-Butyl-2-Cyanoacrylate-Lipiodol-Iopamidol Mixture in Swine: A Comparison of 2 Formulations. J Vasc Interv Radiol 2024; 35:462-468. [PMID: 38007178 DOI: 10.1016/j.jvir.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/17/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
PURPOSE To compare 2 ratios of n-butyl-2-cyanoacrylate (nBCA)-ethiodized oil (Lipiodol)-iopamidol (NLI) in balloon-assisted portal vein embolization (PVE) in swine. MATERIALS AND METHODS In an in vitro study, NLI prepared at a ratio of 2:3:1 (NLI231) or 1:4:1 (NLI141) was injected into 2.5- or 10-mL syringes filled with swine blood, and the viscosity of NLI was measured to determine an appropriate balloon occlusion time. Two portal vein branches in 8 female swine (n = 16 vein branches) were embolized with NLI231 (n = 8) or NLI141 (n = 8) under balloon occlusion. Portal venography was performed before, immediately after, and 3 days after PVE to evaluate the migration of NLI and the recanalization of embolized portal vein branches. Then, the livers were removed for histopathologic evaluation. RESULTS The times to peak viscosity of NLI231 in the 2.5- and 10-mL syringes were 55.8 seconds (SD ± 7.0) and 85.2 seconds (SD ± 6.3), and those to peak viscosity of NLI141 were 129.2 seconds (SD ± 11.8) and 254.0 seconds (SD ± 21.8), respectively. No migration of NLI231 was observed in all 8 procedures immediately or 3 days after PVE. Migration of NLI141 was observed in 6 of 8 procedures within 3 days after PVE. The migration frequency of the embolic material was lower in the NI231 group than in the NLI141 group (0/8 vs 6/8; P = .051). Histologically, NLI231 occupied the portal veins without any thrombi, whereas NLI141 was accompanied by thrombi in the portal veins. CONCLUSIONS NLI231 may be more suitable than NLI141 for balloon-assisted PVE in swine.
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Affiliation(s)
- Ryuta Okuhira
- Department of Radiology, Wakayama Medical University, Wakayama, Japan.
| | | | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Masataka Koike
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Ryota Tanaka
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Takao Koyama
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
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Gracé J, Connor D, Bester L, Rogan C, Parsi K. Polymerisation of cyanoacrylates: The effect of sclero-embolic and contrast agents. Phlebology 2024; 39:114-124. [PMID: 37944534 DOI: 10.1177/02683555231214343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The objective is to investigate the interaction of sclero-embolic and contrast agents with the polymerisation of medical grade n-butyl-cyanoacrylates. METHODS An in vitro spectrophotometric absorbance method was developed to detect changes in light transmission to measure n-BCA polymerisation. The initiation and the rate-of-polymerisation of mixtures of n-BCA with sclero-embolic and contrast agents were investigated. RESULTS Initiation of polymerisation: VENABLOCK™ and HISTOACRYL® were the fastest agents to polymerise, while VENASEAL™ was the slowest. Rate of polymerisation: Hypertonic saline inhibited the polymerisation of all n-BCAs, while hypertonic glucose prolonged the polymerisation rate. ETHANOL and detergent sclerosants had no effect. Contrast agents OMNIPAQUE™ and ULTRAVIST® initiated and prolonged the polymerisation of n-BCA, but in contrast, LIPIODOL® failed to initiate the process. CONCLUSIONS The commercially available medical cyanoacrylates differ in their polymerisation rates. These polymerisation rates are further affected when these products are used in conjunction with other compounds, such as sclero-embolic and contrast agents.
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Affiliation(s)
- Joseph Gracé
- Department of Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - David Connor
- Department of Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | | | | | - Kurosh Parsi
- Department of Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research (AMR), St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
- St Vincent's Hospital, Sydney, NSW, Australia
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Breazeale A, Rahmani R, Gallagher K, Nabavizadeh N. Liver stereotactic body radiation therapy without fiducial or retained ethiodized oil guidance warrants greater than 5 mm planning target volumes. J Med Radiat Sci 2024; 71:110-113. [PMID: 37712320 PMCID: PMC10920930 DOI: 10.1002/jmrs.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION For liver stereotactic body radiation therapy (SBRT), the placement of fiducial markers or retained ethiodized oil by transarterial chemoembolisation (TACE) provides a landmark for consistent target localisation. TACE and fiducial markers are invasive procedures that harbour additional risks. We hypothesise that liver SBRT can be accurately delivered without the use of these invasive surrogate markers. METHODS We retrospectively identified 50 consecutive patients who underwent liver SBRT with respiratory motion management to a single lesion which exhibited retained ethiodized oil per prior TACE delivery. For each SBRT fraction, two manual rigid image registrations were performed by the treating physician. One using the liver contour as a surrogate for the target and second aligning only to the radio-opaque retained ethiodized oil of the treated lesion. The magnitude of the displacement vector between the two registration methods was used to assess the accuracy of target localisation if ethiodized oil was not present. RESULTS For the 50 patients, a total of 244 analysable cone-beam CTs (CBCTs) were included (six CBCTs excluded due to poor ethiodized oil visualisation). Respiratory motion management techniques consisted of active breathing control for 13 and abdominal compression for 37 patients. Forty-two patients had peripheral lesions and eight had central lesions (<2 cm from left and right portal veins). The average target localisation offset between the two registration methods (i.e. liver contour vs. retained ethiodized oil alignment) for patients with a single peripheral or central liver lesion was 5.8 and 5.3 mm, respectively. CONCLUSIONS Across all patients, the average change in target position exceeded 5 mm for image registration methods based on the liver contour alone versus the retained ethiodized oil region. This suggests that margins greater than 5 mm may be required for respiratory motion-managed liver SBRT treatments in patients who do not undergo prior TACE or fiducial placement.
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Affiliation(s)
- Alec Breazeale
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Ramtin Rahmani
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
| | - Kyle Gallagher
- Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Nima Nabavizadeh
- Department of Radiation MedicineOregon Health & Science UniversityPortlandOregonUSA
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Torres TP, Costa P, Moreira H, Dionísio T, Sousa P. Treatment Of Post-Operative Chylothorax: The Role Of Intranodal Lymphangiography And Thoracic Duct Disruption. Port J Card Thorac Vasc Surg 2024; 30:67-70. [PMID: 38345884 DOI: 10.48729/pjctvs.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/23/2023] [Indexed: 02/15/2024]
Abstract
Thoracic duct embolization has been increasingly adopted as a first-line therapy of chylothorax and this procedure includes lipiodol lymphangiography, thoracic duct access and embolization. Lymphangiography itself has a therapeutic role, with volume-dependent success rates of 37%-97% and even a reported 100% success rate in outputs of < 500 mL/day. We present a clinical case of a 48-years-old man diagnosed with esophageal squamous cell carcinoma, who underwent esophagectomy and presented with post-operative high-output (> 1L/day) chylothorax; thoracic duct embolization was proposed. Even though thoracic duct access and embolization were not achieved due to technical and anatomical factors, lipiodol lymphangiography and possibly thoracic duct maceration (after several punctures/attempts) contributed to the clinical success of the procedure, and this chylothorax with output values superior to those reported in the literature resolved within three days. As such, the therapeutic role of intranodal lymphangiography and thoracic duct disruption should be taken into account.
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Affiliation(s)
- Tiago Paulino Torres
- Radiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Pedro Costa
- General Surgery Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Herculano Moreira
- General Surgery Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Teresa Dionísio
- Radiology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | - Pedro Sousa
- Radiology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
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Higashino N, Sonomura T, Ikoma A, Tamai K, Fukuda K, Kawai N, Minamiguchi H. Balloon-Assisted Arterial Embolization of Pseudoaneurysms Using NBCA-Lipiodol-Iopamidol Mixture in Two Clinical Cases. Cardiovasc Intervent Radiol 2024; 47:268-270. [PMID: 37875616 DOI: 10.1007/s00270-023-03571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan.
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Kurumi Tamai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama, 641-8509, Japan
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10
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Kim KM, Kim KY. Lymphangiogenesis after nonvascularized lymph node transplantation: Lymphangiographic findings in mice and minipigs. PLoS One 2023; 18:e0295836. [PMID: 38100487 PMCID: PMC10723711 DOI: 10.1371/journal.pone.0295836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
The establishment of new connections after NVLNT (non-vascularized lymph node transplantation) is still poorly understood. The purpose of this study was to investigate lymphatic connections after NVLNT using lymphangiography. In a mice model, 40 mice were allocated to undergo NVLNT or sham surgery. On day 21 after NVLNT, the lymphatic vessels were observed on near-infrared fluorescence imaging with indocyanine green. In a minipig model, 12 minipigs underwent NVLNT. On day 14 after NVLNT, the transplanted lymph node and donor site were checked by ultrasound, and minipigs with viable transplanted LNs were allocated to lipiodol lymphangiography or MR lymphangiography groups. Transplanted LN engraftment was examined with immunohistochemical staining. After NVLNT in mice, the signal intensities in the popliteal region at 3 minutes and 5 minutes were higher in the transplanted side than the control side (21.3 ± 8.1 vs. 11.0 ± 4.6 at 3 minutes, 26.7 ± 6.8 vs. 19.7 ± 5.9 at 5 minutes), while in the sham group, there were no significant differences between sides. In minipigs, lipiodol lymphangiography (n = 5) showed Lipiodol accumulation in transplanted LNs with innumerable newly formed lymphatic vessels and lymphovenous shunts. MR lymphangiography (n = 5) showed higher enhancement on the transplanted side compared to the control side. Histology showed successful engraftment of transplanted LNs in 16 out of 20 (80%) mice and 9 out of 12 (75%) minipigs. Omnidirectional lymphangiogenesis forming a dense lymphatic network and spontaneous formation of lymphovenous shunts were shown after NVLNT.
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Affiliation(s)
- Kyoung Min Kim
- Departments of Pathology, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Ushijima Y, Nishie A, Fujita N, Kubo Y, Ishimatsu K, Ishigami K. Diagnostic accuracy of percutaneous core biopsy before cryoablation for small-sized renal cell carcinoma. Diagn Interv Radiol 2023; 29:800-804. [PMID: 36994482 PMCID: PMC10679562 DOI: 10.4274/dir.2022.221152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 09/26/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To retrospectively determine the diagnostic accuracy of a percutaneous core biopsy performed before cryoablation for small-sized renal cell carcinoma. METHODS In this study, 216 patients underwent a percutaneous core biopsy for 242 renal lesions suspected to be renal cell carcinoma on image findings before cryoablation at Kyushu University Hospital. We calculated the success rate of the histological diagnosis and investigated factors that may have contributed to the diagnostic success. Complications caused by the biopsy procedure were also evaluated. RESULTS The histological diagnosis was successful in 203 lesions (82.8%). The success rate of the histological diagnosis was 65.4% (34/52 cases) for tumors with a diameter of ≤15 mm and 88.9% (169/190 cases) for those >15 mm. Therefore, tumor diameter was a factor contributing to the histological diagnosis success rate in both univariate and multivariable analyses (P < 0.001). For lesions with a tumor diameter ≤15 mm, the histological diagnosis success rates increased from 50.0% to 76.2% in the presence of pre-lipiodol marking and to 85.7% when the biopsy procedure was performed separately from cryoablation; the latter was statistically significant (P = 0.039). Major complications that may have been caused by the biopsy procedure were grade 3 bleeding and tract seeding (one case each). CONCLUSION Percutaneous core biopsy in cryoablation for small-sized renal cell carcinoma had a high diagnostic rate and was safely performed. For lesions with a tumor diameter ≤15 mm, a separate biopsy procedure and pre-lipiodol marking may improve the diagnostic accuracy.
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Affiliation(s)
- Yasuhiro Ushijima
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Akihiro Nishie
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuichiro Kubo
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
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12
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Jayaraj A, Thaggard D, Raju S. Inguinal intranodal lymphangiography reveals a high incidence of suprainguinal lymphatic disease in patients with leg edema undergoing stenting for symptomatic chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord 2023; 11:1192-1201.e2. [PMID: 37442275 DOI: 10.1016/j.jvsv.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Recent studies have emphasized the important role lymphatics play in the drainage of interstitial fluid and edema prevention. Although the infrainguinal lymphatics have been studied in some depth, with patterns of pathology identified, such data above the groin are sparse, especially for patients with phlebolymphedema. The present study attempts to evaluate the status of lymphatic flow above the inguinal ligament in patients presenting with edema and undergoing stenting for symptomatic chronic iliofemoral venous obstruction (CIVO). METHODS A total of 31 lower limbs that underwent pedal lymphoscintigraphy for leg edema and subsequent stenting for symptomatic CIVO formed the study cohort. Each limb underwent intranodal lymphangiography of an ipsilateral inferior inguinal lymph node (10 mL of lipiodol) at the time of stenting. Fluoroscopic visualization of lipiodol transit was performed at 20, 40, and 60 minutes and 3 hours after injection. Enumeration of the lymph nodes and lymphatic collector vessels from above the inguinal ligament to L1, visualization of the thoracic duct, the time delay to visualization of the thoracic duct, and pathologic changes to the thoracic duct when present were all evaluated. These anomalies were independently scored, with the scores combined to generate a total suprainguinal score (range, 0-3). This score was then compared to the limb's lymphoscintigraphically derived infrainguinal score (total infrainguinal score range, 0-3) using the t test and Spearman correlation. The clinical outcomes (grade of swelling, venous clinical severity score) after stenting were appraised. RESULTS Of the 30 patients (31 limbs), 18 were women, with left laterality noted in 23 limbs. A nonthrombotic iliac vein lesion occurred in 9 limbs and post-thrombotic syndrome in 22 limbs. Of the 31 limbs, 24 (77%) had suprainguinal lymphatic disease (SLD), with 22 of the 24 limbs having severe SLD and 2, mild SLD. When SLD was compared with infrainguinal lymphatic disease, 6 limbs (19%) had the same degree of involvement above and below the groin (1 with normal and 5 with severe disease), 17 limbs (55%) had more severe SLD, and 8 limbs (26%) had more severe infrainguinal lymphatic disease. Three limbs with normal pedal lymphoscintigraphic findings had severe SLD. The Spearman correlation coefficient for the comparison of SLD and infrainguinal disease in the same limb was 0.1 (P = .69). At baseline, the limbs with severe SLD had the same degree of leg swelling and venous clinical severity score as the limbs with absent to mild SLD (P > .1) with similar improvements after stenting (P > .4). Seven limbs underwent complex decongestive therapy (all with severe SLD and concomitant severe infrainguinal disease in one) to treat significant residual leg edema, with improvement. CONCLUSIONS SLD appears to be common in patients with leg edema undergoing stenting for symptomatic CIVO. Such disease appears to affect the thoracic duct more commonly. Although patients with persistent or residual leg edema after stenting can benefit from complex decongestive therapy, further workup in the form of inguinal intranodal lymphangiography and targeted intervention might need to be considered for those who do not benefit from such therapy. Further study is warranted.
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Affiliation(s)
- Arjun Jayaraj
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS.
| | - David Thaggard
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS
| | - Seshadri Raju
- The RANE Center for Venous & Lymphatic Diseases, St Dominic Hospital, Jackson, MS
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13
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Verhaeghe L, Holsbeeck AV, Bonne L, Claus E, Marrannes J, Vandenbulcke R, Jochmans I, Pirenne J, Maleux G. Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites. Diagn Interv Imaging 2023; 104:500-505. [PMID: 37210283 DOI: 10.1016/j.diii.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/28/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil. MATERIALS AND METHODS Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9-86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients' electronic medical records and imaging files. RESULTS Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage. CONCLUSION L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.
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Affiliation(s)
- Laurence Verhaeghe
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium; Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Andries Van Holsbeeck
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Eveline Claus
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Jesse Marrannes
- Department of Radiology, General Hospital AZ Sint-Lucas/Sint-Jan, 8310 Bruges, Belgium
| | - Ruben Vandenbulcke
- Department of Radiology, General Hospital AZ Delta, 8800 Roeselare, Belgium
| | - Ina Jochmans
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplantation Surgery, University Hospitals KU Leuven, 3000 Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals KU Leuven, 3000 Leuven, Belgium.
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14
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Ghelfi J, Dohan A. Intranodal lymphangiography in the management of lymphoceles and chylous ascites. Diagn Interv Imaging 2023; 104:453-454. [PMID: 37349173 DOI: 10.1016/j.diii.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Julien Ghelfi
- University of Grenoble-Alpes, 38000 Grenoble, France; Department of Radiology, Grenoble-Alpes University Hospital, 38000 Grenoble, France; Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University of Grenoble-Alpes, 38000 Grenoble, France.
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, AP-HP, 74014, Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France; Institut Cochin, Université de Paris, INSERM U 1016 CNRS UMR 8104, 75014 Paris, France
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15
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Navarro-Domenech I, Arulanantham S, Liu ZA, Tjong M, Kong V, Malkov V, Tadic T, Fleshner N, Kulkarni G, Zlotta AR, Catton C, Berlin A, Sridhar S, Jiang DM, Chung P, Raman S. Clinical and dosimetric outcomes of image-guided, dose-painted radiotherapy in muscle invasive bladder cancer. Radiat Oncol 2023; 18:154. [PMID: 37730609 PMCID: PMC10512471 DOI: 10.1186/s13014-023-02338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE/OBJECTIVE Definitive radiotherapy (RT) is an alternative to radical cystectomy for select patients with muscle invasive bladder cancer (MIBC); however, there is limited data on dose-painted RT approaches. We report the clinical and dosimetric outcomes of a cohort of MIBC patients treated with dose-painted RT. MATERIAL/METHODS This was a single institution retrospective study of cT2-4N0M0 MIBC patients treated with external beam radiotherapy (EBRT) to the bladder, and sequential or concomitant boost to the tumor bed. The target delineation was guided by either intravesical injection of Lipiodol or through fusion of the pre-treatment imaging. The majority were treated with daily image-guidance. Kaplan-Meier was used to characterize overall survival (OS) and progression-free survival (PFS). Cumulative incidence function (CIF) was used to estimate local (intravesical) recurrence (LR), regional recurrence (RR) and distant metastasis (DM). Univariable and multivariable cause-specific hazard model was used to assess factors associated with LR and OS. RESULTS 117 patients were analyzed. The median age was 73 years (range 43, 95). The median EQD2 to the boost volume was 66 Gy (range 52.1, 70). Lipiodol injection was used in 64 patients (55%), all treated with IMRT/VMAT. 95 (81%) received concurrent chemotherapy, of whom, 44 (38%) received neoadjuvant chemotherapy. The median follow-up was 37 months (IQR 16.2, 83.3). At 5-year, OS and PFS were 79% (95% CI 70.5-89.2) and 46% (95% CI 36.5-57.5). Forty-five patients had bladder relapse, of which 30 patients (67%) were at site of the tumor bed. Nine patients underwent salvage-cystectomy. Late high-grade (G3-G4) genitourinary and gastrointestinal toxicity were 3% and 1%. CONCLUSION Partial boost RT in MIBC is associated with good local disease control and high rates of cystectomy free survival. We observed a pattern of predominantly LR in the tumor bed, supporting the use of a dose-painted approach/de-escalation strategy to the uninvolved bladder. Prospective trials are required to compare oncological and toxicity outcomes between dose-painted and homogeneous bladder RT techniques.
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Affiliation(s)
- Inmaculada Navarro-Domenech
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Shinthujah Arulanantham
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada.
| | - Michael Tjong
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Vickie Kong
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Victor Malkov
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Tony Tadic
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Neil Fleshner
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Girish Kulkarni
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Alexandre R Zlotta
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Charles Catton
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Srikala Sridhar
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Di Maria Jiang
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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Tao S, Lin B, Zhou H, Sha S, Hao X, Wang X, Chen J, Zhang Y, Pan J, Xu J, Zeng J, Wang Y, He X, Huang J, Zhao W, Fan JB. Janus particle-engineered structural lipiodol droplets for arterial embolization. Nat Commun 2023; 14:5575. [PMID: 37696820 PMCID: PMC10495453 DOI: 10.1038/s41467-023-41322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
Embolization (utilizing embolic materials to block blood vessels) has been considered one of the most promising strategies for clinical disease treatments. However, the existing embolic materials have poor embolization effectiveness, posing a great challenge to highly efficient embolization. In this study, we construct Janus particle-engineered structural lipiodol droplets by programming the self-assembly of Janus particles at the lipiodol-water interface. As a result, we achieve highly efficient renal embolization in rabbits. The obtained structural lipiodol droplets exhibit excellent mechanical stability and viscoelasticity, enabling them to closely pack together to efficiently embolize the feeding artery. They also feature good viscoelastic deformation capacities and can travel distally to embolize finer vasculatures down to 40 μm. After 14 days post-embolization, the Janus particle-engineered structural lipiodol droplets achieve efficient embolization without evidence of recanalization or non-target embolization, exhibiting embolization effectiveness superior to the clinical lipiodol-based emulsion. Our strategy provides an alternative approach to large-scale fabricate embolic materials for highly efficient embolization and exhibits good potential for clinical applications.
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Affiliation(s)
- Sijian Tao
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
- School of Biomedical Engineering, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Bingquan Lin
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Houwang Zhou
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Suinan Sha
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Xiangrong Hao
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Xuejiao Wang
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Jianping Chen
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Yangning Zhang
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Jiahao Pan
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Jiabin Xu
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Junling Zeng
- Laboratory Animal Research Center of Nanfang Hospital, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Ying Wang
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Xiaofeng He
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, P. R. China
| | - Jiahao Huang
- School of Biomedical Engineering, Southern Medical University, 510515, Guangzhou, P. R. China.
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, 524000, Zhanjiang, P. R. China.
| | - Wei Zhao
- Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, P. R. China.
| | - Jun-Bing Fan
- Cancer Research Institute, School of Basic Medical Sciences, Southern Medical University, 510515, Guangzhou, P. R. China.
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17
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Ting YL, Lin HY, Huang TT, Hwang YS, Chui CS, Li MR, Wu TH. Quantitative Assessment of Lipiodol-Related Artifact Reduction for Dual-Energy Computed Tomography After Transcatheter Arterial Chemoembolization: A Phantom Study Evaluating the Use of Metal Artifact Reduction Algorithms. J Comput Assist Tomogr 2023; 47:704-712. [PMID: 37707399 DOI: 10.1097/rct.0000000000001477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This study used metal artifact reduction (MAR) software to examine the computed tomography (CT) number of dual-energy CT (DECT) of hepatocellular carcinoma after transcatheter arterial chemoembolization. METHODS Hollow columnar acrylic phantoms were filled with lipiodol and inserts of 2 sizes (large and small) were used to simulate liver tumors on a Revolution GSI CT scanner. The CT numbers of a single test object were collected twice: once with and once without the MAR algorithm. Lipiodol beam-hardening artifacts were quantified by measuring CT numbers in a region of interest around the tumor-simulating insert. RESULTS The virtual monochromatic CT numbers of large and small tumors were closely related to energy. For small tumors, CT numbers increased with energy. For large tumors, CT numbers increased with energy at 1 cm from the margin but decreased with an increase in energy at 5 cm. Regardless of the size, distance, or location of the tumor, the CT numbers fluctuated more at low energy levels. CONCLUSIONS At 1 cm from the margin, the CT numbers with MAR were significantly different from those without MAR. Low-energy CT numbers with MAR were near reference values. Metal artifact reduction exhibited superior performance for small tumors. Tumor margin images are affected by artifacts caused by Lipiodol. However, with MAR, CT numbers can be effectively calibrated, thus enabling clinicians to more accurately evaluate hepatocellular carcinoma development and identify residual tumors and recurrent or metastatic lesions.
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Affiliation(s)
| | | | | | - Yi-Shuan Hwang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tu Cheng Hospital, New Taipei, Taiwan
| | | | | | - Tung-Hsin Wu
- From the Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University
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18
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Guirguis N, Zellagui Y, Matoori S. Real-Time Tracking of In Situ-Forming Alginate Hydrogel by Contrast-Enhanced Computed Tomography. AAPS J 2023; 25:79. [PMID: 37552408 DOI: 10.1208/s12248-023-00843-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023] Open
Abstract
Hydrogel-based biomaterials have gained broad acceptance for tissue engineering and drug delivery applications. As their function generally depends on their localization, identifying the hydrogel position in the body is relevant and will alert physicians about potentially dangerous hydrogel migration. Monitoring the localization of hydrogels by imaging is challenging due to their high water content. Here, we developed a method to render alginate hydrogels visible on computed tomography (CT) and X-ray for real-time tracking of hydrogels inside the body. This method is based on physically immobilizing emulsion droplets of ethiodized oil, an FDA-approved positive CT contrast agent, in calcium-crosslinked alginate hydrogels. We prepared an oil-in-water emulsion of ethiodized oil with micron-sized emulsion droplets and encapsulated it in a calcium-crosslinked alginate hydrogel. This injectable in situ-forming hydrogel was stable for at least 2 weeks in vitro, visible on CT and X-ray in mice, and showed contrast agent concentration-dependent signal intensities. Hydrogels retrieved from mice after imaging had suitable rheological properties with a storage modulus of about 2 kPa and a loss modulus of about 0.35 kPa. This proof-of-concept study highlights the potential of ethiodized oil to localize hydrogels in real time inside the body and identifies a new use of this FDA-approved contrast agent.
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Affiliation(s)
- Natalie Guirguis
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Québec, H3T 1J4, Canada
| | - Yanis Zellagui
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Québec, H3T 1J4, Canada
- École Nationale Supérieure de Chimie de Mulhouse, Université de Haute-Alsace, 3 Rue Alfred Werner, 68200, Mulhouse, France
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Québec, H3T 1J4, Canada.
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Maruyama M, Takaki H, Yamada N, Hirata Y, Yamakado K, Kitagaki H. Liver regeneration after portal vein embolization: comparison between absolute ethanol and N-butyl-cyanoacrylate in an in vivo rat model. Diagn Interv Radiol 2023; 29:621-627. [PMID: 36994506 PMCID: PMC10679635 DOI: 10.4274/dir.2022.211144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/25/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare the effects of absolute ethanol (ethanol) and N-butyl-cyanoacrylate (NBCA) on non-embolized liver lobe regeneration in a rat model. METHODS Twenty-seven Sprague-Dawley rats underwent portal vein embolization (PVE) using ethanol:lipiodol, 1:1 (ethanol group, n = 11, 40.74%), NBCA:lipiodol, 1:1 (NBCA group, n = 11, 40.74%), or sham treatment (sham group, n = 5, 18.52%). The non-embolized and embolized lobe-to-whole liver weight ratios 14 days after PVE were compared among the groups (n = 5, 18.52%). The expressions of CD68 and Ki-67 and embolized-lobe necrotic area percentages one day after PVE were compared between the ethanol (n = 3, 11.11%) and NBCA (n = 3, 11.11%) groups. RESULTS The non-embolized lobe-to-whole liver weight ratio after PVE was significantly higher in the NBCA group (n = 5, 33.33%) than in the ethanol group (n = 5, 33.33%) (84.28% ± 1.53% vs. 76.88% ± 4.12%, P = 0.029). The embolized lobe-to-whole liver weight ratio after PVE was significantly lower in the NBCA group than in the ethanol group (15.72% ± 1.53% vs. 23.12% ± 4.12%, P = 0.029). The proportions of CD68- and Ki-67-positive cells in the non-embolized lobe after PVE were significantly higher in the NBCA group (n = 30, 50%) than in the ethanol group (n = 30, 50%) [60 (48-79) vs. 55 (37-70), P = 0.003; 1 (0-2) vs. 1 (0-2), P = 0.004]. The embolized-lobe necrotic area percentage after PVE was significantly larger in the NBCA group (n = 30, 50%) than in the ethanol group (n = 30, 50%) [29.46 (12.56-83.90%) vs. 16.34 (3.22-32.0%), P < 0.001]. CONCLUSION PVE with NBCA induced a larger necrotic area in the embolized lobe and promoted greater non-embolized liver lobe regeneration compared with PVE with ethanol.
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Affiliation(s)
- Mitsunari Maruyama
- Department of Radiology, Shimane University Faculty of Medicine Enya-cho Izumo, Japan
| | - Haruyuki Takaki
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan
| | - Naoko Yamada
- Department of Pathology, Hyogo College of Medicine, Hyogo, Japan
| | - Yutaka Hirata
- Division of Physiome, Department of Physiology, Hyogo College of Medicine, Hyogo, Japan
| | | | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine Enya-cho Izumo, Japan
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Yang D, Yang J, Zhu F, Hui J, Li C, Cheng S, Hu D, Wang J, Han L, Wang H. Complications and local recurrence of malignant liver tumor after ablation in risk areas: a retrospective analysis. Eur J Gastroenterol Hepatol 2023; 35:761-768. [PMID: 37272505 PMCID: PMC10234327 DOI: 10.1097/meg.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/24/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Microwave ablation (MWA) is an effective local treatment for malignant liver tumors; however, its efficacy and safety for liver tumors adjacent to important organs are debatable. PATIENTS AND METHODS Forty-three cases with liver tumors adjacent to important organs were the risk group and 66 cases were the control group. The complications between two groups were compared by chi-square test and t-test. Local tumor recurrence (LTR) was analyzed by log-rank test. Factors affecting complications were analyzed by logistic regression and Spearman analyses. Factors affecting LTR were analyzed by Cox regression analysis. A receiver operating characteristic curve predicted pain treated with drugs and LTR. RESULTS We found no significant difference in complications and LTR between two groups. The risk group experienced lower ablation energy and more antennas per tumor than control group. Necrosis volume after MWA was positively correlated with pain; necrosis volume and ablation time were positively correlated with recovery duration. Major diameter of tumor >3 cm increased risk of LTR by 3.319-fold, good lipiodol deposition decreased risk of LTR by 73.4%. The area under the curve (AUC) for necrosis volume in predicting pain was 0.74, with a 69.1 cm3 cutoff. AUC for major diameter of tumor in predicting LTR was 0.68, with a 27.02 mm cutoff. CONCLUSION MWA on liver tumors in at-risk areas is safe and effective, this is largely affected by proper ablation energy, antennas per tumor, and experienced doctors. LTR is primarily determined by major diameter of tumor and lipiodol deposition status.
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Affiliation(s)
- Dong Yang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
- Oncology Department, Shandong University of Traditional Chinese Medicine, Jinan City
| | - Jundong Yang
- Radiotherapy Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Fenghua Zhu
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Jing Hui
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Changlun Li
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Shuyuan Cheng
- Radiotherapy Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, PR China
| | - Dongyu Hu
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Junye Wang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Lei Han
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
| | - Huili Wang
- Oncology Department, Affiliated Hospital of Jining Medical University, Jining
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Tsuji Y, Miura H, Hirota T, Ota Y, Yamashita M, Asai S, Fujihara A, Hongo F, Ukimura O, Yamada K. Transarterial ethiodised oil marking before CT-guided renal cryoablation: evaluation of tumour visibility in various renal cell carcinoma subtypes. Clin Radiol 2023; 78:279-285. [PMID: 36710120 DOI: 10.1016/j.crad.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 01/15/2023]
Abstract
AIM To evaluate ethiodised oil retention of transarterial embolisation using ethiodised oil (ethiodised oil marking) before computed tomography (CT)-guided percutaneous cryoablation (PCA) according to renal cell carcinoma (RCC) subtype. MATERIALS AND METHODS Ethiodised oil marking was performed 1-3 days before PCA in 99 patients with 99 RCCs from 2016 to 2020. Ethiodised oil retention on CT images was evaluated retrospectively and CT attenuation values in the tumour were measured. Regions of interest (ROI) were placed on the tumours to calculate: average (ROI-average), maximal (ROI-max), minimum (ROI-min), and standard deviation (ROI-SD). Qualitative scores comprising a five-point scale (5, excellent; 1, poor) were evaluated for the retention scores (RS) of ethiodised oil in the tumour (ethiodised oil-RS) and the visualisation scores (VS) of the boundary between the tumour and renal parenchyma (boundary-VS). RESULTS The histological subtypes comprised clear cell (ccRCC; n=85), papillary (pRCC; n=6), and chromophobe/oncocytoma renal cell carcinoma (chrRCC; n=8). The mean ROI-average, ROI-max, and ROI-SD were significantly higher in ccRCCs than in chrRCCs and pRCCs (p<0.05). The mean ethiodised oil-RS was significantly lower in pRCCs than in ccRCCs (p=0.039), and the mean boundary-VS was >4 in all subtypes. Even with poor intratumour ethiodised oil retention (n=6), sufficient boundary-VS was obtained due to "inverted marking." All PCA procedures were completed without additional intravenous contrast material injection at the time of PCA. CONCLUSION Regardless of the tumour subtypes, ethiodised oil marking aids in visualising the boundary between the tumour and parenchyma on non-contrast CT in PCA.
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Affiliation(s)
- Y Tsuji
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan.
| | - H Miura
- Department of Radiology, Kyoto Second Red Cross Hospital, 355-5 Haruobi-cho, Kamigyo-ku, Kyoto, Japan
| | - T Hirota
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - Y Ota
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - M Yamashita
- Department of Radiology, Kyoto First Red Cross Hospital, 15-749 Hon-machi, Higashiyama-ku, Kyoto, Japan
| | - S Asai
- Department of Radiology, Fukuchiyama City Hospital, 231 Atsunaka-machi, Fukuchiyama City, Kyoto, Japan
| | - A Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - F Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - O Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
| | - K Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, Japan
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22
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Zhang L, Shi H, Zheng C, Liang B. Bleomycin- Ethiodized Oil Transarterial Embolization of a Giant Hepatic Hemangioma. J Vasc Interv Radiol 2023; 34:514-514.e1. [PMID: 36841575 DOI: 10.1016/j.jvir.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/27/2022] [Accepted: 11/08/2022] [Indexed: 02/25/2023] Open
Affiliation(s)
- Lijie Zhang
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Liang
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Kayalı A. Transhepatic Embolisation of the Cystic Duct Stump with a Glue and Lipiodol Mixture. Cardiovasc Intervent Radiol 2023; 46:689-691. [PMID: 36813852 DOI: 10.1007/s00270-023-03384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Alperen Kayalı
- School of Medicine, Department of Radiology, Hatay Mustafa Kemal University, 3140, Hatay, Turkey.
- Faculty of Medicine, Department of Radiology, Hatay Mustafa Kemal University, 31060, Hatay, Turkey.
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Jin L, Chun HJ, Oh JS, Choi BG, Lee HG, Kim IJ. Selective arterial embolization of renal angiomyolipoma: comparing ethanol-lipiodol emulsion and polyvinyl alcohol particles as embolic agents. Diagn Interv Radiol 2023; 29:170-174. [PMID: 36960593 PMCID: PMC10679591 DOI: 10.5152/dir.2022.21625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine the effectiveness and safety of two embolic agents, an ethanol-lipiodol emulsion and polyvinyl alcohol (PVA) particles, for selective arterial embolization (SAE) of renal angiomyolipoma (AML). METHODS Retrospectively, we reviewed the medical records and imaging data of renal AML patients who received SAE in our hospitals between July 2007 and January 2018. Among those eligible for analysis were patients with complete medical information, preoperative and postoperative contrast-enhanced computed tomography scans, and follow-up data. An ethanol-lipiodol emulsion was used to embolize 15 AMLs, and PVA particles were used to embolize 16 AMLs. We compared the tumor responses and adverse events between the two embolization-agent groups. RESULTS After embolization, no significant differences were observed in the shrinkage rates: 34.2% ± 3.4% for the ethanol-lipiodol emulsion group and 26.3% ± 3.0% for the PVA particles group (P = 0.090). Minor post-embolization complications were also similar between the groups, and there were no severe adverse events. The length of hospital stay after SAE was 2.5 ± 0.5 days for the ethanol-lipiodol emulsion group and 1.9 ± 0.5 days for the PVA particles group and was not significantly different (P = 0.425). CONCLUSION The results showed that SAE with ethanol-lipiodol emulsion or PVA particles was safe and efficient in decreasing tumor size and controlling renal AML hemorrhage.
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Affiliation(s)
- Long Jin
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
- Department of Medicine Radiology, Graduate School of Medical Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Jung Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Byung Gil Choi
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Hae Giu Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Il Jung Kim
- Department of Radiology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Republic of Korea
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Tayier R, Wang C, Ma P, Yuan Y, Zhang Y, Wu S, Zhang L. Iodine Nutritional Status of Pregnant Women After 14 Years of Lipiodol Supplementation: a Cross-Sectional Study in Historically Iodine-Deficient Areas of China. Biol Trace Elem Res 2023; 201:14-22. [PMID: 35322354 DOI: 10.1007/s12011-022-03123-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 01/11/2023]
Abstract
Southern Xinjiang has a history of serious iodine deficiency. Since 2007, pregnant women in this area have taken iodized salt and oral lipiodol preparations to prevent iodine deficiency disorders. However, the current status of iodine nutrition and thyroid function in this population is unknown. A cross-sectional study was conducted on 555 pregnant women from 5 counties (cities) in southern Xinjiang and 429 pregnant women from 3 counties in northern Xinjiang. The participants were given a questionnaire and serum concentrations of free triiodothyronine (FT3), free thyroxine (FT4), thyrotropic stimulating hormone (TSH), thyroglobulin antibody (Tg-Ab), and thyroid peroxidase antibody (TPO-Ab), and the urine iodine concentration (UIC) was measured. The median UIC and interquartile range [M (IQR)] of the 984 pregnant women in the study was 189.38 (143.15, 288.77) μg/L. Positive Tg-Ab and TPO-Ab titers were detected in 6.74% and 9.55%, 8.30% and 9.84%, and 7.39% and 10.55% in T1, T2, and T3, respectively. The incidence of subclinical hypothyroidism, clinical hypothyroidism, and isolated hypothyroxinemia in pregnant women in areas where lipiodol pills were taken was 4.32%, 0%, and 1.44%, respectively, which was significantly lower than those in areas where lipiodol pills were not taken. The median UIC (IQR) of pregnant women in the two regions was 213.80 (130.44, 331.77) μg/L and 168.30 (155.0, 254.8) μg/L, the UIC of pregnant women who took lipiodol pills was higher than in those who did not take lipiodol pills, and the difference was statistically significant (p < 0.05). According to WHO standards, all pregnant women in southern Xinjiang are in a state of adequate iodine nutrition. Taking lipiodol pills has improved the iodine nutrition level of pregnant women in this area. The results of this study did not find that oral lipiodol pills had adverse effects on pregnant women's thyroid function, but it is necessary to further study the effect of oral lipiodol pills on the offspring.
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Affiliation(s)
- Rishalaiti Tayier
- College of Public Health, Xinjiang Medical University, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Chenchen Wang
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China
| | - Pinjiang Ma
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China
| | - Yimu Yuan
- Xinjiang Production and Construction Corps Hospital, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Yuxia Zhang
- Urumqi Maternal and Child Health Hospital, Urumqi, 830011, Xinjiang, People's Republic of China
| | - Shunhua Wu
- Department of Occupational and Environmental Health, School of Public Health, Xinjiang Medical University, Urumqi, 830001, People's Republic of China.
| | - Ling Zhang
- Xinjiang Uighur Autonomous Region Centre for Disease Control and Prevention, Urumqi, 830011, People's Republic of China.
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Yang Q, Bai X, Bao H, Li Y, Men W, Lv L, Liu Z, Han X, Li W. Invasive treatment of persistent postoperative chylothorax secondary to thoracic duct variation injury: Two case reports and literature review. Medicine (Baltimore) 2022; 101:e31383. [PMID: 36316910 PMCID: PMC9622594 DOI: 10.1097/md.0000000000031383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make treatment difficult. No studies in the literature have reported the successful treatment of chylothorax second to thoracic duct variation by lipiodol-based lymphangiography. PATIENT CONCERNS A 63-year-old male and a 28-year-old female with primary lung adenocarcinoma were treated by video-assisted thoracoscopic cancer resection, and suffered postoperative chylothorax. Conservative treatment was ineffective, including nil per os, persistent thoracic drainage, fatty food restriction, and somatostatin administration. DIAGNOSIS Postoperative chylothorax. INTERVENTIONS Patients received lipiodol-based lymphangiography under fluoroscopic guidance. Iatrogenic injuries were identified at thoracic duct variations, including an additional channel in case 1 and the lymphatic plexus instead of the thoracic duct in case 2. OUTCOMES Thoracic duct variations were identified by lipiodol-based lymphangiography, and postoperative chylothorax was successfully treated by lipiodol embolizing effect. LESSONS Thoracic duct variations should be considered after the failure of conservative treatment for postoperative chylothorax secondary to pulmonary resection. Lipiodol-based lymphangiography is valuable for identifying the thoracic duct variations and embolizing chylous leakage.
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Affiliation(s)
- Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xu Bai
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Han Bao
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yukang Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wanfu Men
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ling Lv
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhenghua Liu
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiangjun Han
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
- *Correspondence: Xiangjun Han, Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China (e-mail: )
| | - Wenya Li
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Abstract
Transcatheter arterial chemoembolization (TACE) is the recommended treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the HCC radiological characteristics associated with prognosis of patients with intermediate stage HCC receiving TACE. Patients with HCC BCLC stage B from January 2005 to December 2009 were collected. According to mRECIST criteria, patients with complete response and partial response were assigned to the objective response (OR) group, while those with stable disease and progressive disease were assigned to the nonobjective response (non-OR) group. Among a total of 128 enrolled patients, there were 66 (51.6%) and 62 (48.4%) patients in the OR group and non-OR group, respectively. The clinical parameters in the two groups were similar, although HCC size was smaller in the OR group. Logistic analysis found combined radiological characteristics including complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush were significant correlated with achievement of OR (odds ratio 2.46, 95% CI 1.08-5.61, P = .032). However, no radiological characteristics had significant strength to predict overall survival. Patients with OR after TACE had significantly longer survival time than those with non-OR. Combined characteristics of complete lipiodol retention, tumor feeding artery blockage, and no residual tumor blush had a positive impact on OR in TACE. In patients receiving TACE, those who achieved OR had a better overall survival.
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Affiliation(s)
- Shou-Wu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, Chung Hsing University, Taiwan
| | - Chieh-Ling Yen
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chi Cheng
- Koo Foundation Sun Yat-Sen Cncer Center Department of Radiology, Taipei, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng Shun Yang
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Sciences, Chung Hsing University, Taichung, Taiwan
| | - Teng-Yu Lee
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
- *Correspondence: Teng-Yu Lee, Division of Hepatology and Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung 40705, Taiwan (e-mail: )
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Mazzella A, Spaggiari L. Invited commentary: indigo carmine and lipiodol mixture marking in lung segmentectomy. Eur J Cardiothorac Surg 2022; 62:6711393. [PMID: 36135805 DOI: 10.1093/ejcts/ezac469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antonio Mazzella
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Adam LC, Savic LJ, Chapiro J, Letzen B, Lin M, Georgiades C, Hong KK, Nezami N. Response assessment methods for patients with hepatic metastasis from rare tumor primaries undergoing transarterial chemoembolization. Clin Imaging 2022; 89:112-119. [PMID: 35777239 PMCID: PMC9470015 DOI: 10.1016/j.clinimag.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study assessed the response to conventional transarterial chemoembolization (cTACE) in patients with liver metastases from rare tumor primaries using one-dimensional (1D) and three-dimensional (3D) quantitative response assessment methods, and investigate the relationship of lipiodol deposition in predicting response. MATERIALS AND METHODS This retrospective bicentric study included 16 patients with hepatic metastases from rare tumors treated with cTACE between 2002 and 2017. Multi-phasic MR imaging obtained before and after cTACE was used for assessment of response. Response evaluation criteria in solid tumors (RECIST) and modified-RECIST (mRECIST) were utilized for 1D response assessment, and volumetric RECIST (vRECIST) and enhancement-based quantitative European Association for Study of the Liver EASL (qEASL) were used for 3D response assessment. The same day post-cTACE CT scan was analyzed to quantify intratumoral lipiodol deposition (%). RESULTS The mean and standard deviation (SD) of diameter of treated lesions per targeted area was 7.5 ± 5.4 cm, and the mean and SD of number of metastases in each targeted area was 4.2 ± 4.6. cTACE was technically successful in all patients, without major complications. While RECIST and vRECIST methods did not allocate patients with partial response, mRECIST and qEASL identified patients with partial response. Intratumoral lipiodol deposition significantly predicted treatment response according qEASL (R2 = 0.470, p < 0.01), while no association was shown between lipiodol deposition within treated tumor area and RECIST or mRECIST (p > 0.212). CONCLUSION 3D quantitative volumetric response analysis can be used for stratification of response to cTACE in patients with hepatic metastases originating from rare primary tumors. Lipiodol deposition could potentially be used as an early surrogate to predict response to cTACE.
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Affiliation(s)
- Lucas C Adam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Lynn J Savic
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Institute of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) (Digital) Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Letzen
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Visage Imaging, Inc., San Diego, CA, USA
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelvin K Hong
- Division of Vascular and Interventional Radiology, Russel H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nariman Nezami
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Liu CH, Peng CM, Hwang JI, Liang PC, Chen PJ, Abi-Jaoudeh N, Giiang LH, Tyan YS. Phase I Dose-Escalation Study of Tirapazamine Chemoembolization for Unresectable Early- and Intermediate-Stage Hepatocellular Carcinoma. J Vasc Interv Radiol 2022; 33:926-933.e1. [PMID: 35504436 DOI: 10.1016/j.jvir.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 04/03/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the safety of replacing doxorubicin with tirapazamine in conventional transarterial chemoembolization (TACE) in an Asian population with hepatocellular carcinoma (HCC), and to determine the optimal tirapazamine dose for phase II studies. MATERIALS AND METHODS This was a phase I, 3 + 3 dose-escalation study for patients with unresectable early- and intermediate-stage HCC who received 5, 10, or 20 mg/m2 of intra-arterial (IA) tirapazamine followed by ethiodized oil/gelatin sponge-based embolization. Key eligibilities included HCCs no more than 10 cm in diameter, prior embolization allowed, Eastern Cooperative Oncology Group performance status of 0 or 1, Child-Pugh score of 5-7, and platelet count of ≥60,000 μL. Dose-limiting toxicity (DLT) was defined as any grade 3 nonhematological or grade 4 hematological toxicity, with the exception of transient elevation of aminotransferase levels after the procedure. RESULTS Seventeen patients were enrolled, 59% of whom had progression from a prior HCC therapy and 35% of whom had progression or recurrence after TACE. All patients tolerated the tirapazamine TACE well without any DLT or serious adverse event. Using the modified Response Evaluation Criteria in Solid Tumors, the complete response (CR) rate was 47%, and the CR + partial response rate was 65%. The median duration of response was not reached. The median time to progression was 12.6 months (95% confidence interval, 5.1-not reached). The median overall survival was 29.3 months. The selected phase II dose was set at a fixed dose of 35 mg of IA tirapazamine. CONCLUSIONS IA tirapazamine with transarterial embolization was well tolerated and showed promising efficacy signals in intermediate-stage HCC, justifying pursuit of a phase II study.
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Affiliation(s)
- Chang-Hsien Liu
- Department of Medical Imaging, China Medical University Hsinchu Hospital and China Medical University, Hsinchu, Taiwan, Republic of China; Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan, Republic of China.
| | - Cheng-Ming Peng
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Jen-I Hwang
- Department of Radiology, Taichung Veteran General Hospital, and Department of Medical Imaging, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, and National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Nadine Abi-Jaoudeh
- Department of Radiology, University of California, Irvine Medical Center, Orange, California, USA
| | - Lung-Hui Giiang
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Shen Tyan
- Department of Radiology, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
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Wang MQ, Duan F, Guan Y, Yuan B, Wang Y, Yan J, Zhang JL, Fu JX, Yuan K, Sun X, Zhang H, Ye HY, Cai SW, Duan W, Meng L, Huyan X. Long-term outcomes of transarterial embolization with lipiodol-bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score-matched analysis. Eur Radiol 2022; 32:6840-6849. [PMID: 35763092 DOI: 10.1007/s00330-022-08972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the efficacy of transarterial embolization (TAE) with polyvinyl alcohol (PVA) particles alone and lipiodol-bleomycin emulsion (LBE) plus PVA particles for patients with unresectable large symptomatic focal nodular hyperplasia (FNH). METHODS We performed a retrospective analysis of patients who underwent TAE either with PVA particles alone (group A, n = 46) or LBE plus PVA particles (group B, n = 35) for large (≥ 7 cm) symptomatic FNH between January 2002 and February 2019. Propensity score matching (PSM) (1:1) was performed to adjust for potential baseline confounders. Technical success, adverse events (AEs), symptom relief, and changes in the lesion size after TAE were evaluated. Statistical analysis included Wilcoxon rank sum test and χ2 test. RESULTS After PSM, no significant differences in baseline characteristics were found between the groups (31 in group A and 31 in group B, with a mean age of 31 years). Technical success was achieved in all patients (100%), without major AEs in both groups. Complete resolution of the abdominal symptoms was reported in 77.4% in group A and 100% in group B (p = 0.037) during a mean follow-up period of 72 months; complete resolution (CR) of the FNH rate was significantly higher in group B than in group A (93.6% vs. 67.7%; p = 0.019). CONCLUSION Compared with the use PVA particles alone, TAE with LBE plus PVA particles in the treatment of patients with large symptomatic FNH had a significantly higher rates of CR of the FNH and complete relief of the symptoms. KEY POINTS • Transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus PVA particles for the large symptomatic FNH yielded better results than with PVA particles alone, in terms of complete resolution of FNH lesions (93.6% vs 67.7%) and complete relief of the abdominal symptoms (100% vs 77.4%) during a mean follow-up period of 72 months (38-170 months). • No major complications were recorded in both groups, and no significant difference in the incidence of postembolization syndrome were observed between the two groups.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yang Guan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jieyu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China
| | - Jin Xin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xuedong Sun
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Heng Zhang
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hui Yi Ye
- Department of Diagnostic Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Shou Wang Cai
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Wedong Duan
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Limin Meng
- Department of Medical Imaging, Air Force Medical Center of PLA, Beijing, People's Republic of China
| | - Xiaoyuan Huyan
- The First Health Care Department, The Second Medical Center & National Clinical Research Center for Geriatric disease, Chinese PLA general Hospital, Beijing, 100853, People's Republic of China
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Doemel LA, Santana JG, Savic LJ, Gaupp FML, Borde T, Petukhova-Greenstein A, Kucukkaya AS, Schobert IT, Hamm CA, Gebauer B, Walsh JJ, Rexha I, Hyder F, Lin M, Madoff DC, Schlachter T, Chapiro J, Coman D. Comparison of metabolic and immunologic responses to transarterial chemoembolization with different chemoembolic regimens in a rabbit VX2 liver tumor model. Eur Radiol 2022; 32:2437-2447. [PMID: 34718844 PMCID: PMC9359419 DOI: 10.1007/s00330-021-08337-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the effects of TACE using Lipiodol, Oncozene™ drug-eluting embolics (DEEs), or LUMI™-DEEs alone, or combined with bicarbonate on the metabolic and immunological tumor microenvironment in a rabbit VX2 tumor model. METHODS VX2 liver tumor-bearing rabbits were assigned to five groups. MRI and extracellular pH (pHe) mapping using Biosensor Imaging of Redundant Deviation in Shifts (BIRDS) were performed before and after intra-arterial therapy with conventional TACE (cTACE), DEE-TACE with Idarubicin-eluting Oncozene™-DEEs, or Doxorubicin-eluting LUMI™-DEEs, each with or without prior bicarbonate infusion, and in untreated rabbits or treated with intra-arterial bicarbonate only. Imaging results were validated with immunohistochemistry (IHC) staining of cell viability (PCNA, TUNEL) and immune response (HLA-DR, CD3). Statistical analysis was performed using Mann-Whitney U test. RESULTS pHe mapping revealed that combining cTACE with prior bicarbonate infusion significantly increased tumor pHe compared to control (p = 0.0175) and cTACE alone (p = 0.0025). IHC staining revealed peritumoral accumulation of HLA-DR+ antigen-presenting cells and CD3 + T-lymphocytes in controls. cTACE-treated tumors showed reduced immune infiltration, which was restored through combination with bicarbonate. DEE-TACE with Oncozene™-DEEs induced moderate intratumoral and marked peritumoral infiltration, which was slightly reduced with bicarbonate. Addition of bicarbonate prior to LUMI™-beads enhanced peritumoral immune cell infiltration compared to LUMI™-beads alone and resulted in the strongest intratumoral immune cell infiltration across all treated groups. CONCLUSIONS The choice of chemoembolic regimen for TACE strongly affects post-treatment TME pHe and the ability of immune cells to accumulate and infiltrate the tumor tissue. KEY POINTS • Combining conventional transarterial chemotherapy with prior bicarbonate infusion increases the pHe towards a more physiological value (p = 0.0025). • Peritumoral infiltration and intratumoral accumulation patterns of antigen-presenting cells and T-lymphocytes after transarterial chemotherapy were dependent on the choice of the chemoembolic regimen. • Combination of intra-arterial treatment with Doxorubicin-eluting LUMI™-beads and bicarbonate infusion resulted in the strongest intratumoral presence of immune cells (positivity index of 0.47 for HLADR+-cells and 0.62 for CD3+-cells).
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Affiliation(s)
- Luzie A Doemel
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Jessica G Santana
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Lynn J Savic
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
- Berlin Institute of Health, 10178, Berlin, Germany
| | - Fabian M Laage Gaupp
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Tabea Borde
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, Technische Universitat München, Munich, Germany
| | - Alexandra Petukhova-Greenstein
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Ahmet S Kucukkaya
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Isabel T Schobert
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Charlie A Hamm
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - John J Walsh
- Department of Biomedical Engineering, School of Engineering & Applied Science, 17 Hillhouse Avenue, New Haven, CT, 06510, USA
| | - Irvin Rexha
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Fahmeed Hyder
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Biomedical Engineering, School of Engineering & Applied Science, 17 Hillhouse Avenue, New Haven, CT, 06510, USA
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Visage Imaging, Inc., San Diego, CA, 92130, USA
| | - David C Madoff
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Division of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT, 06510, USA
- Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Smilow Cancer Hospital Care Center - North Haven, 6 Devine Street, Fl 2, North Haven, CT, 06473, USA
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
| | - Daniel Coman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
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Be KH, Khor R, Lim Joon D, Starvaggi B, Chao M, Ng SP, Ng M, Zorron Cheng Tao Pu L, Efthymiou M, Vaughan R, Chandran S. Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers. World J Gastroenterol 2021; 27:7387-7401. [PMID: 34876797 PMCID: PMC8611208 DOI: 10.3748/wjg.v27.i42.7387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/26/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Image-guided radiotherapy (IGRT) has significantly improved the precision in which radiotherapy is delivered in cancer treatment. Typically, IGRT uses bony landmarks and key anatomical structures to locate the tumor. Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue. The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied. However, placement requires expertise and specialized endoscopic ultrasound equipment. This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT.
AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients.
METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne, Australia was conducted. Up to four liquid fiducials were inserted per patient, each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil (Lipiodol; Aspen Pharmacare) and n-butyl 2-cyanoacrylate (Histoacryl®; B. Braun). A 23-gauge injector (Cook Medical) was used for the injection. All procedures were performed by or under the supervision of a gastroenterologist. Liquid fiducial-based IGRT (LF-IGRT) consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy. Patients received standard-IGRT (S-IGRT) if fiducial visibility was insufficient, consisting of bone match as a surrogate for tumor position. Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments.
RESULTS 52 patients were referred for liquid fiducial placement within the study period. A total of 51 patients underwent liquid fiducial implantation. Of these a total of 31 patients received radiotherapy. Among these, the median age was 77.4 years with a range between 57.5 and 88.8, and 64.5% were male. Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT. There were no complications after endoscopic implantation of liquid fiducials in our cohort. The cohort overall survival (OS) post-radiotherapy was 19 mo (range 0 to 87 mo). Whilst the progression-free survival (PFS) post-radiotherapy was 13 mo (range 0 to 74 mo). For those treated with curative intent, the median OS was 22.0 mo (range 0 to 87 mo) with a PFS median of 14.0 mo (range 0 to 74 mo). Grade 3 complication rate post-radiotherapy was 29%.
CONCLUSION LF-IGRT is feasible in 87.1% of patients undergoing liquid fiducial placement through standard gastroscopy injection technique. Our cohort has an overall survival of 19 mo and PFS of 13 mo. Further studies are warranted to determine the long-term outcomes of liquid-fiducial based IGRT.
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Affiliation(s)
- Kim Hay Be
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Richard Khor
- Department of Radiation Oncology, Austin Health, Heidelberg 3084, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne 3086, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Ben Starvaggi
- Department of Radiation Oncology, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Michael Chao
- Department of Radiation Oncology, Austin Health, Heidelberg 3084, Victoria, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health, Heidelberg 3084, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne 3086, Victoria, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Michael Ng
- Genesis Care, East Melbourne 3002, Victoria, Australia
| | | | - Marios Efthymiou
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Rhys Vaughan
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville 3010, Victoria, Australia
| | - Sujievvan Chandran
- Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia
- Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville 3010, Victoria, Australia
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Hazhirkarzar B, Tang H, Ghadimi M, Baghdadi A, Motaghi M, Wu Q, Shaghaghi M, Kamel I. Predicting early necrosis of colorectal liver metastases using volumetric enhancement on baseline MRI and oil deposition on post-cTACE unenhanced CT. Abdom Radiol (NY) 2021; 46:4610-4618. [PMID: 34089068 DOI: 10.1007/s00261-021-03133-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To predict tumor necrosis after conventional TACE (cTACE) in patients with colorectal liver metastasis (CRLM) based on volumetric oil deposition on CT one day after treatment. METHODS Thirty-four lesions in 20 men and 6 women were included in this IRB-approved HIPAA-compliant, retrospective lesion-by-lesion-based study. Semiautomatic volumetric segmentation of target lesions was performed on baseline MRI and post-treatment CT. Predicted percentage of tumor necrosis was defined as 100%-(%baseline MRI enhancement-%CT oil deposition). Necrosis on post-TACE MRI was measured after volumetric segmentation to assess the accuracy of predicting tumor necrosis. The relationship between predicted necrosis percent and post-cTACE measured necrosis percent on MRI was compared using Pearson correlation analysis. Inter-reader agreement was calculated by intraclass correlation coefficient (ICC) after using the same method. RESULTS Patients in this cohort had a mean age of 64 ± 14 years. Mean percentage of the viable tumor on pre-cTACE venous phase MRI was 58.5% ± 23.9%. Mean oil deposition was 19.8% ± 14.6%. Mean percentage of calculated necrosis one month after cTACE was 59.2% ± 22.7% on venous phase MRI, which had a significant correlation with predicted necrotic percentage of 61.3% ± 19.3% (r = 0.89, p < 0.0001). ICC for enhancement percentage on pre-cTACE and post-cTACE venous phase MRIs were 0.93 (95% CI 0.83, 0.97) and 0.86 (95% CI 0.66, 0.94), respectively. ICC for oil deposition was 0.92 (95% CI 0.81, 0.96). CONCLUSION Measuring oil deposition of the whole tumor on CT one day after cTACE can assist to predict post-cTACE tumor necrosis.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Tang
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Maryam Ghadimi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Azarakhsh Baghdadi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mina Motaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qingxia Wu
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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Park C, Gwon DI, Chu HH, Kim JW, Kim JH, Ko GY. Correlation of tumor response on CT with pathologically proven necrosis in hepatocellular carcinoma treated by conventional transcatheter arterial chemoembolization: threshold value of intratumoral Lipiodol accumulation predicting tumor necrosis. Abdom Radiol (NY) 2021; 46:3729-3737. [PMID: 33141259 DOI: 10.1007/s00261-020-02845-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate associations between pathology and CT assessments made according to the mRECIST in HCC treated by conventional TACE (cTACE), and to identify predictors of complete tumor necrosis. METHODS From March 2016 to July 2018, 83 patients with a total of 100 masses were retrospectively included. Patients underwent sequential cTACE and portal vein embolization, and later hepatic surgery. Evaluation of treatment response and measurement of baseline lipiodol accumulation as mean HU was performed on CT at the time point closest to the time of operation (mean, 54.5 days after cTACE). Significant predictors associated with complete necrosis were identified by multivariate analysis. The optimal cut-off HU value of lipiodol accumulation for prediction of complete necrosis was determined using a ROC analysis. RESULTS According to mRECIST, complete response (CR, n = 70) and partial response (n = 30) were classified. 34.3% (24/70) masses classified as CR according to mRECIST were found to have viable lesions on pathology. On multivariate analysis, mean HU of lipiodol accumulation was the only significant predictor of complete necrosis (p = .003, odds ratio 1.746, 95% CI 1.201-2.539). On ROC analysis, 460 HU as a cut-off value was significantly associated with complete necrosis (67.4% sensitivity, 75.0% specificity). CONCLUSIONS A threshold value for lipiodol accumulation > 460 HU was highly sensitive and specific for complete necrosis, even in complete response according to mRECIST. Therefore, if lipiodol accumulation is insufficient in post-TACE CT, recurrence should be monitored more sensitively.
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Affiliation(s)
- Chan Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
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Margallo Iribarnegaray J, Abad Gómez JA, Barreales Valbuena M, de Granda-Orive JI. Cyanoacrylate/lipiodol aspiration after upper endoscopy. Arch Bronconeumol 2021; 57:498. [PMID: 35698961 DOI: 10.1016/j.arbr.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/20/2020] [Indexed: 06/15/2023]
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Sommer CM, Pieper CC, Offensperger F, Pan F, Killguss HJ, Köninger J, Loos M, Hackert T, Wortmann M, Do TD, Maleux G, Richter GM, Kauczor HU, Kim J, Hur S. Radiological management of postoperative lymphorrhea. Langenbecks Arch Surg 2021; 406:945-969. [PMID: 33844077 DOI: 10.1007/s00423-021-02094-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. METHOD A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. RESULTS Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. CONCLUSION The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.
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Affiliation(s)
- C M Sommer
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany.
- Clinic of Radiology and Neuroradiology, Sana Kliniken Duisburg, Zu den Rehwiesen 9-11, 47055, Duisburg, Germany.
- Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany.
| | - C C Pieper
- Clinic of Diagnostic and Interventional Radiology, Bonn University Hospital, Venusberg-Campus 1, 53105, Bonn, Germany
| | - F Offensperger
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - F Pan
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - H J Killguss
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - J Köninger
- Clinic of General, Visceral, Thoracic and Transplantation Surgery, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - M Loos
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T Hackert
- Clinic of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - M Wortmann
- Clinic of Vascular and Endovascular Surgery, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - T D Do
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - G Maleux
- Department of Radiology, Leuven University Hospitals, Herestraat 49, 3000, Leuven, UZ, Belgium
| | - G M Richter
- Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany
| | - H U Kauczor
- Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany
| | - J Kim
- Department of Radiology, School of Medicine, Ajou University Hospital, Ajou University, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - S Hur
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Ihwa-dong, Jongno-gu, Seoul, Republic of Korea
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Ito K, Shimada J, Terauchi K, Shimomura M, Nishimura M, Iwasaki Y, Kato D, Yanada M, Ueshima Y, Suzuki H, Inoue M. [Surgical Strategy for Multiple Synchronous Primary Lung Cancer Showing Ground Glass Opacities:Percutaneous Preoperative Computed Tomography-guided Lipiodol Marking Followed by Video-assisted Thoracic Surgery]. Kyobu Geka 2021; 74:4-8. [PMID: 33550312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
From May 2006 to March 2018, a total of 30 patients with multiple ground glass opacities( GGO) lessor equal to 2.0 cm underwent percutaneous preoperative computed tomography (CT)-guided Lipiodolmarking and subsequent video-assisted thoracic surgery( VATS). There were 22 patients with 2 GGOs,6 patients with 3 GGOs, 1 patient with 4 GGOs, and 1 patient with 5 GGOs. Of the 71 CT-guided Lipiodolmarking procedures were successfully completed. All 71 Lipiodol spots were detected with C-armshapedfluoroscopy and completely resected. Pneumothorax was the most common complication andoccurred in 22 (73.3%) of 30 cases. There were severe complications in two (6.7%) cases of pneumothoraxrequiring chest tube placement and three( 10.0%) cases of bloody sputum. Of 30 cases multipleGGOs revealed 24 synchronous lung cancer (19 patients with double lung cancer, 3 patients with triplelung cancer, 1 patient with quadruple lung cancer, and 1 patient with quintuple lung cancer). PreoperativeCT-guided lipiodol marking and VATS resection is a safe and reliable method for synchronous multiplelung cancer showing GGO.
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Affiliation(s)
- Kazuhiro Ito
- Department of Thoracic Surgery, Kyoto Yamashiro Medical Center, Kizugawa, Japan
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Savic LJ, Chapiro J, Funai E, Bousabarah K, Schobert IT, Isufi E, Geschwind JFH, Stark S, He P, Rudek MA, Perez Lozada JC, Ayyagari R, Pollak J, Schlachter T. Prospective study of Lipiodol distribution as an imaging marker for doxorubicin pharmacokinetics during conventional transarterial chemoembolization of liver malignancies. Eur Radiol 2020; 31:3002-3014. [PMID: 33063185 DOI: 10.1007/s00330-020-07380-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the prognostic potential of Lipiodol distribution for the pharmacokinetic (PK) profiles of doxorubicin (DOX) and doxorubicinol (DOXOL) after conventional transarterial chemoembolization (cTACE). METHODS This prospective clinical trial ( ClinicalTrials.gov : NCT02753881) included 30 consecutive participants with liver malignancies treated with cTACE (5/2016-10/2018) using 50 mg DOX/10 mg mitomycin C emulsified 1:2 with ethiodized oil (Lipiodol). Peripheral blood was sampled at 10 timepoints for standard non-compartmental analysis of peak concentrations (Cmax) and area under the curve (AUC) with dose normalization (DN). Imaging markers included Lipiodol distribution on post-cTACE CT for patient stratification into 1 segment (n = 10), ≥ 2 segments (n = 10), and lobar cTACE (n = 10), and baseline enhancing tumor volume (ETV). Adverse events (AEs) and tumor response on MRI were recorded 3-4 weeks post-cTACE. Statistics included repeated measurement ANOVA (RM-ANOVA), Mann-Whitney, Kruskal-Wallis, Fisher's exact test, and Pearson correlation. RESULTS Hepatocellular (n = 26), cholangiocarcinoma (n = 1), and neuroendocrine metastases (n = 3) were included. Stratified according to Lipiodol distribution, DOX-Cmax increased from 1 segment (DOX-Cmax, 83.94 ± 75.09 ng/mL; DN-DOX-Cmax, 2.67 ± 2.02 ng/mL/mg) to ≥ 2 segments (DOX-Cmax, 139.66 ± 117.73 ng/mL; DN-DOX-Cmax, 3.68 ± 4.20 ng/mL/mg) to lobar distribution (DOX-Cmax, 334.35 ± 215.18 ng/mL; DN-DOX-Cmax, 7.11 ± 4.24 ng/mL/mg; p = 0.036). While differences in DN-DOX-AUC remained insignificant, RM-ANOVA revealed significant separation of time concentration curves for DOX (p = 0.023) and DOXOL (p = 0.041) comparing 1, ≥ 2 segments, and lobar cTACE. Additional indicators of higher DN-DOX-Cmax were high ETV (p = 0.047) and Child-Pugh B (p = 0.009). High ETV and tumoral Lipiodol coverage also correlated with tumor response. AE occurred less frequently after segmental cTACE. CONCLUSIONS This prospective clinical trial provides updated PK data revealing Lipiodol distribution as an imaging marker predictive of DOX-Cmax and tumor response after cTACE in liver cancer. KEY POINTS • Prospective pharmacokinetic analysis after conventional TACE revealed Lipiodol distribution (1 vs. ≥ 2 segments vs. lobar) as an imaging marker predictive of doxorubicin peak concentrations (Cmax). • Child-Pugh B class and tumor hypervascularization, measurable as enhancing tumor volume (ETV) at baseline, were identified as additional predictors for higher dose-normalized doxorubicin Cmax after conventional TACE. • ETV at baseline and tumoral Lipiodol coverage can serve as predictors of volumetric tumor response after conventional TACE according to quantitative European Association for the Study of the Liver (qEASL) criteria.
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Affiliation(s)
- Lynn J Savic
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Eliot Funai
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Isabel T Schobert
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Edvin Isufi
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | | | - Sophie Stark
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Ping He
- Sidney Kimmel Comprehensive Cancer Center at Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center at Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Carlos Perez Lozada
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Rajasekhara Ayyagari
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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Kong V, Kwan M, Chen S, Chung P, Craig T, Rosewall T. Quantification of interobserver variability in image registration using cone beam CT for partial bladder radiotherapy-a comparison between lipiodol and bladder wall surface. Br J Radiol 2019; 92:20180413. [PMID: 30383462 PMCID: PMC6404814 DOI: 10.1259/bjr.20180413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/12/2018] [Accepted: 10/26/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: The use of lipiodol or bladder wall surface (BWS) for image guidance has improved the treatment quality for partial bladder irradiation. Currently, this procedure is manually performed by different users. This study assessed the interobserver variability of using image guidance for partial bladder irradiation. METHODS: 7 observers were prospectively recruited to manually register 5 cone beam CTs (CBCT) from each of 20 bladder cancer patients with lipiodol injected for tumor demarcation. Lipiodol and BWS were used to register the CBCT to pre-treatment reference images, and displacement values in three directions were collected. Mean difference among observers and the 95% limit of agreement were calculated to measure interobserver variability. Margin required and the resultant treatment volume were compared between the surrogates. RESULTS: A total of 4200 displacement values were collected for analysis. Lipiodol was superior to BWS, with a mean difference among observers of <2 mm and a 95% limit of agreement of <5 mm in all directions. Of the three directions, greatest variability was observed in the superior-inferior direction for both surrogates, hence requiring a larger margin than the other two directions. After applying the corresponding margin, the mean volume of BWS-planning target volume was calculated to be significantly larger than lipiodol-planning target volume (166 cm3vs 134 cm3, p < 0.05). CONCLUSIONS: The use of lipiodol achieved a higher interobserver agreement than BWS. A larger margin in the superior-inferior direction is recommended due to greater interobserver variability observed in this direction for both surrogates. ADVANCES IN KNOWLEDGE: The uncertainty associated with the image registration by multiple observers for bladder image-guided radiotherapy is quantified for two surrogates.
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Affiliation(s)
| | - Maisie Kwan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Susan Chen
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
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Matsumoto T, Tomita K, Maegawa S, Nakamura T, Suzuki T, Hasebe T. Lymphangiography and Post-lymphangiographic Multidetector CT for Preclinical Lymphatic Interventions in a Rabbit Model. Cardiovasc Intervent Radiol 2018; 42:448-454. [PMID: 30460384 DOI: 10.1007/s00270-018-2123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the feasibility of lymphangiography and the visibility of the lymphatic system using post-lymphangiographic multidetector CT (MDCT) for preclinical lymphatic interventions in a rabbit model. MATERIALS AND METHODS Lymphangiography via the popliteal lymph node or vessel after surgical exposure was performed, using six healthy female Japanese White rabbits. Lipiodol was manually injected for lymphangiography. Post-lymphangiographic MDCT examinations were performed in all rabbits. The dataset images were subjected to image processing analysis utilizing the three-dimensional maximum intensity projection technique. Three reviewers evaluated the degree of depiction of the lymphatic system using a four-point visual score (1, poor; 2, fair; 3, good; 4, excellent). The distance between the body surface and cisterna chyli was measured on post-lymphangiographic MDCT axial image. RESULTS Lymphangiography was successfully performed in all rabbits. The popliteal lymph node was detectable in 90%. The visualization of lymphatic system via the popliteal node was achieved in 89%. Mean visual scores of > 3.0 were realized by the right femoral lymphatic vessel, left femoral lymphatic vessel, left iliac lymphatic vessel, left lumbar lymphatic trunks and cisterna chyli, whereas mean visual scores of < 3.0 were yielded by the right iliac lymphatic vessel, right lumbar lymphatic trunks and thoracic duct. The distance between the body surface and cisterna chyli on post-lymphangiographic MDCT axial images was 4.33 ± 0.14 cm. CONCLUSION Lymphangiography is feasible, and the visibility of the lymphatic system on post-lymphangiographic MDCT in a rabbit model provides enough information for interventional radiologists to perform preclinical lymphatic interventions.
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Affiliation(s)
- Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Shunto Maegawa
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Takako Nakamura
- Advanced Coating Technology Research Center, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, 305-8565, Japan
| | - Tetsuya Suzuki
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8522, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
- Center for Science of Environment, Resources and Energy, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8522, Japan.
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Ishimaru H, Morikawa M, Sakugawa T, Sakamoto I, Motoyoshi Y, Ikebe Y, Uetani M. Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature. World J Gastroenterol 2018; 24:4291-4296. [PMID: 30310262 PMCID: PMC6175758 DOI: 10.3748/wjg.v24.i37.4291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/04/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma (HCC). Even after the injection of 7 mL of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient’s level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms. The patient’s level of consciousness gradually improved after 8 wk in intensive care. In this case, a vascular lake emerged during chemoembolization and drained into systemic veins, offering a pathway carrying lipiodol to pulmonary vessels, the most likely cause of this serious complication. We should be aware that vascular lakes in HCC may drain into systemic veins and can cause intratumoral arteriovenous shunts.
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Affiliation(s)
- Hideki Ishimaru
- Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Minoru Morikawa
- Department of Radiology, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Takayuki Sakugawa
- Department of Radiology, University of the Ryukyus, Okinawa 903-0213, Japan
| | - Ichiro Sakamoto
- Department of Radiology, Nagasaki Harbor Medical Cancer, Nagasaki 850-8555, Japan
| | - Yasuhide Motoyoshi
- Department of Gastroenterology, Nagasaki Harbor Medical Cancer, Nagasaki 850-8555, Japan
| | - Yohei Ikebe
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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Ghelfi J, Perolat R, Cheuret J, Fontaine E, Boatta E, Thony F, Sengel C, Delouche A, Ferretti G, Michy T. Is There a Place for Repeat Lymphangiography in Postoperative Chylous Ascites? Cardiovasc Intervent Radiol 2018; 41:1633-1635. [PMID: 29931386 DOI: 10.1007/s00270-018-1994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France.
| | - Romain Perolat
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Julie Cheuret
- Clinique universitaire de gynécologie-obstétrique, CHU de Grenoble, La Tronche, France
| | - Eric Fontaine
- Responsable du Centre Agréé de Nutrition Parentérale à Domicile, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Emanuele Boatta
- Unité d'imagerie interventionnelle, CHU de Strasbourg, 67000, Strasbourg, France
| | - Frederic Thony
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Christian Sengel
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Aurelie Delouche
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Gilbert Ferretti
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU de Grenoble, BP 217, 38043, Grenoble Cedex 09, France
| | - Thierry Michy
- Clinique universitaire de gynécologie-obstétrique, CHU de Grenoble, La Tronche, France
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CHIAPPA S, GALLI G, GUARINO M, BARBAINI S, RAVASI G. Histological Study of Malignant Lymphomas Treated with Intralymphatic Injection of Lipiodol F I181. Tumori 2018; 49:87-106. [PMID: 14041588 DOI: 10.1177/030089166304900201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Najmi Varzaneh F, Pandey A, Aliyari Ghasabeh M, Shao N, Khoshpouri P, Pandey P, Zarghampour M, Fouladi D, Liddell R, Anders RA, Kamel IR. Prediction of post-TACE necrosis of hepatocellular carcinoma usingvolumetric enhancement on MRI and volumetric oil deposition on CT, with pathological correlation. Eur Radiol 2018; 28:3032-3040. [PMID: 29383518 DOI: 10.1007/s00330-017-5198-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate whether volumetric enhancement on baseline MRI and volumetric oil deposition on unenhanced CT would predict HCC necrosis and response post-TACE. METHOD Of 115 retrospective HCC patients (173 lesions) who underwent cTACE, a subset of 53 HCC patients underwent liver transplant (LT). Semiautomatic volumetric segmentation of target lesions was performed on dual imaging to assess the accuracy of predicting tumour necrosis after TACE in the whole cohort and at pathology in the LT group. Predicted percentage tumour necrosis is defined as 100 % - (%baseline MRI enhancement - %CT oil deposition). RESULTS Mean predicted tumour necrosis by dual imaging modalities was 61.5 % ± 31.6%; mean percentage tumour necrosis on follow-up MRI was 63.8 % ± 31.5 %. In the LT group, mean predicted tumour necrosis by dual imaging modalities was 77.6 % ± 27.2 %; mean percentage necrosis at pathology was 78.7 % ± 31.5 %. There was a strong significant correlation between predicted tumour necrosis and volumetric necrosis on MRI follow-up (r = 0.889, p<0.001) and between predicted tumour necrosis and pathological necrosis (r = 0.871, p<0.001). CONCLUSION Volumetric pre-TACE enhancement on MRI and post-TACE oil deposition in CT may accurately predict necrosis in treated HCC lesions. KEY POINTS • Imaging-based tumour response can assist in therapeutic decisions. • Lipiodol retention as carrier agent in cTACE is a tumour necrosis biomarker. • Predicting tumour necrosis with dual imaging potentially obviates immediate post-treatment MRI. • Predicting tumour necrosis would facilitate further therapeutic decisions in HCC post-cTACE. • Pre-TACE MRI and post-TACE CT predict necrosis in treated HCC.
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Affiliation(s)
- Farnaz Najmi Varzaneh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Ankur Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Mounes Aliyari Ghasabeh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Nannan Shao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Pegah Khoshpouri
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Pallavi Pandey
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Manijeh Zarghampour
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Daniel Fouladi
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Robert Liddell
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA
| | - Robert Albert Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ihab R Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
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Miura H, Yamagami T, Tanaka O, Yoshimatsu R, Ichijo Y, Kato D, Shimada J. CT findings after lipiodol marking performed before video-assisted thoracoscopic surgery for small pulmonary nodules. Acta Radiol 2016; 57:303-10. [PMID: 25795703 DOI: 10.1177/0284185115576047] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/08/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND In preoperative lipiodol marking for small pulmonary nodules, lipiodol has a potential risk of distribution in the surrounding lung structure. There are no reports about the detailed accumulation and distribution of lipiodol. PURPOSE To evaluate computed tomography (CT) findings after lipiodol marking before thoracoscopic surgery for pulmonary nodules. MATERIAL AND METHODS Sixty-four consecutive CT-guided lipiodol markings for 103 nodules were performed in 55 patients. Lipiodol (0.2-0.4 mL) was injected using a 21-gauge needle near the nodule. The appearance of lipiodol spots was classified into the following three types on CT: type 1, dense; type 2, punctate; and type 3, unclear. The distribution of lipiodol was also investigated. Statistical analyses were performed on the accumulation and distribution related to nodule factors. Incidences of complications were also investigated. RESULTS A total of 110 markings were performed because of seven additional procedures due to insufficient marking. All nodules were successfully resected on the same day. The appearances of the lipiodol spots were type 1 (82%), type 2 (11%), and type 3 (7.3%). The areas of distribution were lung parenchyma (54%), central bronchus (39%), peripheral bronchovascular bundle (24%), needle tract (20%), pleural space (19%), another segment of ipsilateral lung (5.5%), and contralateral lung (0.9%). Distribution into pleural space and central bronchus was frequently seen in the shallow nodules (P < 0.05). Complications were pneumothorax (61%) and pulmonary hemorrhage (35%). There were no serious symptoms. CONCLUSION The appearance of the lipiodol spot was dense in most cases, despite frequent distribution in the surrounding lung structures without serious complications.
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Affiliation(s)
- Hiroshi Miura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Osamu Tanaka
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yusuke Ichijo
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daishiro Kato
- Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junichi Shimada
- Division of Chest Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Pasmans R, Schreuder T. [A man with an image from the past]. Ned Tijdschr Geneeskd 2016; 160:D53. [PMID: 27405573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the past intrathecal injection of ethiodized oil was used as a radio-opaque contrast agent. Nowadays the intrathecal use of ethiodized oil is very limited, however because of its inert properties it remains visible on radiological investigations even many decades after injection. Therefore, knowledge and recognition of this radiological feature is important since this prevents unnecessary further investigations.
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Affiliation(s)
- R Pasmans
- Zuyderland, afd. Neurologie, Heerlen
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Okabe K, Beppu T, Komori H, Sano O, Yamanaka T, Haraoka K, Ouchida Y, Fujiyama S, Baba H. [Postoperative cholangitis of balloon-occluded transarterial chemoembolization (B-TACE) for hepatocellular carcinoma]. Gan To Kagaku Ryoho 2014; 41:2119-2121. [PMID: 25731442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In 35 patients who underwent balloon-occluded transarterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) since January 2013, 5 patients (14%) had postoperative cholangitis, 1 of whom required drainage of a liver abscess. Four of these patients(80%)were treated with cisplatin (CDDP)-epirubicin (EPI)-Lipiodol (Lp) emulsion, and 1 was treated with EPI-Lp emulsion.The balloon was located and inflated at the lobar level (C: conventional)in 3 patients (60%) and at the subsegmental or more distal level (SS: superselective) in 2 patients (40%). Chemical vascular damage was considered to cause the cholangitis.We conclude that it is necessary to determine the optimal drug for B-TACE to reduce vascular damage. Miriplatin may be useful because of its lower vascular damage compared with CDDP-Lp and EPI-Lp.
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Park S, Hwang SM, Lim OK, Hwang C, Lee DH. Compliant neurovascular balloon catheters may not be compatible with liquid embolic materials: intraprocedural rupture of the protecting balloon during tumor embolization using n-butyl cyanoacrylate and lipiodol mixture. J Neurointerv Surg 2014; 7:740-3. [PMID: 25165384 DOI: 10.1136/neurintsurg-2014-011331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/04/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Soonchan Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seon Moon Hwang
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Changmo Hwang
- Biomedical R&D Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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