Effect of lipiodol on recovery of goiter in children aged 8 to 10 years / 中华地方病学杂志

Objective:To analyze the changes of thyroid volume before and after supplementation with lipiodol pills in children with goiter, and to evaluate the recovery effect of lipiodol pills supplementation on children with goiter in the short term.Methods:In October 2018, 4 townships and towns in Linxia Hui Autonomous Prefecture with relatively serious historical conditions and high goiter rate of children aged 8 to 10 were selected for thyroid examination in 19 primary schools within the jurisdiction. Sixty children with goiter were selected as research subjects; at the same time, 138 children of the same age with normal thyroid B-ultrasound examination results were selected as control in the same period. Under the condition of normal diet, children with goiter were intervened by taking 200 mg lipiodol pills at one time. After 6 months, the thyroid volume of children with goiter and control children was measured by B-ultrasound.Results:Fifty-three children with goiter were finally included, with a sex ratio of 1.00 ∶ 1.04 (26 ∶ 27). There were 138 control children in the same period, with a sex ratio of 1.00 ∶ 1.30 (60 ∶ 78). Six months after taking lipiodol pills, the median thyroid volume of children with goiter was 3.7 ml, which was significantly different from that before supplementing with lipidol pills (5.8 ml, Z = - 7.95, P < 0.001), and not significantly different from that of control children (4.1 ml) in the same period ( Z = - 0.91, P = 0.365). Among them, 90.6% (48/53) of children with goiter recovered to the normal range, and 100.0% (15/15), 81.8% (18/22) and 93.8% (15/16) children's thyroid recovered returned to the normal range in the 8-, 9-, and 10-year-old age groups, respectively, and the highest proportion was in the 8-year-old age group. Stratified by age and gender, the thyroid volume of children with goiter in all age groups and gender after supplementation with lipiodol pills was lower than that before supplementation with lipiodol pills ( P < 0.001), but there was no difference compared with the control children in the same period ( P > 0.05). After supplementing with lipiodol pills, the diameters of thyroid in children with goiter were significantly lower than those before supplementing with lipiodol pills ( P < 0.001). Compared with the control children in the same period, there were significant differences in the right width, left length and right long diameter of the thyroid ( P < 0.05). Conclusion:Supplementing lipiodol pills can restore the thyroid volume of 8 - 10 year old children with goiter to normal range in a short term, and can effectively treat simple goiter.

Percutaneous Lipiodol Lymphangiogram in Chylous Leakage Successful Embolisation Post Mastectomy: A Case Report

@#Complication of chyle leakage is rare post mastectomy, ranging from 0.36 – 0.84%. This case report discuses a rare case of chylous leakage post mastectomy in a 79-year-old female. The complication was suspected when the draining colour of axillary drainage change from serous fluid to milky colour, diagnosis then confirmed clinically and biochemically as chyle. The patient was initially managed conservatively, but this was not successful and was referred to an interventional radiology for lymphangiogram and embolization. Percutaneous lipiodol embolization was performed with immediate success.

Resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol: experiencia en dos centros universitarios / Videotoracoscopy resection of pulmonary nodules marked with lipiodol: experience in two university centers

INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.

BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.

A Case of Lymphangiography Treatment with Lipiodol for Postoperative Chylomediastinum after Redo Mitral Valve Surgery / 日本心臓血管外科学会雑誌

A 71-year-old female, who had diabetes mellitus and chronic renal failure on dialysis, had undergone mitral valve repair and tricuspid valve annuloplasty. Five months after the operation, she suffered from infectious endocarditis and underwent mitral valve replacement. Postoperatively, a total fluid volume of 300 to 600 ml/day was drained from the pericardial tube, and its appearance became milky after the start of oral intake of food. She was diagnosed with chylomediastinum. Despite fasting and total parenteral nutrition for 2 weeks and subcutaneous octreotide administration, the volume of fluid drainage was not reduced. Therefore, we planned lymphangiography treatment with Lipiodol on postoperative day 37. On operation, under local anesthesia, the left inguinal lymph node was punctured under ultrasound guidance, and Lipiodol was injected at a rate of 12 ml/h for 1h. On the next day, the volume of fluid drainage was reduced, and the pericardial tube could be removed 9 days after lymphangiography.

The effect of lipiodol on dose distribution of carbon ion therapy after transcatheter arterial chemoembolization / 中华放射医学与防护杂志

Objective@#To investigate the effect of lipiodol as embolization agents in liver, after transcatheter arterial chemoembolization, on dose calculation under the carbon ion treatment plan.@*Methods@#The actual relative linear stopping powers(RLSP)in pure lipiodol, pure gel and lipiodol-gel mixture, together with the correctd RLSPs from their CT images, were compared.In seven typical cases with lipiodol deposition area, carbon ion treatment plan was performed for the original lipiodol images.Successively on the basis of analysis that has made, the RLSP in lipiodol deposition area was corrected to be as in normal liver tissue, for which the carbon ion treatment plan was again performed.A comparison was made of differences in water equivalent depth (WED) and dose distribution on different CT images.@*Results@#The RLSP value corrected according to CT image HU value, lipiodol, and lipiodol-gel mixture may increase by 4.6%-139.0% compared with the measured value. In seven typical cases, deposited lipiodol can cause WED to increase by (0.89±0.41) cm along the field track and RBE by(3.83±1.71)Gy within the 1 cm of distal area of target.@*Conclusions@#In order to improve the accuracy of dose distribution calculation, the HU value and/or RLSP in deposited lipiodol area in liver after transcatheter arterial chemoembolization should being corrected to be as in the normal liver tissue.

Marcación de nódulos pulmonares con lipiodol bajo tomografía computada: experiencia local y correlación anatomopatológica / Marking of pulmonary nodules with lipiodol by computerized tomography: local experience and anatomopathological correlation

El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.

The purpose of this study is describing a novel and minimally invasive technique of CT-guided marking of small pulmonary nodules with lipiodol prior to resection by videothoracoscopic surgery with radioscopic support. This is a retrospective study that includes 51 consecutive patients between June 2012 and September 2017, with the final diagnosis confirmed by pathology. Malignant nodules represented 81% of the cases with the remaining 19% being benign nodules. Through this technique, 100% of the marked nodules were successfully identified and extracted with few procedure related complications and no adverse clinical outcome, demonstrating the effectiveness and safety of the procedure.

Lipiodol brain embolism through right inferior phrenic artery-pulmonary vein shunt after transcatheter arterial chemoembolization

Lipiodol brain embolism is a rare complication associated with transcatheter arterial cheomoembolization (TACE). The present case describes a patient with lipiodol brain embolism who presented with several symptoms, including drowsy mental state, right facial palsy, and weakness in the right upper and lower limbs. The patient's non-enhanced computed tomography scan and magnetic resonance imaging (MRI) findings revealed multifocal lipiodol deposition and an acute infarction of the brain. A retrospective review of the angiography findings revealed a right inferior phrenic artery-pulmonary vein shunt, which was not observed during the previous TACE. Three days after TACE, the patient's symptoms improved; however, the extent of the brain hyperintensity had widened further on the following MRI. The patient gradually recovered and was finally discharged.

Angio-Computed Tomograph-Guided Immediate Lipiodol Computed Tomograph for Diagnosis of Small Hepatocellular Carcinoma Lesions during Transarterial Chemoembolization / 中华医学杂志(英文版)

<p><b>Background</b>The diagnosis and treatment of small hepatocellular carcinoma (HCC) play a vital role in the prognosis of patients with HCC. The purpose of our study was to evaluate angio-computed tomography (angio-CT)-guided immediate lipiodol CT (a CT scan performed immediately after transarterial chemoembolization [TACE]) in the diagnosis of potential HCCs ≤1 cm in diameter.</p><p><b>Methods</b>This study retrospectively analyzed 31 patients diagnosed with HCCs after routine imaging (contrast-enhanced CT or magnetic resonance imaging) or pathologic examinations with undefined or undetermined tumor lesions (diameter ≤1 cm) from February 2016 to September 2016. After TACE guided by digital subtraction angiography of the angio-CT system, potential HCC lesions with a diameter ≤1 cm were diagnosed by immediate lipiodol CT. The number of well-demarcated lesions was recorded to calculate the true positive rate. The correlation between the number of small HCCs detected by immediate lipiodol CT and the size of HCC lesions (diameter >1 cm) diagnosed preoperatively was analyzed 1 month after TACE. A paired t-test was used to analyze differences in liver function. Pearson analysis was used to analyze correlation. Chi-square test was used to compare the rates.</p><p><b>Results</b>Fifty-eight lesions were detected on preoperative routine imaging examinations in 31 patients including 15 lesions with a diameter ≤1 cm. Ninety-one lesions were detected on immediate lipiodol CT, of which 48 had a diameter ≤1 cm. After 1 month, CT showed that 45 lesions had lipiodol deposition and three lesions had lipiodol clearance. Correlation analysis showed that the number of small HCCs detected by lipiodol CT was positively correlated with the size of HCC lesions diagnosed by conventional imaging examination (R = 0.54, P < 0.05).</p><p><b>Conclusion</b>Immediate lipiodol CT may be a useful tool in the diagnosis of potential HCC lesions with a diameter of ≤1 cm.</p>

Chinese medicine ligustrazine combined with percutaneous transhepatic tumor intramuscular injection of lipiodol pirarubicin combined with transhepatic arterial chemotherapy in advanced liver cancer and safety observation / 中国生化药物杂志

Objective Observing the clinical effect of Ligustrazine Phosphate Tablets combined with percutaneous intratumoral injection of lipiodol THP on advanced hepa-tocellular carcinoma.Methods83 patients with advanced hepatocellular carcinoma from January 2012 to September 2014 were analyzed.Double-blind, randomized method All patients were divided into the control group 41 cases and observation group 42 cases.The control group were treatedwith percutaneous transhepatic intratumoral injection of lipiodol THP, the observation groupwere given Ligustrazine Phosphate Tablets combined with percutaneous intratumoral injection of lipiodol THP to treat.After treatment, the two groups of patients with treatment efficacy, adverse reactions and Karnofsky and prothrombin time were analyzed.ResultsAftertreatment, the efficacy of the two groups of patients were compared, the results showed that patients in the observation group total effective rate of the control group (χ2=4.034),the difference was statistically significant (P<0.05);two groups adverse reactions in patients after treatment were compared, liver pain, blood toxicity, fever, gastrointestinal reactions similar proportion of patients, the difference was not statistically significant;Theproportion of patients in the observation group AFP<8.1ng/mL was significantly higher (χ2=4.338), the difference was statistically significant (P<0.05);patients were observed after treatment Karnofsky score was significantly higher, the difference was statistically significant (t=7.141, P<0.05);after two groups of patients were compared prothrombin time, the difference was not statistically significant.ConclusionHepatic arterial chemoembolization and percutaneous intratumoral injection of THP lipiodol emulsion on the basis of the combination of Ligustrazine Phosphate Tablets can effectively improve the efficacy of treatment, and has good security, which is a safe and effective methods of treatment should be to promote and use in clinical.

Transhepatic arterial embolization with superparamagnetic iron oxide and lipiodol for the treatment of VX2 tumor in rabbits / 中南大学学报(医学版)

Objective:To evaluate the feasibility and therapeutic efficacy of transhepatic arterial embolization with superparamagnetic iron oxide (SPIO) and lipiodol (LIP) for the treatment of VX2 tumor in rabbits.Methods:Twenty-four rabbits with hepatic VX2 tumors by surgical implantation were randomly divided into 4 groups and treated with transhepatic arterial embolization of 4 different agents as follows (n=6 each):doxorubicin (DOX) group,DOX-LIP group,SPIO-DOX group,and SPIO-DOX-LIP group.Liver function (AST and ALT) was measured at 0,1,3,5 and 7 d after transhepatic arterial embolization.The serum DOX level was measured at 0,5,15,30,60,and 120 minutes after transhepatic arterial embolization.MRI was performed at 7 d after the treatment to assess the distribution of SPIO in the SPIO-DOX group and SPIO-DOX-LIP group,while CT was performed to assess the distribution of LIP in the DOX-LIP group and SPIO-DOX-LIP group.All the rabbits were sacrificed and their livers were removed at 7 d after treatment for the detection of tissue DOX level.The histopathologic examinations were performed including HE staining,Prussian blue staining and TUNEL assay,and then the tumor necrosis percentage and apoptosis index were calculated.Results:Compared to the DOX group,the levels of AST and ALT in other 3 groups were significantly elevated at 1 and 3 d after embolization (P＜0.05).The levels of ALT and AST in the DOX group,DOX-LIP group or SPIO-DOX-LIP group returned to the baseline at day 7,there were no significant differences (P＞0.05).The SPIO-DOX-LIP group exhibited the lowest serum DOX level at all time points up to 120 minutes after embolization (P＜0.05).However,the tissue DOX level in the SPIO-DOX-LIP group was the highest among all groups at day 7 (P＜0.05).The SPIO-DOX group and SPIO-DOX-LIP group showed significantly lower MRI signal intensity of tumors in T2 weighted imaging (T2WI) at day 7.Meanwhile DOX-LIP group and SPIO-DOX-LIP group showed that high-density lipiodol was deposited in the tumors in CT images.Histopathologic findings showed an almost complete central necrosis coagulation of tumors in the SPIO-DOX-LIP group,and the tumor necrosis percentage and tumor apoptosis index were significantly increased in the SPIO-DOX-LIP group compared to those in other 3 groups (P＜0.05).Conclusion:This novel drug-delivery system of SPIO nano-drug carrier together with LIP is safe and feasible when it is used for transhepatic arterial embolization for liver tumor.It provides an excellent MR and CT visualization and improves the therapeutic efficacy for the treatment of rabbit VX2 liver tumor.

TACE by using microspheres and lipiodol for the treatment of hepatocellular carcinoma: analysis of short-term efficacy / 介入放射学杂志

Objective To evaluate the short-term curative effect and the safety of transcatheter arterial chemoembolization (TACE) therapy by using microspheres and lipiodol for hepatocellular carcinoma (HCC).Methods A total of 87 patients with pathologically proved HCC were randomly divided into the study group (n=44,using embospheres of 100-300 μm in diameter together with lipiodol) and the control group (n=43,using gelfoam particles of 350-560 μm in diameter together with lipiodol).Postopertaive biochemical (liver function and AFP) findings and imaging (CT and/or MRI) manifestations were recorded,and the clinical efficacy and adverse reactions were analyzed.Results TACE was performed in all 87 patients.After the treatment,both the disease benefit rate and the postoperative reduction in AFP level in the study group were remarkably better than those in the control group (P＜0.05),but postoperative liver function indexes were not significantly different from the preoperative ones (P＞0.05).The average number of interventional therapy within the follow-up period of 6 months in the study group was smaller than that in the control group (P＜0.05).No statistically significant differences in 6-,12-and 18-month survival rates existed between the two groups (P＞0.05).Conclusion In treating HCC,TACE by combination use of microspheres and lipiodol is safe,its short-term curative effect is more obvious than TACE by combination use of gelfoam particles and lipiodol,and it can reduce the times of interventional procedure.Before TACE,careful planning of the pre-treatment of hepatic artery-portal vein fistula and the superselective catheterization with micro catheter should be taken into consideration.

Embolización portal hepática preoperatoria con lipiodol y gelatina absorbible / Preoperative hepatic portal vein embolisation with lipiodol and absorbable gelatin

Objetivo: Describir los resultados de la embolización portal hepática (EPH) preoperatoria con lipiodol y gelatina absorbible para generar hipertrofia hepática y permitir la hepatectomía derecha en pacientes con tumores hepáticos e hígado remanente futuro insuficiente. Materiales y métodos: Entre marzo de 2002 y abril de 2014, en 18 pacientes candidatos a hepatectomía derecha se realizó EPH con lipiodol y esponja de gelatina absorbible mezclada con contraste yodado. La estimación de los volúmenes hepáticos preembolización se hizo por tomografía computada con contraste endovenoso. Los pacientes fueron abordados mediante punción percutánea bajo guía ecográfica, seguida de angiografía. El control de la hipertrofia con estimación del volumen se realizó a la cuarta semana posembolización y el seguimiento se llevó a cabo ambulatoriamente o mediante historia clínica. Resultados: La mediana de edad fue de 58 años (relación hombre/mujer de 1:0,8) y el volumen hepático total estimado (mediana) de 1587,75 cm³. La estimación previa del volumen hepático y su relación con la porción futura remanente pre-EPH fue de 19,9%, mientras que el promedio absoluto de crecimiento del parénquima hepático remanente futuro pos-EPH se encontró entre los 306,2 y 475,2 cm³, con un 43,5% de aumento. La mediana de incremento de la relación volumen hepático total y la porción remanente pos-EPH fue de 8,5% (p< 0,001). Como complicaciones, se registró un hematoma y una necrosis aséptica. Conclusión: La EPH con lipiodol y esponja de gelatina absorbible es un procedimiento seguro y efectivo, que surge como alternativa a otros materiales de embolización.

Objective: To evaluate outcomes of preoperative hepatic portal vein embolisation with lipiodol and absorbable gelatin in order to generate liver hypertrophy and enable right hepatectomy in selected patients with liver tumours and future insufficient residual liver. Materials and methods: Portal vein embolisation (PVE) with lipiodol and absorbable gelatin sponge mixed with iodine based contrast was performed in 18 patient candidates for right hepatectomy between March 2002 and April 2014. The preembolisation liver volume evaluations were performed by computed tomography with intravenous contrast. Patients underwent an ultrasound-guided percutaneous puncture, followed by angiography. The controls of hypertrophy and volume estimation were performed in the 4 th week after portal embolisation. The patients were followed-up on an outpatient basis or by using their medical records. Results: The median age was 58 years, with a 1:0.8 male: female ratio. The total estimated liver volume, excluding the tumour, of all patients evaluated prior to surgery was 1587.75 cm³ (median). The previous estimated liver volume and its relation to the future remaining portion before PVE was 19.9%. The absolute median growth of future residual liver parenchyma post-PVE was 306.2 to 475.2 cm³, being an increase of 43.5%, and the mean growth of liver volume and remaining portion ratio post-PVE was 8.5% (P<.001). Complications were one haematoma and one aseptic necrosis. Conclusión: The selection of patients is of paramount importance, and PVE with lipiodol and absorbable gelatin in our environment is a safe and effective procedure.

Comparative study on the efficacy and safety of interventional therapy of uterine fibroid using Embosphere and Pingyangmycin lipiodol emulsion / 实用放射学杂志

Objective To observe the curative effect and safety of interventional therapy of uterine fibroids using Embosphere and Pingyangmycin lipiodol emulsion.Methods The clinical data of 120 cases with uterine fibroids treated in our hospital were reviewed,and the patients were according to the different treatments given,divided into two groups (each with 60 cases).Patients in control group were treated with interventional therapy of Pingyangmycin lipiodol emulsion,while patients in the study group were given interventional therapy of Embosphere.The clinical efficacy and safety in the two groups were compared.Results The total efficiency in the study group was 93.33%,which was significantly higher than that in the control group (75.00%),and the difference was statistically significant (P<0.05).The comprehensive indexes after the treatment were improved in both groups compared with those before the treatment,and the improvement in the study group was significantly better than the control group (P<0.05,P<0.01).Besides,the total incidence of adverse effects in the study group was 11.67%,which was significantly lower than that in the control group (26.67%)(P<0.05). Conclusion The interventional therapy using Embosphere has better effect on uterine fibroid compared with the therapy using Pingyangmycin lipiodol emulsion,which is worthwhile to be brought into clinical application.

MRI Findings of Lipiodol Uptake in Hepatocellular Carcinomas: A Focus on Signal Intensity / 이화의대지

OBJECTIVES: To evaluate MRI findings of non-recurrent hepatocellular carcinomas with lipiodol uptake (LHCCs) treated with transarterial chemoembolization. METHODS: 28 LHCCs were divided into two groups according to amount of lipiodol uptake and tumor size, retrospectively. According to amount of lipiodol uptake, HCCs were classified into group A with dense lipiodol uptake (more than 90%) and group B with partial lipiodol uptake (between 50% and 90%). For HCC size analysis, group I was defined by a longest diameter of less than 2 cm, and group II was defined by a longest diameter of greater than or equal to 2 cm. RESULTS: In group A (n=16), eight LHCCs showed high signal intensity (SI) on T2-weighted images (T2WI), ten LHCCs showed low SI on T1-weighted imaged (T1WI), six LHCCs showed decreased SI at higher b value of diffusion-weighted images (DWI). In group B (n=12), six LHCCs revealed high SI on T2WI, six LHCCs revealed low SI on T1WI, ten LHCCs decreased SI at higher b value of DWI. As compared with tumor size and SI, six of 12 LHCCs in group I and eight of 16 LHCCs in group II showed high SI on T2WI. Six LHCCs in group I and ten LHCCs in group II showed low SI on T1WI. All LHCCs were not enhanced. CONCLUSION: Signal intensities of LHCCs were variable, but more than half of LHCCs showed high SI on T2WI, low SI on T1WI, decreased SI at higher b value of DWI, regardless of lipiodol uptake or tumor size.

Intratumoral injection of emulsion with hot lipiodol and pirarubicin for treatment of liver metastases lack of blood supply / 实用放射学杂志

Objective To explore the efficacy of percutaneous intratumoral injection of mixed emulsion with hot lipiodol and pira-rubicin for treatment of liver metastases lack of blood supply.Methods 12 patients with liver metastases,confirmed by the clinical and pathological examination,were treated by intratumoral injection of mixed emulsion with heating lipiodol and pirarubicin using 21G biliary needle under CT guidance.The adverse events were recorded and the treatment efficacy was also assessed according to the imaging findings.Results 8 patients achieved a partial remission of lesions,and 3 ones had stable condition.No serious adverse reactions occurred.Conclusion It is effective,simple,convenient and safe for treatment of liver metastases lack of blood supply with percutaneous intratumoral injection of emulsion with hot lipiodol and pirarubicin.

An A to Z of Lipiodol Beyond the Clinical Practice in the Management of Hepatocellular Carcinoma

Lipiodol based conventional transarterial chemoembolization (TACE) is a standard of care for unresectable, non-invasive, and multinodular Hepatocellular carcinoma (HCC)s. The procedure relies on the intra-arterial administration of lipiodol/cytotoxic agent emulsion followed by the infusion of embolic material. Lipiodol, with its oily nature and radiopacifying properties, is in the center of the TACE procedure. Unstability and unpredictable therapeutic effect of hydrophilic cytotoxic drugs emulsified in the lipiodol and technical problems lie beyond the control of clinicians. Thus, interest in the properties and respective roles for lipiodol in the management of HCC is essential for the clinicians.

CT Perfusion Imaging Can Predict Patients' Survival and Early Response to Transarterial Chemo-Lipiodol Infusion for Liver Metastases from Colorectal Cancers

OBJECTIVE: To prospectively evaluate the performance of computed tomography perfusion imaging (CTPI) in predicting the early response to transarterial chemo-lipiodol infusion (TACLI) and survival of patients with colorectal cancer liver metastases (CRLM). MATERIALS AND METHODS: Computed tomography perfusion imaging was performed before and 1 month after TACLI in 61 consecutive patients. Therapeutic response was evaluated on CT scans 1 month and 4 months after TACLI; the patients were classified as responders and non-responders based on 4-month CT scans after TACLI. The percentage change of CTPI parameters of target lesions were compared between responders and non-responders at 1 month after TACLI. The optimal parameter and cutoff value were determined. The patients were divided into 2 subgroups according to the cutoff value. The log-rank test was used to compare the survival rates of the 2 subgroups. RESULTS: Four-month images were obtained from 58 patients, of which 39.7% were responders and 60.3% were non-responders. The percentage change in hepatic arterial perfusion (HAP) 1 month after TACLI was the optimal predicting parameter (p = 0.003). The best cut-off value was -21.5% and patients who exhibited a > or = 21.5% decrease in HAP had a significantly higher overall survival rate than those who exhibited a < 21.5% decrease (p < 0.001). CONCLUSION: Computed tomography perfusion imaging can predict the early response to TACLI and survival of patients with CRLM. The percentage change in HAP after TACLI with a cutoff value of -21.5% is the optimal predictor.

Arterial embolization of massive hepatocellular carcinoma with lipiodol and gelatin sponge.

BACKGROUND: Transarterial chemoembolization (TACE) has been used to treat unresectable massive hepatocellular carcinoma (HCC). Lots of embolic agents have been applied in embolization because of it can decrease patient discomfort and side‑effects. AIM: The aim was to evaluate the clinical efficacy and safety of TACE with lipiodol and gelatin sponge. MATERIALS AND METHODS: A total of 109 patients with massive HCC (the size of tumor >10 cm and unresectable) from January 2011 to August 2014 in our institution was divided into group A and group B based on the different embolitic agents. Before and about 1‑month after each case of TACE, clinical and biological data such as tumor size, child‑pugh stage, serum Alpha‑fetoprotein (AFP), complications, were recorded at the same time. RESULTS: In group A, the diameter of the tumor reduced from 12.57 ± 1.26 cm to 9.04 ± 0.89 cm. No patient was complete response (CR), partial response (PR) 36, stable disease (SD) 7 and PD 6; in group B, the diameter of tumor decreased from 12.08 ± 1.42 cm to 8.43 ± 1.05 cm, CR 0, but PR 27, SD 18 and PD 15. RR in group A was significantly higher than in group B (P < 0.05).The change of child‑pugh stage and AFP pre‑ and post‑operative in group A can be found significantly better than in group B. CONCLUSIONS: TACE with lipiodol and gelatin sponge is a highly effective for massive HCC.

TACE combined with injection of hyper-thermic lipiodol into tumor body for the treatment of large hepatic carcinoma / 介入放射学杂志

Objective To investigate the clinic effects of transcatheter arterial chemoembolization (TACE) combined with injection of hyper- thermic lipiodol into tumor body in treating large hepatic carcinoma. Methods A total of 86 patients with primary hepatic carcinoma were randomly and equally divided into the study group (n = 43) and control group (n = 43). TACE combined with injection of hyper-thermic lipiodol into tumor body was carried out in the patients of the study group , while only TACE was performed in the patients of the control group. The results were compared between the two groups. Results The effective rate of the study group and the control group was 68%and 53%respectively , and the difference between the two groups was statistically significant. The difference in the changes of tumor size after the treatment between the two groups was also statistically significant. In the study group, the survival rates at 6, 12, 18 and 24 months after the treatment were 100% (n = 43), 84% (n = 36), 53% (n = 23) and 33%(n=14) respectively, while in the control group the survival rates were 94% (n=40), 70% (n=30), 37%(n = 16) and 21%(n = 9) respectively. No statistically significant differences in postoperative liver function damage existed between the two groups. Conclusion TACE combined with injection of hyper-thermic lipiodol into tumor body is obviously superior to routine TACE in treating large hepatic carcinoma.

Lipiodol-induced pneumonitis following transarterial chemoembolization for ruptured hepatocellular carcinoma / 영남의대학술지

Transarterial chemoembolization (TACE) is a widely accepted nonsurgical modality used for the treatment of multinodular hepatocellular carcinoma (HCC). The careful selection of the candidate is important due to the risk of developing various side effects. Fever, nausea, abdominal pain, and liver enzyme elevation are commonly known side effects of TACE. Hepatic failure, ischemic cholecystitis, and cerebral embolism are also reported, although their incidence might be low. Pulmonary complication after TACE is rare, and the reported cases of lipiodol pneumonitis are even rarer. A 53-year-old man was treated with TACE for ruptured HCC associated with hepatitis B virus infection. On day 19 after the procedure, the patient complained of dyspnea and dry cough. Chest computed tomography showed diffuse ground glass opacities in the wholelung fields, suggesting lipiodol-induced pneumonitis. After 2 weeks of conservative management, the clinical symptoms and radiologic abnormalities improved. Reported herein is the aforementioned case of lipiodol-induced pnemonitis after TACE, with literature review.