First Human Experience with Directly Image-able Iodinated Embolization Microbeads

Elliot B. Levy, Venkatesh P. Krishnasamy, Andrew L. Lewis, Sean Willis, Chelsea Macfarlane, Victoria Anderson, Imramsjah M.J. van der Bom, Alessandro Radaelli, Matthew R. Dreher, Karun V. Sharma, Ayele Negussie, Andrew S. Mikhail, Jean Francois H. Geschwind, Bradford J. Wood

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To describe first clinical experience with a directly image-able, inherently radio-opaque microspherical embolic agent for transarterial embolization of liver tumors. Methodology: LC Bead LUMI™ is a new product based upon sulfonate-modified polyvinyl alcohol hydrogel microbeads with covalently bound iodine (~260 mg I/ml). 70–150 μ LC Bead LUMI™ iodinated microbeads were injected selectively via a 2.8 Fr microcatheter to near complete flow stasis into hepatic arteries in three patients with hepatocellular carcinoma, carcinoid, or neuroendocrine tumor. A custom imaging platform tuned for LC LUMI™ microbead conspicuity using a cone beam CT (CBCT)/angiographic C-arm system (Allura Clarity FD20, Philips) was used along with CBCT embolization treatment planning software (EmboGuide, Philips). Results: LC Bead LUMI™ image-able microbeads were easily delivered and monitored during the procedure using fluoroscopy, single-shot radiography (SSD), digital subtraction angiography (DSA), dual-phase enhanced and unenhanced CBCT, and unenhanced conventional CT obtained 48 h after the procedure. Intra-procedural imaging demonstrated tumor at risk for potential under-treatment, defined as paucity of image-able microbeads within a portion of the tumor which was confirmed at 48 h CT imaging. Fusion of pre- and post-embolization CBCT identified vessels without beads that corresponded to enhancing tumor tissue in the same location on follow-up imaging (48 h post). Conclusion: LC Bead LUMI™ image-able microbeads provide real-time feedback and geographic localization of treatment in real time during treatment. The distribution and density of image-able beads within a tumor need further evaluation as an additional endpoint for embolization.

Original languageEnglish (US)
Pages (from-to)1177-1186
Number of pages10
JournalCardiovascular and interventional radiology
Volume39
Issue number8
DOIs
StatePublished - Aug 1 2016

Keywords

  • Embolization
  • Hepatic
  • Image-able

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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