First Human Experience with Directly Image-able Iodinated Embolization Microbeads

Cardiovasc Intervent Radiol. 2016 Aug;39(8):1177-86. doi: 10.1007/s00270-016-1364-8. Epub 2016 May 20.

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.

Keywords: Embolization; Hepatic; Image-able.

Publication types

  • Case Reports

MeSH terms

  • Acrylic Resins / therapeutic use
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / therapy*
  • Cone-Beam Computed Tomography / methods
  • Embolization, Therapeutic / methods*
  • Fluoroscopy
  • Humans
  • Liver / diagnostic imaging
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / therapy*
  • Male
  • Microspheres
  • Middle Aged
  • Polyvinyl Alcohol / therapeutic use
  • Treatment Outcome

Substances

  • Acrylic Resins
  • polyvinyl alcohol hydrogel
  • Polyvinyl Alcohol
  • Radio-Opaque acrylic resin