Elliot B Levy1, Venkatesh P Krishnasamy2, Andrew L Lewis3, Sean Willis3, Chelsea Macfarlane3, Victoria Anderson2, Imramsjah Mj van der Bom4, Alessandro Radaelli5, Matthew R Dreher3, Karun V Sharma6, Ayele Negussie2, Andrew S Mikhail2, Jean-Francois H Geschwind7, Bradford J Wood2. 1. Center for Interventional Oncology, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA. levyeb@cc.nih.gov. 2. Center for Interventional Oncology, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, USA. 3. Biocompatibles, UK Ltd, A BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK. 4. Philips, Image Guided Interventions, Clinical Science IGT Systems North & Latin America, Philips, 2 Canal Park, Cambridge, MA, 02141, USA. 5. Philips, Image Guided Interventions, Image-Guided Therapy Systems, Philips, Veenpluis 4-6, 5680 DA, Best, The Netherlands. 6. Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA. 7. Department of Radiology and Biomedical Imaging, 330 Cedar Street, PO Box 208042, New Haven, CT, 06520, USA.
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.
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 BeadLUMI™ is a new product based upon sulfonate-modified polyvinyl alcohol hydrogel microbeads with covalently bound iodine (~260 mg I/ml). 70-150 μ LC BeadLUMI™ 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 BeadLUMI™ 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 BeadLUMI™ 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.
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