Lipiodol Deposition and Washout in Primary and Metastatic Liver Tumors After Chemoembolization

Abstract

Background/Aim: Lipiodol is the key component of conventional trans-arterial chemoembolization. Our aim was to evaluate lipiodol deposition and washout rate after conventional trans-arterial chemoembolization in intrahepatic cholangiocarcinoma and hepatic metastases originating from neuroendocrine tumors and colorectal carcinoma. Patients and Methods: This was a retrospective analysis of 44 patients with intrahepatic cholangiocarcinoma and liver metastasis from neuroendocrine tumors or colorectal carcinoma who underwent conventional trans-arterial chemoembolization. Lipiodol volume (cm 3 ) was analyzed on non-contrast computed tomography imaging obtained within 24 h post conventional trans-arterial chemoembolization, and 40-220 days after conventional trans-arterial chemoembolization using volumetric image analysis software. Tumor response was assessed on contrast-enhanced magnetic resonance imaging 1 month after conventional trans-arterial chemoembolization.Results: The washout rate was longer for neuroendocrine tumors compared to colorectal carcinoma, with half-lives of 54.61 days (p<0.00001) and 19.39 days (p<0.001), respectively, with no exponential washout among intrahepatic cholangiocarcinomas (p=0.83). The half-life for lipiodol washout was longer in tumors larger than 300 cm 3 compared to smaller tumors (25.43 vs. 22.71 days). Lipiodol wash out half-life was 54.76 days (p<0.01) and 29.45 days (p<0.00001) for tumors with a contrast enhancement burden of 60% or more and less than 60%, respectively. A negative exponential relationship for lipiodol washout was observed in nonresponders (p<0.00001). Conclusion: Lipiodol washout is a time-dependent process, and occurs faster in colorectal carcinoma tumors, tumors smaller than 300 cm 3 , tumors with baseline contrast enhancement burden of less than 60%, and non-responding target lesions.Lipiodol is the key component of conventional trans-arterial chemoembolization (cTACE) for primary and metastatic liver tumors (1, 2). This agent serves as a tumor-seeking, embolic and drug carrier agent, and is used in combination with chemotherapy for cTACE (3). In addition, the radiopacity of lipiodol helps to easily visualize and track it (4, 5). It has been shown that lipiodol retention in the treated tumor is related to tumor necrosis (6). Therefore, it could be considered as an imaging surrogate for response (7). While there are different one-dimensional (1D), two-dimensional 3261 This article is freely accessible online.

Intraarterial Therapies for the Management of Hepatocellular Carcinoma

“…A study conducted by Miszczuk et al reports that lipiodol can be a potential imaging biomarker after cTACE for tumor response. Patients with a higher overall lipiodol coverage showed higher response rates ( p < 0.05) upon 30-day follow-up imaging studies [ 164 , 165 , 166 , 167 ]. Although the mainstay of tumoral response evaluation is currently the assessment of imaging response (such as with mRECIST) and chemical biomarker response (AFP), precision-medicine-based studies have recently gained momentum, thus allowing clinicians to individualize treatment plans based on genomics [ 168 ].…”

Research Progress on the Prediction of TACE Efficacy by Lipiodol Deposition

“…Therefore, TACE selectively targets the tumor-feeding arteries to deliver chemotherapy agents, thereby achieving local treatment of the tumor while minimizing damage to normal liver tissue. tissues [20]. In contrast, lipiodol deposited in tumor tissues may be consumed by tumor cells that maintain a differentiated state and retain the ability to consume foreign substances.…”

“…In cases where tumors invade the blood flow pathway in the liver, hepatic arteriovenous fistulas (HAVFs) may occur, which can not only cause portal hypertension but also increase the chances of tumor cell dissemination to distant organs. In interventional therapy, hemodynamic changes caused by abnormal shunting can directly affect the efficacy of TACE, and lipiodol can even cause pulmonary and systemic embolism through abnormal shunt pathways [20].…”

CT-guided biopsies of unspecified suspect intrahepatic lesions: pre-procedure Lipiodol-marking improves the biopsy success rate

“…[12][13][14] Intravenous contrast is promptly washed out of the lesion and liver parenchyma and may not allow sufficient differentiation during the entire examination. 15,16 In comparison, Lipiodol is interventionally administered intra-arterial during angiography and provides a long-lasting uptake (Lipiodol washout half-life 29 to 55 days 17 ) in the lesion or perilesional altered tissue during the complete intervention. 12,18 A novel approach uses fusion imaging, ultrasound, or real-time fluoroscopy synchronized with previously acquired contrast-enhanced CT or MRI images to delineate the lesion during the intervention.…”