ARRS 2022 Abstracts

RETURN TO ABSTRACT LISTING


E2028. Slower Than Molasses: A Current Review of the Diagnostic and Therapeutic Uses of Lipiodol
Authors
  1. Brandon Rodgers; The Ohio State University Wexner Medical Center
  2. Robert Moranville; The Ohio State University Wexner Medical Center
  3. Marc Fromherz; Carilion Roanoke Memorial Hospital
  4. Michael Cline; The Ohio State University Wexner Medical Center
  5. Mina Makary; The Ohio State University Wexner Medical Center
Background
The radiological application of Lipiodol began in 1921, when its radiopaque properties were first discovered and utilized during the first myelogram. Since this initial application, Lipiodol has been used as a contrast agent for a myriad of imaging techniques, some of which include hysterosalpingography, urethrography, or lymphangiography. Its role in diagnostic imaging has since expanded, and newer theragnostic and therapeutic applications have been discovered. Although the exact mechanisms are unknown, Lipiodol exhibits unique properties that preferentially select for tumors. Combining this preferential selection and its radiopaque features, interventional radiologists have used Lipiodol in combination with cytotoxic drugs to combat hepatocellular carcinoma (HCC), colorectal cancer liver metastases (CRLM), angiomyolipomas (AML), pancreatic tumors, and much more. Recently, its application as a diagnostic and therapeutic agent in lymphatic pathologies including chylothorax, chylous ascites, lymphoceles, and lymphatic leakages, has drastically increased. Lymphangiography can be completed under ultrasound or fluoroscopic guidance as well as direct nodal visualization with the assistance of dye. Following its injection, Lipiodol slowly traverses the lymphatic vessels and allows for pathological visualization and also has direct therapeutic effects stemming from its ability to concentrate at aberrant sites causing inflammatory reactions that close off these vessels. For severe lymphatic cases, Lipiodol can be mixed with embolic or cytotoxic agents to ensure precise delivery and treatment. Recent innovative techniques such as thoracic duct stenting and externalization have also been developed for the treatment of chylothorax or complications stemming from portal hypertension that offer improved morbidity rates when compared to traditional thoracic duct embolization.

Educational Goals / Teaching Points
After viewing this exhibit, the learner will be able to understand the historical use of Lipiodol as both a diagnostic and therapeutic tool within radiology. With the aid of current evidence-based guidelines, they will be able to describe the current applications of Lipiodol for various pathologies, the different imaging and procedural techniques required for its utilization, and future applications it may have based on current research.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
As a contrast agent, Lipiodol is used as a diagnostic and therapeutic tool throughout the body; therefore, this review will cover various imaging modalities used for its administration and visualization, including ultrasound, MRI, CT, and fluoroscopy. This review will also cover the relevant vascular and lymphatic anatomy as it pertains to Lipiodol’s treatment of various tumors and lymphatic pathology.

Conclusion
The historical use of Lipiodol as a diagnostic and therapeutic agent is vast. With the emergence of new applications for Lipiodol and innovative techniques within interventional radiology, this exhibit aims to improve awareness and potential utilization of Lipiodol-based imaging and treatment.