Contrast media-doped hydrodissection during thermal ablation: optimizing contrast media concentration for improved visibility on CT images.

OBJECTIVE The purpose of this study is to determine a concentration of iodinated contrast media in saline and 5% dextrose in water (D5W) for organ hydrodissection, a technique used to physically separate and protect tissues adjacent to thermal ablations. MATERIALS AND METHODS A total of 28 samples were prepared from 1:1000-1:1 iohexol or iothalamate meglumine contrast media in either normal saline or D5W. Samples alone or juxtaposed with a homogeneous liver-mimicking phantom were imaged by CT using 80-120 kVp and 10-300 mAs. Mean CT numbers and noise were measured from the fluid, background air, phantom adjacent to the fluid, and phantom distant from the fluid. Visibility was determined from the contrast-to-noise ratio between the fluid and phantom, whereas streaking artifact was quantified by relative noise in the phantom. Measures were individually fit using multiple linear regression to determine an optimal contrast-to-fluid ratio for increased visualization without streaking. Contrast media- and blood-doped saline and D5W were also tested to determine whether such doping altered their electrical conductivity. RESULTS Iohexol concentration most influenced CT number; volumetric ratios of 1:1000-1:1 produced 20 HU to over 3000 HU. CT numbers were weakly dependent on x-ray tube voltage, whereas contrast-to-noise ratio and streaking artifacts were somewhat dependent on tube output. An optimal ratio of iohexol in fluid was determined to be 1:50. There was no significant difference between the electrical impedances of doped and pure saline or D5W (p > 0.5, all cases). CONCLUSION A 1:50 ratio of iohexol in saline or D5W provides an optimal combination of increased visibility on CT without streaking artifacts.

[1]  D. Breen,et al.  No-touch wedge ablation technique of microwave ablation for the treatment of subcapsular tumors in the liver. , 2013, Journal of vascular and interventional radiology : JVIR.

[2]  J. McGahan Challenges in abdominal/pelvic biopsy techniques , 2013, Abdominal Imaging.

[3]  D. Gervais,et al.  Imaging-guided adrenal tumor ablation. , 2013, AJR. American journal of roentgenology.

[4]  M. Beland,et al.  Utility of iodinated contrast medium in hydrodissection fluid when performing renal tumor ablation. , 2010, Journal of vascular and interventional radiology : JVIR.

[5]  D. Gervais,et al.  Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. , 2009, AJR. American journal of roentgenology.

[6]  M. Davies,et al.  Bowel displacement for CT-guided tumor radiofrequency ablation: techniques and anatomic considerations. , 2009, Journal of endourology.

[7]  W. Lau,et al.  The Current Role of Radiofrequency Ablation in the Management of Hepatocellular Carcinoma: A Systematic Review , 2009, Annals of surgery.

[8]  T. Winter,et al.  Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses. , 2008, AJR. American journal of roentgenology.

[9]  Paolo Bianchi,et al.  Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: A multivariate analysis , 2007, Journal of Gastrointestinal Surgery.

[10]  B. Wood,et al.  Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors. , 2006, Journal of vascular and interventional radiology : JVIR.

[11]  T. Winter,et al.  Radiofrequency ablation of peripheral liver tumors: intraperitoneal 5% dextrose in water decreases postprocedural pain. , 2006, AJR. American journal of roentgenology.

[12]  T. Winter,et al.  Unintended thermal injuries from radiofrequency ablation: protection with 5% dextrose in water. , 2006, AJR. American journal of roentgenology.

[13]  H. Rhim,et al.  Radiofrequency ablation of the liver in a rabbit model: creation of artificial ascites to minimize collateral thermal injury to the diaphragm and stomach. , 2006, Journal of vascular and interventional radiology : JVIR.

[14]  C. Brace,et al.  Electrical isolation during radiofrequency ablation: 5% dextrose in water provides better protection than saline , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[15]  S Nahum Goldberg,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria. , 2005, Radiology.

[16]  T. Winter,et al.  Use of dextrose 5% in water instead of saline to protect against inadvertent radiofrequency injuries. , 2005, AJR. American journal of roentgenology.

[17]  W. Lees,et al.  CT Mapping of the Distribution of Saline During Radiofrequency Ablation with Perfusion Electrodes , 2005, CardioVascular and Interventional Radiology.

[18]  J. Charboneau,et al.  Hypertensive Crisis in a Patient Undergoing Percutaneous Radiofrequency Ablation of an Adrenal Mass Under General Anesthesia , 2004, Anesthesia and analgesia.

[19]  R. Zagoria Imaging-guided radiofrequency ablation of renal masses. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[20]  A. Siriwardena,et al.  Radiofrequency ablation of liver tumours: systematic review. , 2004, The Lancet Oncology.

[21]  D. Lu,et al.  Minimizing diaphragmatic injury during radiofrequency ablation: efficacy of intraabdominal carbon dioxide insufflation. , 2004, AJR. American journal of roentgenology.

[22]  C. Angeletti,et al.  Radiofrequency Ablation of Lung Malignancies: Where Do We Stand? , 2004, CardioVascular and Interventional Radiology.

[23]  S. Solomon,et al.  Thermal protection during radiofrequency ablation. , 2004, AJR. American journal of roentgenology.

[24]  C. Bartolozzi,et al.  CT-guided radiofrequency ablation of osteoid osteoma: long-term results , 2004, European Radiology.

[25]  D. Blankenbaker,et al.  Radiofrequency ablation in the musculoskeletal system. , 2004, Seminars in roentgenology.

[26]  M. Blute,et al.  Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. , 2003, AJR. American journal of roentgenology.

[27]  K. Takeda,et al.  Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition. , 2003, Journal of vascular and interventional radiology : JVIR.

[28]  Luigi Solbiati,et al.  Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. , 2003, Radiology.

[29]  Cheol Min Park,et al.  Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[30]  S. Goldberg,et al.  Colonic perforation and abscess following radiofrequency ablation treatment of hepatoma. , 2002, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[31]  D. Lu,et al.  Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model. , 2002, Radiology.

[32]  L. Swanstrom,et al.  Radiofrequency ablation lesions in a pig liver model. , 1999, The Journal of surgical research.