Techniques to Form a Suitable Lipiodol-Epirubicin Emulsion by Using 3-Way Stopcock Methods in Transarterial Chemoembolization for Liver Tumor

J Vasc Interv Radiol. 2017 Oct;28(10):1461-1466. doi: 10.1016/j.jvir.2017.03.032. Epub 2017 May 11.

Abstract

Purpose: To compare physicochemical properties of emulsions of ethiodized oil (Lipiodol; Guerbet, Villepinte, France) and epirubicin prepared using different techniques for conventional transarterial chemoembolization.

Materials and methods: Lipiodol was mixed with epirubicin solution (8.33 mg/mL) by using a 3-way stopcock. The following technical parameters were compared: ratio of epirubicin solution to Lipiodol (1:2 vs 1:1), number of pumping exchanges through the stopcock (20 exchanges vs 10 exchanges), pumping speed (1 s/push vs 2 s/push), and first push syringe (epirubicin solution vs Lipiodol).

Results: The mean percentage of water-in-oil was 70.45 ± 1.51 in the 1:2 epirubicin-Lipiodol ratio and 16.03 ± 2.95 in the 1:1 ratio (P < .001). The first push syringe did not influence emulsion type. Median droplet sizes were significantly larger in the slower pumping speed (52.0 μm in 2 s vs 33.7 μm in 1 s; P < .001), whereas there was no significant difference in number of pumping exchanges. Droplet sizes enlarged during 30 minutes after pumping. Viscosity was lower in the 1:1 ratio and the slower pumping speed. Viscosity decreased during 30 minutes after pumping.

Conclusions: The ratio of epirubicin to Lipiodol is a significant factor to form water-in-oil emulsions with higher viscosity. The percentage of water-in-oil is limited to 70% using current pumping techniques. The pumping speed strongly influences droplet size and viscosity.

MeSH terms

  • Antibiotics, Antineoplastic / chemistry*
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic / methods*
  • Contrast Media / chemistry
  • Emulsions / chemistry*
  • Epirubicin / chemistry*
  • Ethiodized Oil / chemistry*
  • Humans
  • Iopamidol / analogs & derivatives
  • Iopamidol / chemistry
  • Liver Neoplasms / therapy*
  • Treatment Outcome
  • Viscosity

Substances

  • Antibiotics, Antineoplastic
  • Contrast Media
  • Emulsions
  • iomeprol
  • Epirubicin
  • Ethiodized Oil
  • Iopamidol