Ultravist 300

Hepatic tumors were treated with an emulsion of a chemotherapeutic agent and an embolic agent diluted with iodized contrast (Ultravist 300, Bayer Vital GmbH, Leverkusen, Germany). For HCCs, a combination of doxorubicin and ethiodized oil (Lipiodol, Guerbet LLC, Bloomington, IN, USA) was used. Liver metastases from colorectal, gastric or pancreatic cancer were treated using a chemotherapeutic agent in accordance with the respective guidelines as well as degradable starch microspheres (EmboCept S, PharmaCept GmbH, Berlin, Germany) or drug eluting beads (DcBeads, BTG International Ltd, London, UK). TACE procedures were conducted via the right femoral artery. A hepatography and a contrast-enhanced cone-beam computed tomography (CT) scan in late arterial contrast phase were performed using a distinct microcatheter. Depending on the tumor type and the number, size, localization and arterial supply of the tumor, a superselective (subsegmental), selective (segmental) or non-selective (lobar) approach was performed.

Iopromide 300 mgI/mL (Ultravist 300, Bayer Vital GmbH, Leverkusen, Germany) and an injection system with an approved DualFlow option (MEDRAD^® Centargo, Bayer U.S. LLC, Indianola, PA, USA) were used for all injection protocols. The iodine dose was adapted by body weight using a dosing factor of 500 mgI/kg for 120 kV SF, and a 40% reduced iodine dose of 300 mgI/kg for 80 kV protocols. The CM was preheated to 37 °C and injected according to the protocols summarized in Table 2.

Patients fasted at least 6 h (demanded glucose level <160 mg/dL). Prior to the injection of approximately 250 MBq ¹⁸F-FDG whole-body, ¹⁸F-FDG-PET/CT images were acquired using a Biograph 64 TruePoint w/TrueV and Biograph mCT Flow 20-4R PET/CT scanner (Siemens, Healthcare GmbH, Erlangen, Germany) and were initiated approximately 60 min after intravenous tracer administration. After intravenous injection of a contrast agent (Ultravist 300, Bayer Vital GmbH, Leverkusen, Germany or Imeron 350, 2.5 mL/s, Bracco Imaging Deutschland GmbH, Konstanz, Germany) diagnostic CT scans of the neck, thorax, abdomen and pelvis (100–190 mAs; 120 kV) were acquired.
To depict the venous phase, initiation of CT acquisition was delayed 90 s after injection of the contrast agent.

Splenic arteriography was performed on a biplane digital subtraction angiography (DSA) system (Philips Allura™, Philips Healthcare, Best, Netherlands or Toshiba Infinix DP-i, Toshiba Medical Systems, Tokio, Japan) via femoral artery access. Using a 5-French guiding catheter (Cobra 2, Sidewinder 1, or Sidewinder 2, Terumo Europe, Leuven, Belgium) contrast agent (Ultravist 300, Bayer Vital, Leverkusen, Germany) was administered in a dose of 15cc and an injection rate of 5cc / s utilizing an automatic injector (Medrad, Bayer Vital, Leverkusen, Germany). A microcatheter (Renegade, Boston Scientific, Natick, MA, USA; Rebar 18 or 27, Medtronic Inc., Minneapolis, MN, USA) was used to advance into the spleen vessels. Aiming to embolize 60% of the caudal pole of the spleen, peripheral branches were selectively cannulated and permanently occluded by coilembolization (IDC coils, Boston Scientific, Natick, MA, USA) or using Histoacryl (Braun Melsungen, Germany). Finally, angiography using the 5-French catheter was performed to document the result (Fig 1). Peri-interventional antibiotic prophylaxis was given with broad-spectrum antibiotics prior to the procedure and for two weeks post-procedural. Post-interventional CT scan was performed to document the immediate results (Fig 2).

The vascular access was via the femoral artery for all angiographic procedures, which were performed by a single interventional radiologist with more than 13 years of experience in interventional procedures. The intra-arterial contrast was injected manually in all cases. Depending on the location of the pathology, antegrade- or retrograde crossover approaches were decided by the angiographer. The diagnostic angiograms were performed with a 5F sheath/catheter, and interventions were performed with a 6F sheath. The angiographer judged contrast (Ultravist 300, Bayer Vital GmbH) volumes individually, where a dilution of 3:2 was commonly used. All procedures were performed in the angiography suite of the hospital (30 × 40 cm detector, Siemens Artis Zee, Siemens Healthineers AG, Erlangen, Germany) with standard image acquisition protocols for lower-limb angiography (2 frames/second). The angiograms were acquired in different angulations in the presence of implants to allow better visualization of blood vessels. The image acquisition was identical for DSA and DVA, whereas the post-processing of both these images from the same non-subtracted image series was different.