Clinical Uses and Short-Term Safety Profile of Ethiodized Poppy Seed Oil Contrast Agent in the Diagnosis and Treatment of Vascular Anomalies and Tumors.

Robert K Clemens,Ahmad I Alomari,Cindy Kerr,Tim Sebastian

doi:10.3390/diagnostics11101776

Abstract

Background: There is a sparsity of data on the use of ethiodized poppy seed oil (EPO) contrast agent (Lipiodol) in patients. We investigated the safety of EPO in children, adolescents, and some adults for diagnostic and therapeutic interventions. Methods: All patients who underwent procedures with EPO between 1995 and 2014 were retrospectively included. Demographic characteristics, diagnosis, dose, route of administration, preparation of EPO in combination with other agents, and complications were recorded. Results: In 1422 procedures, EPO was used for diagnostic or treatment purposes performed in 683 patients. The mean patient age was 13.4 years (range: 2 months–50 years); 58% of patients were female. Venous malformations (n = 402, 58.9%) and arteriovenous malformations (n = 60, 8.8%) were the most common diagnosis. Combined vascular anomalies included capillary–lymphatic–venous malformations, fibroadipose vascular anomalies (n = 54, 7.9%), central conducting lymphatic anomalies (n = 31, 4.5%), lymphatic malformations (n = 24, 3.5%), aneurysmal bone cysts (n = 22, 3.2%), and vascularized tumors (n = 11, 1.6%). In 1384 procedures (96%), EPO was used in various combinations with sclerosing and embolization agents, including sodium tetradecyl sulfate, ethanol, and glue. The mean volume of EPO used in interventions was 3.85 mL (range: 0.1–25 mL) per procedure with a mean patient weight of 45.9 kg (range: 3.7–122.6 kg) and a weight-adjusted dose of 0.12 mL/kg (range: 0.001–1.73 mL/kg). In 56 procedures (4%), EPO was used as a single agent for diagnostic lymphangiography. The mean volume was 4.8 mL (range: 0.3–13 mL) per procedure with a mean patient weight of 27.4 kg (range: 2.4–79.3 kg) and a weight-adjusted dose of 0.2 mL/kg (range: 0.04–0.54 mL/kg). Procedural-related complications occurred in 25 (1.8%) procedures. The 20 minor and 5 major complications were related to the primary treatment agents. None of them were directly related to EPO. No allergic reactions were noted. Conclusion: The use of an ethiodized poppy seed oil contrast agent in children, adolescents, and adults for diagnostic or therapeutic purposes is safe.

Highlights

Sclerotherapy refers to the treatment of slow-flow malformation, and embolization refers to the treatment of high-flow malformation and hypervascular lesions regardless of the agents used
The most common diagnosis documented in 402 patients (58.9%) was venous malformation, followed by arteriovenous malformations in 60 patients (8.8%)
In 56 procedures (4%), ethiodized poppy seed oil (EPO) was used as the contrast agent for diagnostic lymphangiography

Summary

Introduction

Ethiodized poppy seed oil (EPO) has been used for various diagnostic and therapeutic purposes for over a century [1,2]. Lipiodol (Lipiodol Ultrafluide, Laboratoire Guerbet, Aulnay-Sous-Bois, France), which was approved by the FDA in 1954, is currently the only. FDA-approved oil-based contrast agent in the US market following the discontinuation of Ethiodol (Savage Laboratories, Melville, NY, USA) in 2010. Ethiodized poppy seed oil contrast agent is supplied as clear, pale yellow to amber-colored oil in sterile 10 mL vials. The viscous liquid contains 480 mg/mL of iodine organically combined with ethyl esters of fatty acids of poppy seed oil. Due to its high viscosity and dense radiopacity, approved indications for the use of EPO include lymphangiography, hysterosalpingography, and intra-arterial imaging/treatment of hepatocellular carcinoma [4,5,6]. EPO is considered a standard treatment for unexplained and endometriosis-related infertility [7,8], but the dosage of EPO should be as low as possible to minimize the risk of fetal or neonatal thyroid dysfunction [9]

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Discussion

Conclusion