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  • Title: Marking of small pulmonary nodules before thoracoscopic resection: injection of lipiodol under CT-fluoroscopic guidance.
    Author: Kawanaka K, Nomori H, Mori T, Ikeda K, Ikeda O, Tomiguchi S, Yamashita Y.
    Journal: Acad Radiol; 2009 Jan; 16(1):39-45. PubMed ID: 19064210.
    Abstract:
    RATIONALE AND OBJECTIVES: The aim of the present study was to examine the usefulness and record the complications of preoperative lipiodol marking using computed tomographic (CT) fluoroscopy for the intraoperative localization of 107 pulmonary nodules. METHODS: Lipiodol marking was performed under CT fluoroscopic guidance in 65 patients with 107 nodules. Of these, 65 (60.7%) were nodules with ground-glass opacity, and 42 were solid nodules on CT images. All nodules were marked with 0.3 to 0.5 mL lipiodol under CT fluoroscopic guidance 1 or 3 days before or on the day of surgery. At surgery, marked nodules were grasped with ring-shaped forceps under a C-arm fluoroscope and resected. Postoperatively, all 55 patients with malignant tumors (n = 78) were followed by computed tomography at 3-month intervals to detect needle tract or pleural recurrence. RESULTS: All 107 nodules were marked with lipiodol; under the C-arm fluoroscope, they appeared as radiopaque spots. On postprocedural computed tomography, pneumothorax occurred in 20 patients (31%); its incidence was higher in patients with lung emphysema surrounding the nodules (P = .09), three of whom required tube drainage. Computed tomography detected pulmonary hemorrhage in 10 patients (15%); it was more frequent in patients with deep than shallow nodules (>or=6 cm from the pleural surface and <6 cm from the pleural surface, respectively; P = .04). No patients presented with recurrence in needle tracts or on the pleural surface during a median postoperative follow-up of 14 months. CONCLUSION: Lipiodol marking under CT fluoroscopic guidance is a useful and safe procedure for the intraoperative localization of ground-glass opaque and/or small, deep, solid nodules.
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