J Korean Med Sci.  2014 Jan;29(1):129-136. 10.3346/jkms.2014.29.1.129.

Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

• Jin KN
• Lee KW
• Kim TJ
• Song YS
• Kim DI

• KMID: 1796926
• DOI: http://doi.org/10.3346/jkms.2014.29.1.129

Abstract

Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.

Keyword

Lung; Ethiodized Oil; Methylene Blue; Tomography, X-Ray Computed; Radiology, Interventional

MeSH Terms

Animals
Ethiodized Oil/*administration & dosage
Fluoroscopy
Injections, Subcutaneous
Lung/*radiography/surgery
Methylene Blue/*administration & dosage
Preoperative Care
Rabbits
Solitary Pulmonary Nodule/*surgery
Staining and Labeling/methods
Thoracic Surgery, Video-Assisted/*methods
Thoracoscopy/methods
Tomography, X-Ray Computed
Ethiodized Oil
Methylene Blue

Figure

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  Fig. 1 Overview of the experimental design. Animals were randomly divided into two groups: Group A (n = 12) was sacrificed 6 hr after percutaneous injection and Group B (n = 12) was sacrificed 24 hr after a CT guided percutaneous injection of MLM and methylene blue.

• 

  Fig. 2 Examples of evaluation of staining on the lung surface. Photographs show (A) the extensive staining (score 1), (B) localized dispersion of staining (score 2), and (C) minimal dispersion of staining (score 3). The white lines on the bottom of the figure are markings of the ruler. The distance between two lines is one centimeter.

• 

  Fig. 3 Examples of assessment of radio-opacity on the fluoroscopic examinations. The fluoroscopic images show (A) a minimally increased opacity (arrow) (score 1), (B) a low density of increased opacity (arrow) (score 2), and (C) a compact nodular increased opacity (arrow) (score 3).

• 

  Fig. 4 CT and corresponding photomicrograph of lung specimen. MLM in Group B (A-D); (A) discrete and compact nodular opacity (arrowheads), (B) focal neutrophil infiltration, necrosis, and hemorrhage (arrowheads) (H&E, ×12.5), (C) scattered small nodular opacities of lipiodol (long arrows) and faint nodular opacity (arrowheads), (D) focal hemorrhage and necrosis (arrowheads) with diffuse neutrophil infiltration (short arrows) (H&E, ×12.5). MLM in Group A (E, F); (E) faint nodular lipiodol opacity (arrows), (F) focal hemorrhage (arrows) with diffuse neutrophil infiltration (arrowheads) (H&E, ×12.5). Methylene blue in Group A (G, H); (G) faint nodular opacity (arrowheads), and (H) focal extent of neutrophil infiltration, necrosis and hemorrhage (arrowheads) (H&E, ×12.5).

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