title: Intratumoral arteriovenous shunting in malignant gliomas.
abstract: OBJECTIVE
  Intratumoral arteriovenous shunting in glioblastomas has been suspected but neither proven nor quantified.
  
  
  METHODS
  Using a previously described technique of selective intra-arterial intratumoral injection of 99mTc-labeled microparticles (macroaggregated albumin), we measured the amount of radioactivity, by cerebral and pulmonary scintigraphy, in seven patients with malignant gliomas (six with glioblastomas and one with an anaplastic oligodendroglioma). The pulmonary shunt index was calculated as a percentage from the pulmonary/pulmonary plus cerebral radioactivity ratio.
  
  
  RESULTS
  The results revealed a mean pulmonary shunt index of 67% (range, 47-89%), indicating that most of the microparticles injected into the tumor via the arterial route bypassed the tumor and reached the lungs. The measured arteriovenous shunting was greater when the injection was performed in an artery exclusively perfusing the tumor.
  
  
  CONCLUSIONS
  Important intratumoral arteriovenous shunting exists in glioblastomas. The potential consequences of this finding for intra-arterial treatment strategies are discussed.
authors.affiliation: Department of Neurosurgery, University Hospital of Berne, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Mariani
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: J P
authors.initials: JP
authors.lastname: Wielepp
authors.forename: A
authors.initials: A
authors.lastname: Haldemann
authors.forename: R W
authors.initials: RW
authors.lastname: Seiler
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000378:metabolism*; D001932:Brain Neoplasms / Q000098:blood supply* / Q000175:diagnosis; D002533:Cerebral Angiography; D005260:Female; D005909:Glioblastoma / Q000098:blood supply* / Q000175:diagnosis; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009837:Oligodendroglioma / Q000098:blood supply* / Q000175:diagnosis; D011877:Radionuclide Imaging; D012709:Serum Albumin / Q000493:pharmacokinetics*; D013667:Technetium
chemical_list: D012709:Serum Albumin; D013667:Technetium