title: Imaging Predictors of Elevated Lung Shunt Fraction in Patients Being Considered for Yttrium-90 Radioembolization.
abstract: OBJECTIVE
  To identify imaging findings associated with elevated lung shunt fraction (LSF) in patients being considered for yttrium-90 ((90)Y) radioembolization.
  
  
  METHODS
  During the period 2009-2014, 152 consecutive patients underwent planning hepatic arteriography with technetium-99m ((99m)Tc) macroaggregated albumin (MAA) injection. Computed tomography (CT) or magnetic resonance imaging performed before the procedure for each patient was assessed for hepatic vein (HV) tumor thrombus or occlusion from external compression by tumor. When imaging was a multiphase CT scan (117 patients), the arterial phase was evaluated for evidence of early HV opacification (relative to unaffected HVs), indicating hepatic venous shunting. These factors were correlated with LSF determined by (99m)Tc-MAA imaging.
  
  
  RESULTS
  Median LSF was 6.7% (range, < 0.1%-71%), significantly higher for HCC (8.0% vs 6.3% for other tumors, P = .048). Larger tumor size was associated with higher LSF in univariate analysis (P = .001). There was high interobserver agreement for determining hepatic venous shunting (97%, κ = 0.847), which was associated with higher LSF (P < .001; 78% sensitivity, 93% specificity). Of 5 cases of HV tumor thrombus, all had high (> 20%) LSF (P < .001). HV occlusion was also associated with higher LSF (P = .039). Multivariate analysis confirmed that early HV opacification and either HV tumor thrombus or occlusion were associated with higher LSF.
  
  
  CONCLUSIONS
  Early HV opacification and HV tumor thrombus or occlusion on cross-sectional imaging performed before radioembolization are associated with elevated LSF, which may contraindicate or limit the dose delivered in (90)Y radioembolization. This information could be helpful during patient counseling for anticipating the most appropriate mode of liver-directed therapy.
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143. Electronic address: Dare.Olorunsola@gmail.com.
authors: Olufoladare G
authors: OG
authors: Olorunsola
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Maureen P
authors: MP
authors: Kohi
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Spencer C
authors: SC
authors: Behr
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Pallav K
authors: PK
authors: Kolli
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Andrew G
authors: AG
authors: Taylor
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Ricky T
authors: RT
authors: Tong
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Jeanne M
authors: JM
authors: LaBerge
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Robert K
authors: RK
authors: Kerlan
authors: Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, Room 361, San Francisco, CA 94143.
authors: Nicholas
authors: N
authors: Fidelman
mesh_terms: D065638:Absorption, Radiation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008168:Lung / Q000000981:diagnostic imaging / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D018579:Patient Selection; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes