title: Elevated Lung Shunt Fraction as a Prognostic Indicator for Disease Progression and Metastasis in Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To evaluate lung shunt fraction (LSF) as an early predictor for local disease progression or the development of metastatic disease.
  
  
  METHODS
  Retrospective analysis was performed on 52 patients with hepatocellular carcinoma who underwent preradioembolization assessment, including the calculation of LSF. Comparison of preprocedural and postprocedural surveillance imaging was performed. Mean patient age was 67 years (range, 50-88 y), with a mean surveillance of 245 days (range, 24-871 d). Statistical analysis was conducted to assess the relationship between LSF and local disease progression or development of new metastatic disease.
  
  
  RESULTS
  In patients in whom metastatic disease developed during routine surveillance, the mean LSF was almost double that in patients in whom no metastasis developed (18.3% vs 9.3%; P = .001). Patients with elevated LSFs were also more likely to show intrahepatic disease progression (15.6% vs 8.5%; P = .003). LSFs < 8% corresponded to negative predictive values of 74% for local disease progression and 95% for development of metastasis, signaling a better prognosis. Of pretreatment variables examined (age, sex, previous treatment with disease progression, lesion size, lesion number, LSF, α-fetoprotein level, and portal vein thrombus), only LSF was an independent predictor for new metastasis (odds ratio [OR] = 1.2; P = .01). LSF (OR = 1.2; P = .03) and progression after previous treatment (OR = 4.7; P = .04) were independent predictors for local progression.
  
  
  CONCLUSIONS
  As local disease progression and metastatic disease were more likely to occur in patients with elevated LSFs, LSF may be the most sensitive predictor for local disease progression and new metastatic disease.
authors.affiliation: Departments of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Tyler
authors.initials: T
authors.lastname: Sandow
authors.affiliation: Departments of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana; University of Queensland School of Medicine Ochsner Clinical School, New Orleans, Louisiana.. Electronic address: ddevun@ochsner.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: DeVun
authors.affiliation: Departments of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana; University of Queensland School of Medicine Ochsner Clinical School, New Orleans, Louisiana.
authors.forename: Paul
authors.initials: P
authors.lastname: Gulotta
authors.affiliation: Transplant Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana; University of Queensland School of Medicine Ochsner Clinical School, New Orleans, Louisiana.
authors.forename: Humberto
authors.initials: H
authors.lastname: Bohorquez
authors.affiliation: Departments of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana; University of Queensland School of Medicine Ochsner Clinical School, New Orleans, Louisiana.
authors.forename: David
authors.initials: D
authors.lastname: Kirsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D005260:Female; D006801:Humans; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011652:Pulmonary Circulation; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D013668:Technetium Tc 99m Aggregated Albumin; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin