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Comparison of Tc-99m MAA Planar Versus SPECT/CT Imaging for Lung Shunt Fraction Evaluation Prior to Y-90 Radioembolization: Are We Overestimating Lung Shunt Fraction?

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare lung shunt fraction (LSF) prior to Y-90 radioembolization calculated using planar imaging versus SPECT/CT in patients with hepatocellular carcinoma (HCC).

Methods

A single institution retrospective analysis of technetium-99m macroaggregated albumin (Tc-99m MAA) LSF studies for 293 consecutive patients with HCC between 2013 and 2018 was performed. LSF using planar imaging (PLSF) was compared to retrospectively calculated LSF using SPECT/CT (SLSF) via semiautomated segmentation using MIM v.6.9. Sub-analyses of patients were performed based on PLSF range, tumor size, BCLC stage, and Child–Pugh (C–P) score. Mean LSF absolute discrepancy between sub-groups was analyzed. Comparisons were performed using paired t tests and linear regression analysis.

Results

Mean PLSF, 8.27%, was greater than mean SLSF, 3.27% (p < 0.001). When categorizing patients by PLSF ranges of < 10%, 10–19.9%, and ≥ 20%, PLSF remained greater than SLSF in all subgroups (p’s < 0.001). Patients with PLSF ≥ 20% had a greater absolute discrepancy with SLSF (13.31%) compared to patients with PLSF < 20% (4.74%; p < 0.0001). LSF absolute discrepancy was greater for patients with a maximum liver tumor size ≥ 5.0 cm (5.59%) compared to a liver tumor size < 5.0 cm (4.40%; p = 0.0076). For all BCLC grades and C–P scores, PLSF was greater than SLSF. A greater LSF discrepancy existed for patients with a worse C–P score (C–P A: 4.78%, C–P B/C: 6.12%; p = 0.0081), but not BCLC stage (0/A/B: 4.87%, C: 4.56%; p = 0.5993).

Conclusion

In patients with HCC, SLSF is significantly lower compared to PLSF, with a greater discrepancy among patients with a PLSF ≥ 20%, tumor size ≥ 5 cm, and worse C–P score.

Level of Evidence

Level 3, Retrospective Study.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG03, Atlanta, GA, 30322, USA

    Mohammad Elsayed, Minzhi Xing, Zachary Bercu & Nima Kokabi

  2. Morehouse School of Medicine, Atlanta, GA, USA

    Bernard Cheng

  3. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Ila Sethi, David Brandon, David M. Schuster, James Galt & Bruce Barron

Authors
  1. Mohammad Elsayed
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  2. Bernard Cheng
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Correspondence to Mohammad Elsayed.

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Nima Kokabi receives research support from SIRTEX Medical Ltd. The remaining authors have no financial disclosures.

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Elsayed, M., Cheng, B., Xing, M. et al. Comparison of Tc-99m MAA Planar Versus SPECT/CT Imaging for Lung Shunt Fraction Evaluation Prior to Y-90 Radioembolization: Are We Overestimating Lung Shunt Fraction?. Cardiovasc Intervent Radiol 44, 254–260 (2021). https://doi.org/10.1007/s00270-020-02638-8

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  • DOI: https://doi.org/10.1007/s00270-020-02638-8

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