Hepatopulmonary shunting on Tc99m-MAA liver mapping: correlation with dynamic cross-sectional imaging and description of different shunting patterns

  • Mohammed Bermo
  • Manuela C. Matesan
  • Malak Itani
  • Fatemeh Behnia
  • Hubert J. Vesselle
Article
  • 22 Downloads

Abstract

Purpose

The purpose of the study was to correlate lung shunt fraction (LSF) calculated by intra-arterial injection of Technetium-99m (Tc-99m)-labeled macroaggregated albumin (MAA) in a hepatic artery branch with the presence of certain patterns of vascular shunts on dynamic CT or MRI of the liver.

Methods

This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed 523 MAA scans in 453 patients (301 men, 152 women) performed from July 2007 to June 2015 and their correlative cross-sectional imaging. Patterns of vascular shunts on dynamic CT or MRI performed within 3 months of the MAA study and that potentially divert hepatic arterial inflow to the systemic venous return were defined as “target shunts.” Dynamic CT or MRI was classified into three groups with target shunt present, absent, or indeterminate. The mean LSF was compared across the first and second groups using paired t test.

Results

342 CT and MRI studies met inclusion criteria: target shunts were present in 63 studies, absent in 271 studies, and 8 studies were indeterminate. When target shunts were visualized, the mean LSF on corresponding MAA scans was 12.9 ± 10.36% (95% CI 10.29–15.15%) compared to 4.3 ± 3.17% (95% CI 3.93–4.68%) when no target shunt was visualized. The difference was statistically significant (p value < 0.001). Identified target shunts were either direct (arteriohepatic venous shunt) or indirect (arterioportal shunt combined with a portosystemic shunt).

Conclusions

Visualizing certain patterns of vascular shunting on a dynamic CT or MRI scan is associated with high LSF.

Keywords

LSF Arterio-hepatic venous shunt Arterioportal shunt SIRT Yttrium-90 

Notes

Compliance with ethical standard

Conflict of interest

The authors of this publication declare no conflict of interest.

Informed consent

This study was approved by the institutional review board and informed consent was waived.

Supplementary material

261_2018_1602_MOESM1_ESM.mp4 (8.5 mb)
Movie 1: Direct arterio-hepatic venous shunt: Cine of axial arterial phase T1 W MRI of the liver shows enhancing HCC in hepatic segments 4 and 8 associated with isolated enhancement of the middle hepatic vein indicating arteriohepatic venous shunt. Right and left hepatic veins are not enhanced in this arterial phase. (MP4 8731 kb)
261_2018_1602_MOESM2_ESM.mp4 (9.5 mb)
Movie 2: Direct arterio-hepatic venous shunt: Cine of axial arterial phase CT of the liver shows enhancing neuroendocrine tumor of the pancreatic head and an enhancing metastatic lesion in hepatic segments 5 and 6 with early enhancement of the middle hepatic vein, the right hepatic vein, and an accessory right inferior hepatic vein indicating direct arteriohepatic venous shunt. Left hepatic vein is not enhanced in this arterial phase. (MP4 9739 kb)
261_2018_1602_MOESM3_ESM.mp4 (19.3 mb)
Movie 3: Indirect target shunt: Hepatic artery to portal vein (PV) then to recanalized paraumbilical vein: Cine of axial arterial phase T1 W MRI of the liver shows enhancing tumor thrombus in the PV and early enhancement of the left branch of the PV indicating arterioportal shunt, that continues to the paraumbilical vein indicating portosystemic shunting. Note minimal enhancement of the splenic vein and lack of enhancement of the superior mesenteric vein and the patent segment of the main PV indicating adequately-timed arterial phase. (MP4 19809 kb)
261_2018_1602_MOESM4_ESM.mp4 (5.4 mb)
Movie 4: Indirect target shunt: Hepatic artery to portal vein (PV) then to a TIPS: Cine of axial arterial phase T1 W MRI of the liver shows lack of enhancement of the main PV inferior to TIPS, early enhancement of the left branch of the PV indicating arterioportal shunt and enhancement of blood within the TIPS lumen which is a portosystemic shunt. (MP4 5528 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nuclear Medicine, Department of RadiologyUniversity of WashingtonSeattleUSA

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