Hepatopulmonary shunting on Tc99m-MAA liver mapping: correlation with dynamic cross-sectional imaging and description of different shunting patterns
- 103 Downloads
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.
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.
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).
Visualizing certain patterns of vascular shunting on a dynamic CT or MRI scan is associated with high LSF.
KeywordsLSF Arterio-hepatic venous shunt Arterioportal shunt SIRT Yttrium-90
Compliance with ethical standard
Conflict of interest
The authors of this publication declare no conflict of interest.
This study was approved by the institutional review board and informed consent was waived.
- 3.Lupescu IG, Grasu M, Capsa R, Pitrop A, Georgescu SA (2006) Hepatic perfusion disorders: computer-tomographic and magnetic resonance imaging. J Gastrointest Liver Dis 15(3):273–279Google Scholar
- 25.Liu QS, Mei QL, Li YH, et al. (2016) Clinical effect of polyvinyl alcohol particles combined with chemoembolization in treatment of hepatocellular carcinoma complicated by hepatic arteriovenous shunt and related and prognostic factors. Zhonghua Gan Zang Bing Za Zhi 24(11):834–839PubMedGoogle Scholar
- 35.Kuo YC, Kohi MP, Naeger DM, et al. (2013) Efficacy of TACE in TIPS patients: comparison of treatment response to chemoembolization for hepatocellular carcinoma in patients with and without a transjugular intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol 36(5):1336–1343CrossRefGoogle Scholar