Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size.
M Allan Thomas, Tharun Alamuri, Ryan C Lee, Dan Giardina, John Karageorgiou, Naganathan Mani, Daniel A Braga, Christopher D Malone
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引用次数: 0
Abstract
Purpose: To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (90Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality.
Materials and methods: This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSFplanar) and 3 macroaggregated albumin-single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSFFull, LSF2cm, and LSFLeft). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3-8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC.
Results: Median LSF was significantly different (all P < .001) among LSFplanar, LSFFull, LSF2cm, and LSFLeft methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSFplanar of >5% and >10%, respectively, but only 7% and 2% using LSF2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3-8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSFplanar > 20% or LSF2cm > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSFplanar, 9.0%; LSF2cm, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods.
Conclusions: Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in 90Y-RE.
期刊介绍:
JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.