Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 May 28;10(3):uaae016.
doi: 10.1093/bjrcr/uaae016. eCollection 2024 May.

Implications of lung shunt fraction calculation discrepancy in Yttrium-90 radioembolization treatment from 2D planar vs 3D single photon emission CT imaging

Paula Gamero Kubota  1 , Christopher Molvar  1 , Robert Wagner  1 , Emad Allam  1 , James Halama  1 , Judy R James  1
Affiliations
Case Reports

Implications of lung shunt fraction calculation discrepancy in Yttrium-90 radioembolization treatment from 2D planar vs 3D single photon emission CT imaging

Paula Gamero Kubota et al. BJR Case Rep. .

Abstract

The safety and efficacy of Yttrium-90 (Y-90) radio-embolization therapy is partly dependent on the lung shunt fraction (LSF). There may be a notable disparity between LSF when calculated using 2D planar imaging vs 3D single photon emission CT (SPECT); this can affect the total allowable Y-90 dose delivered and therefore change the effectiveness of the procedure. The case presented demonstrates an 81% decrease in LSF when calculated by SPECT as compared to 2D planar imaging. This case highlights the importance of considering the imaging technique and the potential discrepancies that can arise between planar and SPECT imaging in LSF assessment.

Keywords: Y-90; hepatocellular carcinoma; lung shunt fraction; planar imaging; single photon emission CT (SPECT); trans-arterial radioembolization.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Lesion in liver segment 7 as observed on: (A) Coronal T1-weighted LAVA post-contrast MRI showing a lesion with central hypoenhancement and a thick enhancing capsule (red arrow), (B) Axial 2D FIESTA fat sat MRI showing a hyperintense, slightly heterogeneous lesion (red arrow), (C) Axial arterial phase postcontrast MRI showing a hypointense lesion with a thick enhancing capsule (red arrow), and (D) Axial DWI MRI demonstrating diffusion restriction in the nodular lesion (red arrow).
Figure 2.
Figure 2.
Coronal (A) and Axial (B) views of a 3D reconstructed SPECT/CT NM Pre Y-90 images demonstrating the majority of the Tc99m uptake deposited within the right lobe of the liver. No abnormal localization was noted outside of the liver.
Figure 3.
Figure 3.
Anterior (A) and Posterior (B) 2D planar views showing delineated liver and lung regions and counts using coronal slices from 99mTc-MAA planar imaging for the calculation of LSF (C). The planar lung shunt fraction was calculated to be 10.6%.
Figure 4.
Figure 4.
Top row showing the (A) Coronal (B) Sagittal (C) Axial CT views generated by QVolumetrix using 3D SPECT and (D) 3D images of the segmented lung lobes and the liver. The bottom row shows the same views for the 3D SPECT images with clear visualization of the 99mTc-MAA activity and uptake in liver and spill out into the lung regions. SPECT lung shunt fraction was 2%.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kulik L, El-Serag HB.. Epidemiology and management of hepatocellular carcinoma. Gastroenterology. 2019;156(2):477-491.e1. 10.1053/j.gastro.2018.08.065 - DOI - PMC - PubMed
    1. Salem R, Padia SA, Lam M, et al.Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging. 2023;50(2):328-343. 10.1007/s00259-022-05956-w - DOI - PMC - PubMed
    1. Mikell JK, Dewaraja YK, Owen D.. Transarterial radioembolization for hepatocellular carcinoma and hepatic metastases: clinical aspects and dosimetry models. Semin Radiat Oncol. 2020;30(1):68-76. 10.1016/j.semradonc.2019.08.005 - DOI - PMC - PubMed
    1. Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R.. Expected and unexpected imaging findings after 90 Y transarterial radioembolization for liver tumors. Radiographics. 2019;39(2):578-595. 10.1148/rg.2019180095 - DOI - PubMed
    1. Braat AJ, Smits ML, Braat MN, et al.90Y hepatic radioembolization: an update on current practice and recent developments. J Nucl Med. 2015;56(7):1079-1087. 10.2967/jnumed.115.157446 - DOI - PubMed

Publication types