Factors influencing lung shunt fraction on 99m Tc-MAA SPECT/computed tomography imaging in patients with hepatic...

To explore tumor characteristics and prior liver treatment associated with lung shunt fraction (LSF) during technetium-99 m ( 99m Tc)-macroaggregated albumin (MAA) imaging for patients with hepatic malignancies who are to undergo yttrium-90 radioembolization.

Patients with hepatic malignancies who underwent transarterial 99m Tc-MAA single photon emission computed tomography/computed tomography (CT) imaging by consulting 90 Y microspheres for treatment from September 2021 to February 2025 at the Vascular and Interventional Surgery Department of Zhongda Hospital Southeast University were collected. All patients underwent contrast-enhanced CT or MRI for evaluation before hepatic angiography.

Of these 113 patients, with a median age of 60 years, were enrolled in this study. In the high LSF group, the tumor volume ( P = 0.001), perfusion volume ( P = 0.040), and 100INR ( P < 0.001) were significantly higher in these patients than in the other groups; for these patients, serum albumin was significantly lower than that in the other two groups ( P < 0.001). There was a significant difference in LSF between the hepatic vein (HV) groups; the highest LSF was found in such patients with clear evidence of tumor thrombus in the HV (median LSF = 26.50%), which was significantly higher than that in the group with HV invasion and the normal group (respectively, median LSF = 14.08 and 6.55%, P = 0.001); whereas, portal vein did not have any effect on the LSF level ( P = 0.445).

Tumor data, liver function indexes, and specific treatment history are associated with higher LSF and indicate the need for interventions to reduce it.