Abstract No. 385 - Clinical correlation between hepatic vein opacification and hepatopulmonary shunt fraction for 90Y evaluation

Abstract

Purpose Hepatopulmonary shunt (HPS) fraction ≥20% is one of the occasional criteria preventing 90Y therapy. This study aimed to identify if there is clinical correlation between hepatic vein (HV) opacification and HPS during initial evaluation for 90Y therapy. Materials and Methods We collected 90Y candidates from 2004 to 2011. Patient’s underlying disease, imaging, arteriograms, and HPS calculations were retrospectively reviewed. If the HV was opacified during visceral arteriogram, the time between contrast injection and HV visualization was recorded. Statistical analysis with unpaired t-test compared the time of HV visualization in patients with and without an elevated HPS fraction. Results Total of 151 initial 90Y work up studies in 149 patients were included. The diagnoses included 75 HCC, 53 neuroendocrine tumor metastases, 14 colorectal metastases, 3 cholangiocarcinoma and 4 other metastases. Imaging revealed multifocal disease(n=117, 77%), bilobar disease(102, 68%) and macrovascular invasion (41, 27%). Macrovascular invasions included 4 HV and IVC, 2 HV and portal vein (PV), 1 IVC, 11 main PV, 1 right main PV, 16 right PV branch, 2 left main PV and 4 left PV branch. Mean maximum tumor diameter was 6.9±3.6 cm. Twenty-nine patients (19%) did not complete Y90 therapy; due to (18) high HPS, (5) unfavorable vascular anatomy, (2) declining liver function, (1) gastric uptake, (1) extrahepatic tumor, (1) poor tumor localization and (1) misdiagnosis. HV opacification was noted in 15 studies. Nine out of 15 studies showed HPS fraction ≥20%. PPV and NPV of HV opacification as a predictor of high HPS fraction were 60% and 94%. Average time until visualized HV in patients whom HPS fraction ≥20% and Conclusion The results demonstrated that visualization of the HV during initial arteriogram alone may not be sufficient to predict high HPS. We found that HV opacifications were seen on arteriograms earlier in the patients with high HPS (≥20%) than the patients with shunt