Management of High Hepatopulmonary Shunting in Patients Undergoing Hepatic Radioembolization

Purpose: To review the safety of hepatic radioembolization (RE) in patients with high (>= 10%) hepatopulmonary shunt fraction (HPSF) using various prophylactic techniques. Materials and Methods: A review was conducted of 409 patients who underwent technetium 99m-labeled macroaggregated albumin scintigraphy before planned RE. Estimated pulmonary absorbed radiation doses based on scintigraphy and hepatic administered activity were calculated. Outcomes from dose reductions and adjunctive catheter-based prophylactic techniques used to reduce lung exposure were assessed. Results: There were 80 patients with HPSF >= 10% who received RE treatment (41 resin microspheres for metastases, 39 glass microspheres for hepatocellular carcinoma). Resin microspheres were used in 17 patients according to consensus guideline-recommended dose reduction; 38 patients received no dose reduction because the expected lung dose was