Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215.
Massachusetts General Hospital, 55 Fruit Street GRB 298, Boston, MA 02114.
J Vasc Interv Radiol. 2021 Mar;32(3):412-418. doi: 10.1016/j.jvir.2020.11.005. Epub 2020 Dec 17.
To evaluate whether the recalculation of lung shunt fraction (LSF) is necessary prior to next-stage or same lobe repeat radioembolization.
Retrospective chart review was performed for patients who underwent radioembolization between February 2008 and December 2018. Eighty of 312 patients had repeat mapping angiograms and LSF calculations. A total of 160 LSF calculations were made using planar imaging (155, [97%]) and single-photon emission computed tomography (5 [3%]) technetium-99m macroaggregated albumin hepatic arterial injection imaging. The mean patient age was 61.8 years ± 12.7; 69 (86%) patients had metastatic disease and 11 (14%) had hepatocellular carcinoma.
Patients had a median LSF of 5% (interquartile range [IQR] 3%-9%) with a median absolute difference of 1.25 (IQR 0.65-3.4) and a median of 76 days (IQR 42.5-120 days) between repeat LSF calculations. There was a median change in LSF of 0.2% between mapping studies (P = .11). There was no statistical significance between the repeat LSFs regardless of the arterial distribution (P = .79) or between tumor types (P = .75). No patients exceeded lung dose limits using actual or predicted prescribed dose amounts. The actual median lung dose was 2.6 Gy (IQR 1.8-4.4 Gy, maximum = 20.5) for the first radioembolization and 2.0 Gy (IQR 1.3-3.7 Gy, maximum = 10.1) for the second radioembolization.
No significant difference in LSF was identified between different time points and arterial distributions within the same patient undergoing repeat radioembolization. In patients who receive well under 30-Gy lung dose for the initial treatment and a 50-Gy cumulative lung dose, repeat radioembolization treatments in the same patient may not require a repeat LSF calculation.
评估在进行下一次或同一叶重复放射栓塞治疗前是否需要重新计算肺分流分数（LSF）。
对 2008 年 2 月至 2018 年 12 月期间接受放射栓塞治疗的患者进行回顾性图表审查。80 例患者进行了重复血管造影和 LSF 计算。共使用平面成像（155 次，[97%]）和单光子发射计算机断层扫描（5 次，[3%]）锝-99m 聚合白蛋白肝动脉注射成像进行了 160 次 LSF 计算。患者平均年龄为 61.8 岁±12.7 岁；69 例（86%）患者患有转移性疾病，11 例（14%）患有肝细胞癌。
患者的 LSF 中位数为 5%（四分位距[IQR] 3%-9%），绝对差异中位数为 1.25（IQR 0.65-3.4），两次 LSF 计算之间的中位数为 76 天（IQR 42.5-120 天）。两次血管造影研究之间的 LSF 中位数变化为 0.2%（P=.11）。无论动脉分布（P=.79）或肿瘤类型（P=.75）如何，重复 LSF 之间均无统计学意义。没有患者使用实际或预测的处方剂量超过肺剂量限制。第一次放射栓塞的实际中位肺剂量为 2.6 Gy（IQR 1.8-4.4 Gy，最大值为 20.5），第二次放射栓塞的实际中位肺剂量为 2.0 Gy（IQR 1.3-3.7 Gy，最大值为 10.1）。
在同一患者接受重复放射栓塞治疗时，不同时间点和动脉分布之间的 LSF 无显著差异。对于初始治疗时接受的肺剂量低于 30 Gy 且累积肺剂量为 50 Gy 的患者，同一患者的重复放射栓塞治疗可能不需要重复计算 LSF。
