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Citation:
Weerakkody Y, Silverstone L, Chieng R, Lung shunt fraction. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-168653
The hepato-pulmonary lung shunt fraction (LSF) is a parameter that is used to assess the safety of 90Y transarterial radioembolization/selective internal radiation therapy of liver tumors. Excessive arteriovenous shunting can cause radiation pneumonitis.
The lung shunt fraction = (total lung counts) / (total lung counts + total liver counts). It is usually calculated using 99mTc-MAA. Guidelines suggest a maximum per treatment dose of 30Gy and a maximum total dose of 50Gy.
Compared to SPECT/CT, planar scintigraphy may overestimate lung dose especially in those with left-sided tumors, high LSF and high BMI leading to unnecessary dose reduction 1.
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1. Struycken L, Patel M, Kuo P, Hennemeyer C, Woodhead G, McGregor H. Clinical and Dosimetric Implications of Calculating Lung Shunt Fraction for Hepatic 90Y Radioembolization Using SPECT/CT Versus Planar Scintigraphy. AJR Am J Roentgenol. 2022;218(4):728-37. doi:10.2214/ajr.21.26663 - Pubmed
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2. Narsinh K, Van Buskirk M, Kennedy A et al. Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with Y Radioembolization. Radiology. 2017;282(1):281-8. doi:10.1148/radiol.2016152100 - Pubmed
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3. Georgiou M, Kuker R, Studenski M, Ahlman P, Witte M, Portelance L. Lung Shunt Fraction Calculation Using Tc-MAA SPECT/CT Imaging for Y Microsphere Selective Internal Radiation Therapy of Liver Tumors. EJNMMI Res. 2021;11(1):96. doi:10.1186/s13550-021-00837-z - Pubmed
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