MEASURING LUNG SHUNTING IN HEPATOCELLULAR-CARCINOMA WITH INTRAHEPATIC-ARTERIAL TC-99M MACROAGGREGATED ALBUMIN

With increased use of intraarterial administration of chemotherapeutic and radioactive particulate agents, it is necessary to assess agent d elivery in the lung. Methods: Technetium-99m-labeled macroaggregated a lbumin (Tc-99m-MAA) delivered through the hepatic artery was used to d etermine the degree of lung shunting in 125 patients with hepatocellul ar carcinoma (HCC). Results: The percentage of lung shunting varied am ong patients and it ranged from less than 1% to 67.2%, with a median o f 8.1%. The degree of shunting depended on the vascularity of the tumo rs but not on the tumor size. The effect of angiotensin II on lung shu nting was tested on six patients and there was no significant differen ce found between those patients who were pre-treated with angiotensin II and those who were not. One patient who underwent a liver resection , had a significant decrease in lung shunting from 28.5% to less than 1% after surgery. Conclusion: The lack of effect of angiotensin II tog ether with the almost complete ablation of lung shunting by tumor rese ction suggested neoplastic blood vessels were responsible for the shun ting.