Jens Matthias Theysohn MD, Presenter: Nothing to Disclose

Juliane Schelhorn MD, Abstract Co-Author: Nothing to Disclose

Jens-Christian Altenbernd, Abstract Co-Author: Nothing to Disclose

Stefan P. Mueller MD, Abstract Co-Author: Consultant, BTG International Ltd

Michael Forsting MD, Abstract Co-Author: Nothing to Disclose

Thomas C. Lauenstein MD, Abstract Co-Author: Nothing to Disclose

A high hepatopulmonary shunt (HPS) fraction might represent a contraindication for Yttrium 90 radioembolization (RE) in patients with unresectable hepatocellular carcinoma (HCC). The protein kinase inhibitor sorafenib has been shown to possibly reduce the HPS in selected cases. Our aim was to assess if CT predictors for a high HPS exist and if these show changes after sorafenib therapy. 

CT images of 70 HCC patients (mean age 69.8y; 60m, 10w) scheduled for MAA scan were retrospectively evaluated by two radiologists in consensus. Two groups of patients matched for age and gender were evaluated: (a) increased HPS (>15%, n=35), (b) low HPS (<5%, n=35). Tri-phasic CTs prior to the DSA were analyzed regarding signs of early venous enhancement, venous tumor infiltration, portal vein thrombosis, and portosystemic shunts. Conspicuities were correlated with HPS values and where applicable effects of sorafenib on these were recorded before repeated MAA scan. 

In 16/35 patients with high HPS, early (arterial) enhancement of intrahepatic veins and/or tumor infiltration of liver veins could be appreciated; 9 more patients showed compressed/shifted liver veins. Very high HPS (>20%) was associated with early venous enhancement (n=9) more frequently than high HPS (15-20%; n=2). Patients with low HPS did not show these signs. Portal vein thrombosis occurred more often with high HPS (n=21) compared to low HPS (n=9). All other aspects occurred in both groups independent of HPS. Eight patients with high HPS received sorafenib in the aftermath, reducing early (arterial) enhancement of liver veins and/or enhancement of tumor parts infiltrating liver veins in 8/8 cases; additionally a reduction of the HPS in 7/8 cases allowed for Yttrium 90 therapy.

High hepatopulmonary shunts are associated with CT predictors which may be alleviated after sorafenib therapy in selected cases. Early (arterial) enhancement of liver veins is strongly related to very high hepatopulmonary shunts.

Patients with increased risk for a high hepatopulmonary shunt might be identified in CT and could be pre-treated with sorafenib prior to the first MAA scan to prevent repetitive angiographies.

Theysohn, J, Schelhorn, J, Altenbernd, J, Mueller, S, Forsting, M, Lauenstein, T, Evaluation for Radioembolization in HCC: CT Predictors for High Hepatopulmonary Shunt Fractions and Changes Following Sorafenib Therapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014016.html