Prediction of Lung Shunt Fraction for Yttrium-90 Treatment of Hepatic Tumors Using Dynamic Contrast Enhanced MRI with Quantitative Perfusion Processing

Abstract

There is no noninvasive method to estimate lung shunting fraction (LSF) in patients with liver tumors undergoing Yttrium-90 (Y90) therapy. We propose to predict LSF from noninvasive dynamic contrast enhanced (DCE) MRI using perfusion quantification. Two perfusion quantification methods were used to process DCE MRI in 25 liver tumor patients: Kety’s tracer kinetic modeling with a delay-fitted global arterial input function (AIF) and quantitative transport mapping (QTM) based on the inversion of transport equation using spatial deconvolution without AIF. LSF was measured on SPECT following Tc-99m macroaggregated albumin (MAA) administration via hepatic arterial catheter. The patient cohort was partitioned into a low-risk group (LSF (Formula presented.)   (Formula presented.)) and a high-risk group (LSF (Formula presented.)   (Formula presented.)). Results: In this patient cohort, LSF was positively correlated with QTM velocity (Formula presented.) (r = 0.61, F = 14.0363, p = 0.0021), and no significant correlation was observed with Kety’s parameters, tumor volume, patient age and gender. Between the low LSF and high LSF groups, there was a significant difference for QTM (Formula presented.) (0.0760 ± 0.0440 vs. 0.1822 ± 0.1225 mm/s, p = 0.0011), and Kety’s (Formula presented.) (0.0401 ± 0.0360 vs 0.1198 ± 0.3048, p = 0.0471) and (Formula presented.) (0.0900 ± 0.0307 vs. 0.1495 ± 0.0485, p = 0.0114). The area under the curve (AUC) for distinguishing between low LSF and high LSF was 0.87 for (Formula presented.), 0.80 for (Formula presented.) and 0.74 for (Formula presented.). Noninvasive prediction of LSF is feasible from DCE MRI with QTM velocity postprocessing.