Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size

M. Allan Thomas; Tharun Alamuri; Ryan C. Lee; Dan Giardina; John Karageorgiou; Naganathan Mani; Daniel A. Braga; Christopher D. Malone

doi:10.1016/j.jvir.2025.09.006

Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size

M. Allan Thomas
, Tharun Alamuri
, Ryan C. Lee
, Dan Giardina
, John Karageorgiou
, Naganathan Mani
, Daniel A. Braga
, Christopher D. Malone

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose: To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (⁹⁰Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality. Materials and Methods: This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSF_planar) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSF_Full, LSF_2cm, and LSF_Left). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3–8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC. Results: Median LSF was significantly different (all P < .001) among LSF_planar, LSF_Full, LSF_2cm, and LSF_Left methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSF_planar of >5% and >10%, respectively, but only 7% and 2% using LSF_2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSF_planar > 20% or LSF_2cm > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSF_planar, 9.0%; LSF_2cm, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods. Conclusions: Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in ⁹⁰Y-RE.

Original language	English
Article number	107834
Journal	Journal of Vascular and Interventional Radiology
Volume	37
Issue number	1
DOIs	https://doi.org/10.1016/j.jvir.2025.09.006
State	Published - Jan 2026

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10.1016/j.jvir.2025.09.006

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Thomas, M. A., Alamuri, T., Lee, R. C., Giardina, D., Karageorgiou, J., Mani, N., Braga, D. A., & Malone, C. D. (2026). Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size. Journal of Vascular and Interventional Radiology, 37(1), Article 107834. https://doi.org/10.1016/j.jvir.2025.09.006

@article{9995f6b73b9444caabcc28813dfcf451,

title = "Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size",

abstract = "Purpose: To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (90Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality. Materials and Methods: This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSFplanar) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSFFull, LSF2cm, and LSFLeft). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3–8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC. Results: Median LSF was significantly different (all P < .001) among LSFplanar, LSFFull, LSF2cm, and LSFLeft methods, with values of 6.9\%, 3.9\%, 1.4\%, and 0.8\%, respectively. There were 72\% and 19\% of cases with LSFplanar of >5\% and >10\%, respectively, but only 7\% and 2\% using LSF2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSFplanar > 20\% or LSF2cm > 5\%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSFplanar, 9.0\%; LSF2cm, 2.8\%) and the highest percentages of cases with LSF values of >10\% and >20\% across all methods. Conclusions: Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in 90Y-RE.",

author = "Thomas, \{M. Allan\} and Tharun Alamuri and Lee, \{Ryan C.\} and Dan Giardina and John Karageorgiou and Naganathan Mani and Braga, \{Daniel A.\} and Malone, \{Christopher D.\}",

note = "Publisher Copyright: {\textcopyright} 2025 SIR",

year = "2026",

month = jan,

doi = "10.1016/j.jvir.2025.09.006",

language = "English",

volume = "37",

journal = "Journal of Vascular and Interventional Radiology",

issn = "1051-0443",

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}

Thomas, MA, Alamuri, T, Lee, RC, Giardina, D, Karageorgiou, J, Mani, N , Braga, DA & Malone, CD 2026, 'Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size', Journal of Vascular and Interventional Radiology, vol. 37, no. 1, 107834. https://doi.org/10.1016/j.jvir.2025.09.006

Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size. / Thomas, M. Allan; Alamuri, Tharun; Lee, Ryan C. et al.
In: Journal of Vascular and Interventional Radiology, Vol. 37, No. 1, 107834, 01.2026.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver

T2 - Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size

AU - Thomas, M. Allan

AU - Alamuri, Tharun

AU - Lee, Ryan C.

AU - Giardina, Dan

AU - Karageorgiou, John

AU - Mani, Naganathan

AU - Braga, Daniel A.

AU - Malone, Christopher D.

PY - 2026/1

Y1 - 2026/1

N2 - Purpose: To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (90Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality. Materials and Methods: This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSFplanar) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSFFull, LSF2cm, and LSFLeft). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3–8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC. Results: Median LSF was significantly different (all P < .001) among LSFplanar, LSFFull, LSF2cm, and LSFLeft methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSFplanar of >5% and >10%, respectively, but only 7% and 2% using LSF2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSFplanar > 20% or LSF2cm > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSFplanar, 9.0%; LSF2cm, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods. Conclusions: Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in 90Y-RE.

AB - Purpose: To test the hypothesis that lung shunt fraction (LSF) in yttrium-90 (90Y) radioembolization (RE) of the liver can be modeled for clinical relevance and risk on the basis of cancer type, tumor size, and imaging modality. Materials and Methods: This was a retrospective analysis of 354 consecutive cases from a 34-month period at a single institution. Cancer type (hepatocellular carcinoma [HCC] vs non-HCC) and maximum tumor size were tracked. LSF was computed from planar imaging (LSFplanar) and 3 macroaggregated albumin–single photon emission computed tomography (SPECT)/computed tomography (CT) methods with different corrections at the lung/liver boundary (LSFFull, LSF2cm, and LSFLeft). Five tumor categories were analyzed: (a) HCC measuring <3 cm, (b) HCC measuring 3–8 cm, (c) HCC measuring >8 cm, (d) cases with transjugular intrahepatic portosystemic shunt (TIPS)/vascular invasion, and (e) non-HCC. Results: Median LSF was significantly different (all P < .001) among LSFplanar, LSFFull, LSF2cm, and LSFLeft methods, with values of 6.9%, 3.9%, 1.4%, and 0.8%, respectively. There were 72% and 19% of cases with LSFplanar of >5% and >10%, respectively, but only 7% and 2% using LSF2cm. LSF was lower for HCC measuring <3 cm relative to HCC measuring 3–8 cm and >8 cm (P ≤ .003). In the <3-cm HCC group, there were no cases with LSFplanar > 20% or LSF2cm > 5%. Cases with TIPS/vascular invasion maintained the highest median LSF (LSFplanar, 9.0%; LSF2cm, 2.8%) and the highest percentages of cases with LSF values of >10% and >20% across all methods. Conclusions: Despite significant variations with imaging modality and correction methods, consistent trends in LSF magnitude with cancer type and tumor size were still uncovered. The relative risk of observing clinically relevant LSF can be modeled for different liver tumor categories in 90Y-RE.

UR - https://www.scopus.com/pages/publications/105019218727

U2 - 10.1016/j.jvir.2025.09.006

DO - 10.1016/j.jvir.2025.09.006

M3 - Article

C2 - 40939653

AN - SCOPUS:105019218727

SN - 1051-0443

VL - 37

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

IS - 1

M1 - 107834

ER -

Modeling Clinical Relevance and Risk in Yttrium-90 Radioembolization of the Liver: Lung Shunt Fraction Variability According to Imaging Modality, Cancer Type, and Tumor Size

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