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From the Editor’s Desk… – Journal of Hepatology

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From the Editor's Desk… - Journal of Hepatology
Transarterial radioembolization (TARE) with Y90 microspheres is used worldwide to
treat patients with hepatocellular carcinoma (HCC). In contrast with repeated chemoembolization,
Y90-RE is usually designed as a single treatment that nevertheless demands a pre-treatment
work-up. Such
work-up includes injecting Tc-99m macroaggregated albumin (MAA) to estimate lung shunt
fraction
and lung dose. To find out if MAA scans could be eliminated from routine practice
in early HCC,

Gabr
et al.

reviewed the lung shunt fraction from 448 patients with early stage HCC (UNOS T1/T2
or Milan criteria) treated by TARE.
Median lung shunt fraction was 3.9% and resulted in a median lung absorbed dose of
1.9 Gy.
Interestingly, the presence of a transjugular intrahepatic portosystemic shunt (TIPS)
in 38 patients was associated with a higher chance of having a lung shunt fraction
>10% (odds ratio [OR] 16.4;
p removing
the
MAA test
when segmental injections are planned in patients within Milan criteria and without
TIPS
. As a result, time-to-treatment and number of procedures will be reduced, making
TARE less costly and more convenient for patients.

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