Quantification of right to left shunt through pulmonary arteriovenous malformations using 99Tcm albumin microspheres

Clin Radiol. 1988 Nov;39(6):611-4. doi: 10.1016/s0009-9260(88)80065-5.


Calculation of the right-to-left shunt through pulmonary arteriovenous malformations (PAVMs) is important in assessing the effect of therapeutic embolisation or surgical resection. Previously, complicated physiological techniques using radiolabelled inert gases or the 100% oxygen breathing method were required. We describe a new method for quantitating the systemic uptake of intravenously injected 99Tcm albumin microspheres (99Tcm MS) which reflects shunt fraction since these particles do not normally traverse the pulmonary capillary bed. Seven patients with PAVMs were studied and shunt values obtained using 99Tcm MS were validated by simultaneous measurement of shunt fraction using the 100% oxygen method. By comparing radioactive counts in the injection dose to subsequent counts in the right kidney, which was taken as an index of systemic activity, accurate quantification of right-to-left shunt over a wide range of values was obtained (correlation coefficient against 100% oxygen method r = 0.993). The comparison of right kidney counts with total lung counts and total lung counts with injected dose counts, also indicators of shunt fraction, correlated less well with the oxygen method (r = 0.942 and r = 0.88 respectively). Use of 99Tcm labelled microspheres allows simple and precise measurement of right-to-left shunt in patients with PAVMs during routine isotope lung scanning.

MeSH terms

  • Adult
  • Arteriovenous Malformations / blood
  • Arteriovenous Malformations / diagnostic imaging*
  • Arteriovenous Malformations / physiopathology
  • Blood Circulation
  • Female
  • Humans
  • Kidney / diagnostic imaging
  • Lung / diagnostic imaging
  • Male
  • Methods
  • Microspheres
  • Middle Aged
  • Oxygen / blood
  • Pulmonary Artery / abnormalities*
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Veins / abnormalities*
  • Pulmonary Veins / diagnostic imaging
  • Radionuclide Imaging
  • Technetium Tc 99m Aggregated Albumin*


  • Technetium Tc 99m Aggregated Albumin
  • Oxygen