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Narsinh KH, Van Buskirk M, Kennedy AS, Suhail M, Alsaikhan N, Hoh CK, Thurston K, Minocha J, Ball DS, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Nutting CW, Moeslein FM, Savin MA, Schirm S, Putnam SG, Sharma NK, Wang EA, Rose SC. Hepatopulmonary Shunting: A Prognostic Indicator of Survival in Patients with Metastatic Colorectal Adenocarcinoma Treated with 90Y Radioembolization. Radiology 2016; 282:281-288. [PMID: 27440733 DOI: 10.1148/radiol.2016152100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose To determine if high lung shunt fraction (LSF) is an independent prognostic indicator of poor survival in patients who undergo yttrium 90 radioembolization for unresectable liver-dominant metastatic colorectal cancer. Materials and Methods Retrospective data were analyzed from 606 patients (62% men; mean age, 62 years) who underwent radioembolization to treat liver metastases from colorectal adenocarcinoma between July 2002 and December 2011 at 11 U.S. centers. Institutional review board exemptions were granted prior to the collection of data at each site. Overall survival was estimated by using Kaplan-Meier survival and univariate Cox proportional hazards models to examine the effect of LSF on survival and to compare this to other potential prognostic indicators. Multivariate analysis was also performed to determine whether LSF is an independent risk factor for poor survival. Results LSF higher than 10% was predictive of significantly decreased survival (median, 6.9 months vs 10.0 months; hazard ratio, 1.60; P < .001) and demonstrated a mild but significant correlation to serum carcinoembryonic antigen levels and tumor-to-liver volume ratio (Pearson correlation coefficients, 0.105 and 0.113, respectively; P < .05). A progressive decrease in survival was observed as LSF increased from less than 5% to more than 20% (P < .05). LSF did not correlate with the presence of extrahepatic metastases or prior administration of bevacizumab. Conclusion Increased LSF is an independent prognostic indicator of worse survival in patients undergoing radioembolization for liver-dominant metastatic colorectal adenocarcinoma. High LSF correlates poorly to other potential markers of tumor size, such as tumor-to-liver volume ratio or serum carcinoembryonic antigen level, and does not correlate to the presence of extrahepatic metastases. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Kazim H Narsinh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mark Van Buskirk
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Andrew S Kennedy
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Mohammed Suhail
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Naif Alsaikhan
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Carl K Hoh
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Kenneth Thurston
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Jeet Minocha
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - David S Ball
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven J Cohen
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael Cohn
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Douglas M Coldwell
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Alain Drooz
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eduardo Ehrenwald
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samir Kanani
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Charles W Nutting
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Fred M Moeslein
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Michael A Savin
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Sabine Schirm
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Samuel G Putnam
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Navesh K Sharma
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Eric A Wang
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
| | - Steven C Rose
- From the Dept of Radiology, Univ of California San Diego School of Medicine, 200 W. Arbor Dr 8756, San Diego, CA 92103-8756 (K.H.N., M.S., N.A., C.K.H., J.M., S.C.R.); Data Reduction, Chester, NJ (M.V.B.); Sarah Cannon Research Inst, Nashville, Tenn (A.S.K.); Sirtex Medical, West Grove, Pa (K.T.); Fox Chase Cancer Ctr, Philadelphia, Pa (D.S.B., S.J.C., S.G.P.); Radiologic Associates of Hollywood, Pembroke Pines, Fla (M.C.); James Graham Brown Cancer Ctr, Univ of Louisville, Louisville, Ky (D.M.C.); Fairfax Radiological Consultants, Fairfax, Va (A.D.); Abbott Northwestern Hosp, Minneapolis, Minn (E.E.); Inova Fairfax Hosp, Annandale, Va (S.K.); Radiology Imaging Associates, Englewood, Colo (C.W.N.); Dept of Radiology, Univ of Maryland Medical School, Baltimore, Md (F.M.M., N.K.S.); Beaumont Hosp, Royal Oak, Mich (M.A.S., E.A.W.); and Cancer Ctrs of North Carolina, Cary, NC (S.S.)
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