Reply to Comment on: Lung Perfusion Imaging with Technetium-99m-macroaggregated Albumin should be Combined with Contrast-enhanced Echocardiography for the Diagnosis of Hepatopulmonary Syndrome

We appreciate the authors for their interest and knowledgeable comments on our study (1). We completely agree with them on dividing the geometric mean of brain counts by 0.13 since the brain is presumed to receive 13% of the cardiac output (2). We have used this score for shunt calculation.The relationship between brain uptake and quantitation of the right-to-left (R -L) shunt percentage using technetium-99m (Tc-99m)-macroaggregated albumin (MAA) whole-body imaging has been rarely investigated. Ito et al. (3) studied 53 patients and found thatTc-99-MAA brain uptake could completely distinguish patients with or without an R-L shunt and that it could provide complementary information and appears promising in predicting clinical outcomes