No abstract

90 Y radioembolization (selective internal radiation therapy [SIRT]) has emerged as a valuable therapeutic option in unresectable, chemotherapy-refractory hepatic metastases from breast cancer. The objective of the present study was to evaluate 18 F-FDG PET/ CT for predicting survival in these patients. Methods: Fifty-eight consecutive patients with hepatic metastases from breast cancer were treated with SIRT. Before therapy, all patients underwent MRI of the liver. 18 F-FDG PET/CT was performed at baseline and 3 mo after SIRT to calculate percentage changes in maximum 18 F-FDG standardized uptake value (SUV max ) relative to baseline. A decrease of more than 30% in the follow-up scan, compared with the baseline examination, indicated therapy response. Treatment response at 3 mo was also assessed in 43 patients using contrastenhanced MRI and CT on the basis of the Response Evaluation Criteria in Solid Tumors. All patients were followed to complete survival data. Results: Overall median survival after SIRT was 47 wk. Response as assessed with SUV max correlated significantly with survival after radioembolization, with responders having significantly longer survival (65 wk) than nonresponders (43 wk; P , 0.05). In multivariate analysis the change in SUV max was identified as the only independent predictor of survival (hazard ratio, 0.23; P , 0.005). Furthermore, a high pretherapeutic SUV max (.20) was associated with a significantly shorter median survival than was an SUV max of 20 or less (21 vs. 52 wk; P , 0.005). The presence of extrahepatic metastases (mean survival in both groups, 47 wk; P 5 0.92), hormone receptor status (estrogen, P 5 0.53; progesterone, P 5 0.79; Her-2/neu, P 5 0.49), and MRI/CT response (P 5 0.91) did not predict survival. Conclusion: The change in SUV max as assessed by 18 F-FDG PET/CT before and 3 mo after SIRT was identified as the only independent predictor of survival in patients with hepatic metastases of breast cancer. Breastcanceri s the most common malignancy affecting women in developed countries. Despite advances in adjuvant treatment, about 20% of patients with initially local disease will still develop metastases (1), frequently involving the liver. In most patients, curative surgical resection of liver metastases is not an option because of the presence of extrahepatic disease or multisegmental involvement of the liver. Other local therapies, such as radiofrequency ablation, are feasible in only a limited number of patients exhibiting only a few, small hepatic metastases. Despite significant advances in chemotherapeutic options in metastatic breast cancer, the presence of liver metastases limits survival in up to 60% of patients. Median survival in women exhibiting liver metastases of breast cancer has been estimated at about 18 mo (2).More recently, radioembolization using 90 Y-microspheres (selective internal radiation therapy [SIRT]) has emerged as a palliative treatment for hepatic metastases of various tumors (3-6). In hepatic metastases of breast cancer (7-9), reported...

• MRgFUS appears to be a valid alternative to other uterus-preserving therapies • Patient selection is a significant factor in achieving high NPV ratios • MRI screening parameters correlate with the amount of fibroid ablation in MRgFUS • NPV results of more than 80 % correlate with higher clinical success rates.

No abstract

Seven T 2 maps (multiecho (ME) sequence: 3000 ms, eight echoes with 13.2 ms of echo spacing, 20 sections) and T 1 -weighted (T 1 -w) fast low-angle shot (FLASH-water excitation (WE)) data sets from four imaging sessions (right patellae of 10 healthy volunteers) were obtained. A segmentation of cartilage (WE sequence) was overlaid on the ME data and T 2 values were calculated for total cartilage, three layers, three facets (global), and 240 ROIs (regional). Reproducibility (precision error) was calculated as the root mean square average (RMSA) of the individual coefficients of variation (COVs, %) and standard deviations (SDs, ms) for intra-and intersession reproducibility. The precision error was 3-7% and 6 -29% for global and regional T 2 , respectively. There was no difference between intraand intersession reproducibility, but there was worse reproducibility in the superficial layers compared to the deeper layers. Peripheral ROI reproducibility (mean ‫؍‬ 13%) was worse than in the central portions (mean ‫؍‬ 11%), but omission of the periphery did not positively affect the globally calculated T 2 reproducibility. The precision errors were small compared to reported changes in diseased cartilage, suggesting good discriminatory power of the technique. Our data provide a first estimate of global and regional reproducibility errors of T 2 in healthy cartilage, and may serve as a basis for sample size calculations and aid study designs for longitudinal and cross-sectional trials in osteoarthritis (OA). Magn Reson Med 56:527-534, 2006.