Yttrium-90 Radioembolization as Salvage Therapy for Liver Metastases From Colorectal Cancer.

PURPOSE: To report safety and survival outcomes of Yttrium-90 (Y-90) radioembolization when used as salvage therapy for chemotherapy-resistant liver metastases from colorectal cancer. METHODS: In this IRB-approved retrospective study, 45 patients with hepatic metastases from colorectal cancer underwent Y-90 radioembolization after failure of systemic chemotherapy. Toxicities were assessed as per NCI-CTCAE and response based on RECIST and PET. Kaplan-Meier survival analysis was performed to calculate median survival, prognostic factors on univariate analysis, and Cox regression analysis for independent predictors of survival. RESULTS: Y-90 radioembolization was technically successful in all (100%). Twenty-three patients (51%) had no toxicities, whereas 6 patients (13%) had grade 3 toxicities, and no patients had grade 4 toxicity. Two patients died within 30 days of treatment from renal failure unrelated to the procedure. Per RECIST, 1 patient (2%) had partial response, 34 (71%) had stable disease, and 6 (13%) had progressive disease. PET response was seen in 46% of patients with 2 patients (4%) demonstrating complete and 22 (42%) demonstrating partial metabolic response. The median survival was 186 days (95% CI, 149-277 d). Response on PET was the only independent predictor of superior overall survival. Patients who had response on PET following Y-90 therapy had a median overall survival of 317 days (10.6 mo) (95% CI, 193-564 d), whereas patients with no response on PET had a median overall survival of 163 days (5.4 mo) (95% CI, 64-283 d). CONCLUSIONS: Y-90 radioembolization as a salvage therapy for chemotherapy-resistant hepatic metastases from colon cancer was safe and resulted in disease stability. Response on PET was an independent predictor of superior overall survival.

Head and neck infection and inflammation.

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.

Independent evaluation of computer classification of malignant and benign calcifications in full-field digital mammograms.

RATIONALE AND OBJECTIVES: To evaluate whether a computer-aided diagnosis (CADx) technique can accurately classify breast calcifications in full-field digital mammograms (FFDMs) as malignant or benign. The computer technique was developed previously on screen-film mammograms (SFMs) in which individual calcifications were identified manually. The present study evaluated the computer technique independently on a new database of FFDM images with automatic detection of the individual calcifications. MATERIALS AND METHODS: We analyzed 49 consecutive FFDM cases (19 cancers) that showed suspicious calcifications. Four mammography radiologists read soft-copy mammograms retrospectively and electronically indicated the region of calcifications in each image. The computer then automatically detected the individual calcifications within the indicated region and analyzed eight features of calcification morphology and distribution to arrive at an estimated likelihood of malignancy. The radiologists entered Breast Imaging Report and Data System assessments before and after seeing the computer results. Performance was analyzed using receiver operating characteristic analysis. RESULTS: Despite variability in radiologist-indicated regions of calcifications, the computer achieved consistently high performance taking input from the four radiologists (receiver operating characteristic curve area, A(z): 0.80, 0.80, 0.78, and 0.77; differences not statistically significant). Previous results showed that the computer technique achieved an A(z) value of 0.80 on SFMs, which improved radiologists' performance significantly. CONCLUSIONS: The computer technique appears to maintain consistently high performance in classifying calcifications in FFDMs as malignant or benign without requiring substantial modification from its initial development on SFMs. The computer performance appears to be robust with respect to variations in radiologists' input.