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Purpose: The complication profile following repeat Y-radioembolization (RE) is not well understood, and repeat RE is sometimes avoided because of concerns for RE-induced liver disease (REILD) and liver toxicity. The purpose of this study was to examine the incidence of REILD and liver toxicity following repeat Y-RE and to identify potential risk factors., Methods: A retrospective analysis of patients undergoing repeat RE to the same hepatic lobe between 2013 and 2018 was performed. Baseline factors were evaluated as predictors of liver toxicity, mortality, and REILD, which was defined as the presence symptomatic ascites or jaundice in the absence of biliary obstruction within 8 weeks following RE. Post-RE complications were graded according to the Common Terminology Criteria for Adverse Events version 5., Results: A total of 39 patients underwent repeat RE with 14 (35.9%) experiencing Common Terminology Criteria for Adverse Events toxicity of grade 2 or greater, 3 (10.3%) grade 3, and no grade 4 or greater. A Model for End Stage Liver Disease score of 8 or greater was associated with grade 2 toxicity or greater (26.7% vs 75%; P = 0.013). Only 3 patients (7.7%) experienced REILD due to symptomatic ascites without jaundice. Greater than 2 REs were associated with a greater rate of 6-month mortality (12% vs 58.3%, P = 0.003), 12-month mortality (28% vs 75%, P = 0.007), and REILD (0% vs 21.4%, P = 0.016). Age, sex, microsphere type, cirrhosis, Child-Pugh, and Eastern Cooperative Oncology Group status were not significantly associated with complications, REILD, or survival., Conclusions: Repeat Y-RE appears to be well tolerated with a low rate of high-grade adverse events and REILD.

Purpose: Standardized added metabolic (SAM) activity is a functional objective measurement of the total tumoral metabolic activity that avoids partial volume effect and thresholding, which limit conventional PET parameters. The purpose of this study is to investigate the role of SAM in predicting survival in unresectable, chemorefractory colorectal hepatic metastatic disease treated with resin-based Y radioembolization., Materials and Methods: This is a prospective correlative study of patients with unresectable, chemorefractory colorectal liver metastasis who underwent F-FDG PET/CT and CT/MRI before and after Y. Target RECIST, PERCIST, change in total glycolytic activity (ΔTGA), and ΔSAM treatment response were assessed. Percentage changes in diameter, SUVpeak, TGA, and SAM were calculated pre- and post-Y therapy and objective response was defined as >30% change (responders). Survival analysis by Kaplan-Meier, log-rank, and Cox proportional hazard models were performed and significance was set at <0.05., Results: Sixteen patients (mean age of 61.6) were enrolled and performed a total of 20 Y therapies. After Y, target ΔSAM showed an objective response rate of 40% vs. 35%, 30%, and 22.2% based on target ΔTGA, PERCIST, and RECIST criteria, respectively. Median overall survival (OS) of the cohort after Y was 9.2 months (CI 95% 2.2-16.2). Patients demonstrating objective response based on ΔSAM had a median OS of 22.7 months (CI 95% 12.4-33.0) vs. 6.7 (CI 95% 4.2-9.2) in non-responders (P = 0.007). On multivariate analysis, hazard ratios for the objective response group based on target ΔSAM were 0.01 (P = 0.03) vs. 0.05 (P = 0.08), 0.20 (P = 0.29), and 0.91 (P = 0.98) based on target ΔTGA, PERCIST, and RECIST criteria, respectively., Conclusions: In unresectable colorectal liver metastatic disease refractory to standard chemotherapy, ΔSAM predicted OS for assessment of response following Y radioembolization therapy, whereas RECIST, PERCIST, and ΔTGA did not.

Purpose: F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) is known to be a useful diagnostic tool for staging, restaging, and monitoring therapy for lymphoma. The purpose of this retrospective study is to present a spectrum of FDG PET findings at initial presentation of Burkitt lymphoma and subsequent findings after therapy., Method and Materials: We retrospectively reviewed 48 patients with Burkitt lymphoma referred for a total of 160 FDG PET/computed tomography (CT) scans at our institution. We characterized the disease distribution of Burkitt lymphoma in all patients and measured representative FDG activity from initial staging scans. Therapeutic response and disease remission were assessed in patients with PET/CT and clinical follow-up studies., Results: Of the 48 patients diagnosed with Burkitt lymphoma, 25 patients had FDG PET/CT scans for initial staging. All untreated lesions of Burkitt lymphoma were highly FDG avid. The mean maximum standardized uptake value of 54 representative lesions is 16.5 (range: 6-54). Twelve patients were immune compromised. The majority of patients had disease localized to the abdomen and the pelvis. Extranodal involvement was identified in more than half of the patients studied., Conclusion: The American (or sporadic) form of Burkitt lymphoma presented with intense hypermetabolic lesions when untreated. The information is useful in evaluating post-treatment studies in the absence of a pretreatment scan.

A 46-year-old man with atrial fibrillation and coronary artery disease was referred for myocardial perfusion imaging for the evaluation of chest pain. The patient underwent adenosine stress and rest dual-isotope myocardial perfusion imaging. There was no adenosine-induced chest pain or EKG changes specific for ischemia. Myocardial perfusion images demonstrated an apical "hot spot" and decreased tracer activity in the base of the heart. The polar plots showed a bright center with a rim of significant (>2.5 SD) defect around the base of the myocardium. Ischemia in the base of the heart, with the apex of the heart seemingly normal, was rather puzzling and correlation with magnetic resonance images (MRI) showed apical hypertrophy. Examination of the history revealed that the patient was diagnosed with restrictive cardiomyopathy 2 years ago and endocardial biopsy showed intramyocardial glycogen on electron microscopy, suggesting glycogen storage disease. The case illustrates a "hot spot" resulting from apical hypertrophy creating artifactual fixed defects in myocardial perfusion images and in polar maps.