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Objectives: The objectives of this study were to evaluate the efficacy in painmanagement of magnetic resonance (MR)Yguided focused ultrasound for theprimary treatment of painful bone metastases and to assess its potential for localcontrol of bone metastases.Materials and Methods: This was a prospective, single-arm research studywith approval from the institutional review board. Eighteen consecutive patients(female, 8; male, 10; mean [SD] age, 62.7 [11.5] years) with painful bone me-tastases were enrolled. The patients were examined clinically for pain severityand pain interference in accordance with the Brief Pain Inventory-Quality ofLife criteria before and at each follow-up visit. Computed tomography andMR imaging were performed before and at 1 and 3 months after the mag-netic resonanceYguided focused ultrasound treatment. The nonperfused volume(NPV) was calculated to correlate the extension of the ablated pathological tis-sue in the responder and nonresponder patients.Results: No treatment-related adverse events were recorded during the study.The evaluation of pain palliation revealed a statistically significant differencebetween baseline and follow-up values for pain severity and pain interference(P = 0.001, both evaluations). In the evaluation of local tumor control, we ob-served increased bone density with restoration of cortical borders in 5 of the18 patients (27.7%). In accordance with the MD Anderson criteria, completeand partial responses were obtained in 2 of the 18 patients (11.1%) and 4 of the18 patients (22.2%), respectively. Nonperfused volume values ranged between20% and 93%. Mean NPV values remained substantially stable after the treat-ment (P = 0.08). There was no difference in the NPV values between the re-sponder and nonresponder patients (46.7% [24.2%] [25%Y90%] versus 45%[24.9%] [20%Y93%]; P = 0.7).Conclusions: Magnetic resonanceYguided focused ultrasound can be safelyand effectively used as the primary treatment of pain palliation in patientswith bone metastases and has a potential role in local tumor control.Key Words: MRgFUS, high-intensity focused ultrasound, bone metastases,pain palliation, MR-guided interventional radiology, cancer, oncology(Invest Radiol 2013;48: 00Y00)

Purpose: To evaluate the diagnostic performance and effect on therapeutic management of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with peripheral arterial disease (PAD), with conventional digital subtraction angiography (DSA) as the reference standard. Materials and Methods: The study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 212 patients with symptomatic PAD underwent CT angiography and subsequent DSA. For stenosis analysis ( ≥70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Interobserver agreement was determined with generalized k statistics. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In addition, according to the TransAtlantic Inter-Society Consensus (TASC) Document on Management of Peripheral Arterial Disease guidelines, treatment recommendations based on CT angiographic and DSA fi ndings were compared. McNemar test was used to prove signifi cant differences between CT angiographic and DSA fi ndings. Results: A total of 7420 arterial segments were evaluated, with excellent agreement between readers ( κ ≥ 0.928). On a segmental basis, both sensitivity and specifi city for stenosis of 70% or more were at least 96% (3072 of 3113 segments and 4141 of 4279 segments, respectively), with an accuracy of 98% (7213 of 7392 segments), a PPV of 96% (3072 of 3187 segments), an NPV of 99% (3141 of 3187 segments), a PLR of 36.7, and an NLR of 0.013. There was no significant difference between CT angiographic and DSA findings ( P = .62-.87 ). In accordance with TASC II guidelines, 49 patients were referred for conservative treatment, 87 underwent endovascular procedures, 38 underwent surgery, and 17 received hybrid treatment. Therapy recommendations based on CT angiographic fi ndings alone were identical to those based on DSA fi ndings in all but one patient. Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD. The results can be used to effectively guide therapeutic decision making in these patients. © RSNA, 2011.