In patients with BPH, vascular changes are observed in the prostate after Tadalafil administration, which can be detected with CEUS.

What are the novel findings of this work? Fetal magnetic resonance imaging (MRI) can detect additional brain anomalies in about 10% of fetuses with congenital cytomegalovirus (CMV) infection and normal neurosonography. CMV viral load was the only independent predictor of fetal anomalies on MRI later in gestation, thus confirming its prognostic value, mostly when associated with antenatal imaging. What are the clinical implications of this work?The findings of this study support the value of detailed imaging follow-up throughout the remainder of the pregnancy after the diagnosis of fetal CMV infection and the use of fetal MRI even in cases of negative neurosonography to better predict the postnatal prognosis of infected newborns.

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Objective To assess the performance of fetal magnetic resonance imaging (MRI) in detecting associated anomalies in fetuses diagnosed with isolated corpus callosal (CC) anomaly on multiplanar ultrasound evaluation of the fetal brain (neurosonography). Methods This was a multicenter, retrospective cohort study involving 14 fetal medicine centers in Italy, UK, Portugal, Canada, Austria and Spain. Inclusion criteria were fetuses with an apparently isolated CC anomaly, defined as an anomaly of the CC and no other additional central nervous system (CNS) or extra‐CNS abnormality detected on expert ultrasound, including multiplanar neurosonography; normal karyotype; maternal age ≥ 18 years; and gestational age at diagnosis ≥ 18 weeks. The primary outcome was the rate of additional CNS abnormalities detected exclusively on fetal MRI within 2 weeks following neurosonography. The secondary outcomes were the rate of additional abnormalities according to the type of CC abnormality (complete (cACC) or partial (pACC) agenesis of the CC) and the rate of additional anomalies detected only on postnatal imaging or at postmortem examination. Results A total of 269 fetuses with a sonographic prenatal diagnosis of apparently isolated CC anomalies (207 with cACC and 62 with pACC) were included in the analysis. Additional structural anomalies of the CNS were detected exclusively on prenatal MRI in 11.2% (30/269) of cases, with malformations of cortical development representing the most common type of anomaly. When stratifying the analysis according to the type of CC anomaly, the rate of associated anomalies detected exclusively on MRI was 11.6% (24/207) in cACC cases and 9.7% (6/62) in pACC cases. On multivariate logistic regression analysis, only maternal body mass index was associated independently with the likelihood of detecting associated anomalies on MRI (odds ratio, 1.07 (95% CI, 1.01–1.14); P = 0.03). Associated anomalies were detected exclusively after delivery and were missed on both types of prenatal imaging in 3.9% (8/205) of fetuses with prenatal diagnosis of isolated anomaly of the CC. Conclusion In fetuses with isolated anomaly of the CC diagnosed on antenatal neurosonography, MRI can identify a small proportion of additional anomalies, mainly malformations of cortical development, which are not detected on ultrasound. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

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SMARCB1 inactivation is a well-established trigger event in atypical teratoid/rhabdoid tumor. Recently, a role for SMARCB1 inactivation has emerged as a mechanism of clonal evolution in other tumor types, including rare brain tumors. We describe an unusual malignant intra-axial SMARCB1-deficient spindle cell desmoplastic neoplasm, occurring in a 6-year-old child with meningioangiomatosis and a long history of seizures. Striking features of the tumor were a storiform pattern and strong CD34 expression. Undifferentiated round cell areas with isolated rhabdoid cells showing high mitotic index and focal necrosis with INI1 expression loss were present. The meningioangiomatosis component showed few chromosomal imbalances, including chromosomal 22 monosomy (where SMARCB1 maps) and gain at 6q14.3. In addition to these abnormalities, the spindle cell desmoplastic neoplasm and its dedifferentiated SMARCB1-deficient component shared several other aberrations, including homozygous deletion at 9p21.3, losses at 1p, 3p, 3q, 10p, and 13q, gains and losses at 5p and 11p. In line with INI1 loss, the dedifferentiated component showed remarkably decreased levels of SMARCB1 transcript. The residual SMARCB1 allele was wildtype. Our findings suggest progression from the meningioangiomatosis to the malignant desmoplastic neoplasm through the occurrence of complex chromosomal abnormalities, and point to functional silencing of SMARCB1 in the dedifferentiation component.

Spontaneous intracranial hypotension (SIH) is a syndrome characterized by low cerebrospinal fluid (CSF) pressure and debilitating postural headaches. The diagnostic criteria recommended by the Headache Classification Committee of the International Headache Society have changed significantly throughout the last few decades, explaining current uncertainty on how to reliably diagnose and treat this condition [1].

Purpose: In the phase 2 REGOMA trial, regorafenib improved overall survival, as compared with lomustine, in glioblastoma (GBM) patients at rst progression after chemoradiation. Recently, some real-life trials showed similar impact on survival but a higher rate of adverse events than in REGOMA, thus raising concerns over tolerability. The aim of this study was to assess the e cacy and tolerability of a lower intensity regorafenib regimen.Patients and Methods: Regorafenib daily dose was gradually increased from 80 to 160 mg across the rst 2 cycles. Progression-free survival (PFS) and overall survival (OS) were de ned as time from regorafenib initiation and disease progression or death. Results: Sixty-six GBM patients were included. Median age was 60.0 years. Median PFS and OS following regorafenib were 2.7 and 7.1 months, respectively. Best RANO response to regorafenib were partial response (PR) in 10 (15.1%), stable disease in 17 (25.8%), and progressive disease in 39 (59.1%) patients. Forty-six (69.7%) patients presented adverse events of any grade, and 21 (31.8%) grade 3-4 toxicity. In a multivariable analysis, higher age and absence of MGMTp methylation were signi cantly associated with poorer disease control after regorafenib.Conclusions: Our study is the largest observational real-life study on the use of regorafenib. Our lower intensity regimen proved as effective as the standard 160 mg daily schedule (mPFS and mOS being 2.7 vs 2.0 months and 7.1 vs 7.4 months in our study vs REGOMA, respectively). Moreover, we observed a higher rate of PRs as compared with REGOMA (15.0% versus 3.0%). Background Glioblastoma (GBM) is the most common primary brain tumour of the adult. 1 To date, the standard treatment of newly diagnosed GBM is maximal surgical resection followed by chemoradiation using temozolomide (TMZ). 2,3 However, disease progression occurs in almost all patients after rst line treatment, and median overall survival (OS) is of the order of 20 months. 4 Since, no highly effective treatment has been found for disease recurrence, the choice of the best second-line therapy remains an open issue. 5 To date, the most employed medical treatments at recurrence consist of nitrosourea-based schedules and / or antiangiogenic therapy. Lomustine, a nitrosourea alkylating agent, has been used as control in several phase 2 and 3 trials, [6][7][8][9][10][11][12][13] with a low objective response rate (around 10%), almost exclusively limited to patients with O6-methylguanine DNA methyltransferase promoter (MGMTp) methylation. 8,10,12 Bevacizumab is a recombinant humanised antibody that blocks angiogenesis by inhibiting the vascular endothelial growth factor receptor A (VEGF-A). As GBM is a highly vascularised tumour with increased endothelial proliferation and VEGFR expression, 14 bevacizumab has been investigated in several trials in both newly diagnosed and recurrent GBM. 15 Overall, it has been shown to increase progression-free survival (PFS), but not OS. 10 Regorafenib is an oral inhibitor of several kinases involve...