Both visual and semiquantitative indices detected glioblastoma recurrence with high accuracy and were predictive for PFS. Lesion-to-normal-tissue ratios were the best discriminators of PFS; however, none of the investigated parameters predicted OS. These retrospectively established analysis parameters need to be confirmed prospectively.

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The degree of intactness of human cognitive functioning for a given individual spans a wide spectrum, ranging from normal to severely demented. The differential diagnosis for the causes of impairment along that spectrum is also wide, and often difficult to distinguish clinically, which has led to an increasing role for neuroimaging tools in that evaluation. The most frequent causes of dementia are neurodegenerative disorders, Alzheimer's disease being the most prevalent among them, and they produce significant alterations in brain metabolism with devastating neuropathologic, economic, social and clinical consequences. These alterations are detectable through positron emission tomography (PET), even in their earliest stages. The most commonly performed PET studies of the brain are carried out with [18F]fluorodeoxyglucose (FDG) as the imaged radiopharmaceutical. Such scans have demonstrated diagnostic and prognostic utility in evaluating patients with cognitive impairment, and in distinguishing among primary neurodegenerative disorders and other etiologies for cognitive decline. In addition to focusing upon the effects on cerebral metabolism examined with FDG PET, some other changes occurring in the brains of cognitively impaired patients assessable with other radiotracers will be considered. As preventive and disease-modifying treatments are developed, early detection of accurately diagnosed disease processes facilitated by the use of PET has the potential to substantially impact upon the enormous human toll exacted by these diseases.

Rationale:Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is characterized by a pattern of extravasated blood restricted to the perimesencephalic cisterns, normal angiographic findings, and an excellent prognosis with an uneventful course and low risks of complication. The precise etiology of bleeding in patients with PNSAH has not yet been established. The most common hypothesis is that PNSAH is venous in origin. Intracranial venous hypertension has been considered as the pivotal factor in the pathogenesis of PNSAH. The underlying venous pathology such as straight sinus stenosis, jugular vein occlusion may contribute to PNSAH. We describe a patient in whom transverse sinus thrombosis preceded intracranial venous hypertension and PNSAH. These findings supported that the source of the subarachnoid hemorrhage is venous in origin.Patient concerns and diagnoses:A 45-year-old right-handed man was admitted to the hospital with a sudden onset of severe headache associated with nausea, vomiting, and mild photophobia for 6 hours. The patient was fully conscious and totally alert. An emergency brain computed tomography (CT) revealed an acute subarachnoid hemorrhage restricted to the perimesencephalic cisterns. CT angiography revealed no evidence of an intracranial aneurysm or underlying vascular malformation. Digital subtraction angiography of arterial and capillary phases confirmed the CT angiographic findings. Assessment of the venous phase demonstrated right transverse sinus thrombosis. Magnetic resonance imaging confirmed the diagnosis of cerebral venous sinus thrombosis (CVST). Lumbar puncture revealed an opening pressure of 360 mmH2O, suggestive of intracranial venous hypertension. Grave disease was diagnosed by endocrinological investigation.Interventions:Low-molecular-weight heparin, followed by oral warfarin, was initiated immediately as the treatment for cerebral venous sinus thrombosis and PNSAH.Outcomes:The patient discharged without any neurologic defect after 3 weeks of hospital stay. MR venography revealed recanalization of right transverse sinus at the 6-month follow-up. No clinical or neuroimaging evidence of relapse was detected at 12 months follow-up.Lessons:Hyperthyroidism may contribute to the development of CVST. The presence of acute transverse sinus thrombosis, as a cause of PNSAH, provides further support for the hypothesis that the source of PNSAH is venous in origin and intracranial venous hypertension plays a critical role in the pathogenesis of PNSAH.

Background:The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing.This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs.Methods:Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software.Results:Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures.Conclusions:Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.

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SUM MARYLymphangiomas are congenital malformations o f the lymphatics that are curable by extirpation. Accurate delineation of lesion extension is important for pre-operative diagnosis, surgical planning, and assessing recurrence. The radiologic findings were retrospectively evaluated t o determine the imaging appearance o f these benign tumours. The plain radiographs, barium meal, ultrasound, CT, and MR images o f 18 patients with one or more pathologically proved lymphangiomas were reviewed. Plain radiography and barium study showed masses displacing adjacent organs. Ultrasound examination showed uni-or multilocular cystic masses with smooth, thin or irregular, thick walls. Enhancement of the cyst wall was variable on CT and MR studies. The CT density of the fluid ranged from -4 t o 34 HU depending on the lipid content and the presence o f haemorrhage. The cysts were isointense t o muscle on T1 -weighted and hyperintense t o fat on T2-weighted MR images. The MR imaging delineated the tumour lesion extension more clearly than ultrasound and CT scans. Ultrasound, CT, and MR imaging are valuable for evaluating lymphangiomas. Magnetic resonance imaging allows accurate determination of lesion extension.

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