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The purpose of this article was to review the anatomy of the cavernous sinus (CS), illustrate numerous lesions that can affect the CS, and emphasize the imaging characteristics for each lesion to further refine the differential diagnoses. The CS, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The wide-ranging types of pathologies that can involve the CS can be roughly classified as tumoral, congenital, infectious/inflammatory/granulomatous, and vascular. Conditions that affect the CS usually lead to symptoms that are similar to each other; thus, for diagnosis, imaging procedures are required. Radiological evaluations are also required to detect pre- and postoperative CS invasion. Magnetic resonance imaging, which can be supplemented with thin-section contrast-enhanced sequences, is the preferred imaging technique for evaluating the CS. For correct diagnosis of CS lesions and accurate evaluations of CS invasions, it is essential to carefully analyze the anatomical structures within the CS and to acquire precise knowledge about the imaging features of CS lesions, which may frequently overlap.

OBJECTIVE. This study investigates the multiparametric MRI (mpMRI) characteristics and pathologic outcome of wedge-shaped lesions observed on T2-weighted images. MATERIALS AND METHODS. Seventy-six patients with histologically confirmed prostate cancer underwent preoperative 3-T MRI before undergoing radical prostatectomy. Two radiologists worked in consensus to mark wedge-shaped regions of hypointensity on T2-weighted images and assess their appearance on apparent diffusion coefficient (ADC) maps (to determine the degree of hypointensity) and dynamic contrast-enhanced (DCE) MRI (DCE-MRI) (to assess whether they showed early enhancement). The pathologic outcome of wedge-shaped lesions was assessed by matching MR images with whole-mount histologic specimens retrospectively. The difference in quantitative ADC values between malignant and benign wedge-shaped lesions was assessed using a t test. RESULTS. Thirty-five wedge-shaped regions were identified, 12 (34%) of which were found be malignant. Most malignant wedge-shaped regions were highly hypointense (10/12; 83%) on ADC maps and showed early enhancement on DCE-MRI (7/12; 58%). However, benign wedge-shaped lesions were predominantly mildly hypointense (13/23; 57%) on ADC maps and showed no early enhancement (15/23; 65%). Histologic correlates of the benign wedge-shaped regions showed prostatitis (acute inflammation [7/23; 30%] or chronic inflammation [9/23; 39%]), hemosiderin-laden macrophages (6/23; 26%), prominent blood vessels (7/23; 30%), intraluminal blood (6/23; 26%), and nonspecific atrophy (6/23; 26%). The mean (± SD) quantitative ADC value of malignant wedge-shaped regions (1.13 ± 0.11 μm2/ms) was significantly lower (p = 0.0001) than that of benign wedge-shaped regions (1.52 ± 0.27 μm2/ms). CONCLUSION. This study shows that a greater percentage of wedge-shaped features are malignant than was previously thought. Of importance, mpMRI (specifically, ADC maps) can distinguish between malignant and benign wedge-shaped features.

Background: The central nervous system’s involvement in Rheumatoid Arthritis (RA) is infrequent and can be life-threatening. Mass-like CNS involvement is an unusual presentation. A 45 year old man had suffered seropositive rheumatoid arthritis for five years referred to our hospital with one-week history of right-sided facial paralysis, left hemiparesis and headache. Discussion: MRI demonstrated hyperintense mass-like lesion extended from mesencephalon to right hippocampus and basal ganglia on T2 and FLAIR images. On DWI, restricted diffusion was not present. After contrast administration, minimal contrast enhancement was noted. After methotrexate and steroid treatment, the size had been markedly shrunken on the follow-up images. The clinical symptoms were also improved. Conclusion: To our knowledge, the mass-like presentation was not reported in the literature. We report an unusual case of brain involvement of rheumatoid arthritis mimicked tumor

There is no standard procedure for the treatment of benign bone tumors. The bone defect following the curettage of the bone tumor can be filled with autologous bone marrow, polymethylmethacrylate cement, allograft, tricalcium phosphate, and demineralized bone matrix (DBM). All these procedures have their own advantages and disadvantages. Autografting is the gold standard in tumor surgery; nevertheless, its disadvantages including limited access, cosmetic problems, and donor site morbidity make the alternative treatment modalities as viable options. Resorption of graft material and transmission of disease are associated risks of allograft use. [1] Polymethylmethacrylate cement is non-biological and its Young's modulus of elasticity is lower than cortical bone, responds to compression-distraction forces differently compared with cortical bone, and has poor tensile and shear strength. [2] Demineralized bone matrix is expensive and osteoinductive without structural support. [3] Our hypothesis was that cement combined DBM treatment stimulates new bone formation, thus improves the functional scores. To the authors' knowledge, no study has focused on this technique Objectives: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. Patients and methods: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. Results: Median tumor volume was 17.2 cm 3 (range, 2.8 to 139.6 cm 3), median area of the cortical window was 8.3 cm 2 (range, 1.6 to 28.4 cm 2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r=-0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r=-0.577). Conclusion: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.