Objective To evaluate the value of SPECT/CT for detecting the causes of lumbago in post-lumbar spinal fusion patients. Methods From January 2009 to December 2015, 53 patients (31 males, 22 females, age: (42.3±5.3) years) with lumbago after lumbar spinal fusion, without positive CT and digital radiography (DR) findings, were included in this study and were further examined by SPECT/CT imaging. The final diagnosis was made according to clinical symptoms, multimodality imaging findings, and treatment outcome. All patients were followed up for at least 6 months. Results Thirty-eight patients had positive findings with SPECT/CT imaging, including 23 patients with screw loosening, 6 patients with lumbar fusion cage aseptic inflammation and 9 patients with impingement. The other 15 patients had negative results. The diagnostic sensitivity of SPECT/CT for detecting causes of lumbago was 71.7% (38/53). The diagnostic sensitivity and positive predictive value of SPECT/CT for complications caused by internal fixators were both 100% (38/38). Conclusion SPECT/CT scanning could be a clinical valuable tool for inspecting the cause of lumbago in post-lumbar spinal fusion patients.

Objective To explore the diagnostic value of SPECT/CT on fracture healing.Methods A total of 28 patients (13 males,15 females; average age 45.3 years) with fracture were enrolled.All underwent metal fixation.SPECT/CT scans were performed at least 6 months after the metal fixation.X-ray examination before SPECT/CT showed equivocal fracture healing.The fracture delayed union or nonunion were judged by degree of uptake as well as uptake pattern around fracture site.Final diagnosis was confirmed by surgery or follow-up X-ray film.Results Among 28 patients,15 showed delayed union (confirmed by follow-up),and 13 showed nonunion (confirmed by surgery).There were 13 screws in 6 patients showed abnormal uptake,suggesting screw loose (confirmed by surgery).Conclusions SPECT/CT imaging could be of clinical significance in assessing fracture healing.

Objective To study the imaging characteristics of localized myositis ossificans for improving its diagnosis and differen-tial diagnosis ability.Methods The Clinical and radiographic data of 45 cases with localized myositis ossificans proved by pathology or clinical follow up were analyzed retrospectively,summarize its imaging features.Results Of the 45 cases,1 7 cases occurred in the elbow joint,1 5 in the hip joint,13 in the other parts of the body.X-ray showed lining or lamellar high-density ossification in soft tis-sues in 34 cases,of those 12 cases with “shell”ossification.Compared with the X-ray,CT showed more clear ossification.MRI showed the soft tissue mass with peripheral edema in 18 cases;3 cases obvious ossification,no edema around.SPECT/CT showed abnormal imaging agent concentration in soft tissue within 12 cases,of those 5 cases concentration range greater than the range of ossification,4 cases concentration range less than the range of ossification.Conclusion Localized myositis ossificans have certain im-aging characteristics.Integrated application of a variety of imaging combined with the clinical can fully display the evolution of the disease,and improve its diagnosis rate.

Objective To evaluate the clinical value of 18F-FDG PET-CT in detecting or diagnosing the recurrence and metastasis of colorectal cancer in the postoperative patients with rising CEA or CA19-9 during the follow-up.Methods 87 colorectal cancer patients were entered in the trial,all were postoperative,and during the follow-up were rising CEA or CA19-9 found, and then had the whole body 18F-FDG PET-CT examination.The final diagnosis of all patients were based on pathology results of re-operation,colonoscoply,a variety of imaging examination or clinical follow-up. Results For the diagnosis of recurrence or metastasis of postoperative colorectal cancer with rising CEA or CA19-9,PET-CT sensitivity was 91.0%(71/78),specificity 66.7%(6/9),accuracy 88.5%(77/87).Among the 61 patients who have recently (in 3 months) had conventional chest,abdominal and pelvic imaging examination (ultrasound,CT and MRI),32 patients PET-CT found the lesions that the conventional imaging did not found.The treatment programs of 21 patients have been changed,correction rate was 34.4%(2 1/61). Conclusion The 18F-FDG PET-CT imaging had a significant value in the diagnosis of recurrence and metastasis and restaging in the postoperative colorectal cancer with rising CEA or CA19-9 during the follow-up.

Objective To explore the value of MRS and DWI in diagnosis of cervical spinal cord injury.Methods The MRI plain scan images of 95 cases who suffering from cervical spinal cord injury were analyzed.They were divided into two groups according to the T2 signal of cervical cord,63 cases in Group A(incomplete injury group)with no abnormal on T2 ,32 cases in Group B(complete injury group)with high signal on T2 .The other 50 cases with no injury of cervical cord were recruited as control group (Group C). All the cases were performed with MRS and DWI.The N-acetyl aspartic acid(NAA),choline compounds(Cho)and creatine(Cr)as well as the peak area of lactic acid (Lac)on MRS,and apparent diffusion coefficient(ADC)on DTI were measured separately.Mean-while,NAA/Cho,NAA/Cr,Cho/Cr,Lac/Cho and ADC were analyzed.Results On MRS sequence,the values of NAA/Cho and NAA/Cr were lower in Group B (P <0.05)when compared with Group A.The values of NAA/Cho and NAA/Cr were also lower in Group B,when compared Group C.However,the value of Lac/Cho in Group B was higher than it in Group C(P <0.05).When com-pared Group A with Group C,the value of Lac/Cho only increased in the former.However,on DWI,the value of ADC in Group A was(0.79±0.1 7)×10 -3 mm2/s,lower than that of Group C(0.93±0.1 5)×10 -3 mm2/s (P =0.026);the value of ADC in Group B was(1.21±0.20)×10 -3 mm2/s,significantly higher than that of Group C(P =0.01 7).When compared with Group B,the value of ADC in Group A was a lightly lower (P =0.143)with no statistical significance.Conclusion MRS can noninvasively and quantita-tively reflect the changes of metabolism of medium in injured cervical cord and help characterize the severity and degree of cervical cord injury from metabolic and molecular level.DWI has high sensitivity on early diagnosis of cervical cord injury.The combination of MRS and DWI has important value for formulating reasonable treatment plan and prognostic evaluation.

Objective To evaluate the MRI findings of synovial hemangioma.Methods Twenty-three patients with synovial hemangioma were analyzed retrospectively,and MRI characteristics were summarized.Results Of the 23 patients,there were localized type in 6 and diffuse type in 17.Localized tumors located in the articular synovial tissue and didn't invade articular capsule and peripheral tissues.T hey had envelope,well-defined margin and regular shape.5 cases showed heterogeneous signal with iso-intense or hypo-intense on T1WI,hyper-intense and internal patchy or multiple pinstripe hypo-intense on T2WI and fat-suppression sequence.Diffuse tumors distributed inside and outside the articulation,and invaded the articular capsule or peripheral tissues.17 cases were heterogeneous signal with iso-intense or hypo-intense and internal patchy or sinuous hyper-intense on T1WI,hyper-intense and internal patchy,nodular and multiple pinstripe hypo-intense on T2WI and fat-suppression sequence.Thick flow void of the vessels were showed in 6 cases and phlebolithes were showed in 3 cases.15 cases underwent contrast-enhanced scan,and the tumors showed patchy,nodular or tortuous vascular heterogeneous enhancement with internal patchy,nodular or cord-like non-enhanced areas.Conclusion Fatty-fibrous tissues and flow void of the vessels in the tumor are valuable MRI features for diagnosis of the synovial hemangioma.

Objective To investigate the MRI characteristics of primary myxofibrosarcoma (MFS) in the extremity soft-tissues.Methods The MRI of 14 cases of MFS confirmed by operation and pathology were analyzed retrospectively.Results In the 14 cases,9 were in the thigh,3 in the lower leg,and 2 in the upper arm.The volumes of the tumors were relatively big and all located in the subcutaneous fat or superficial inter-muscular space.The tumor showed expanding growth and had well-defined boundary.On T1 WI,one case showed isosignal intensity,one showed equal signal intensity mostly,and 12 cases showed patch slightly low signal intensity;On fat suppression T2 WI and STIR,tumors showed high-low mixed signal intensity,which mainly showed high signal intensity;On MRI enhanced study,inhomogeneous enhancement was observed in most of the tumors,and "tail sign" was showed in 11 cases.Conclusion MFS is of characteristics on MRI,the position of tumor is shallow,the tumor is relatively big and has clear boundary.On T1 WI,most tumors show iso-low mixed signal intensity.On fat suppression T2WI and STIR,tumors show high-low mixed signal intensity;On enhanced MRI,inhomogeneous enhancement and "tail sign" are its characteristic signs.

ObjectiveTo construct traditional Chinese medicine （TCM） diagnostic scale of turbid toxin syndrome in order to provide corresponding reference for the standardization of TCM syndromes and studies. MethodsWe systematically searched the Chinese Medical Dictionary （CMD）， China Knowledge Network （CNKI）， Wanfang Data Knowledge Service Platform （WF） and VIP database for TCM classics and modern literature on turbid toxin syndrome， and initially screened the four diagnosis information of turbid toxin syndrome， established a pool of information entries， and conducted a cross-sectional clinical survey. Discrete trend method， correlation coefficient method， Cronbach's coefficient method， and factor analysis method were applied to objectively screen the entries. The diagnostic scale of turbid toxin syndrome were constructed through three rounds of Delphi method expert survey to determine the scale entries， using hierarchical analysis to get the judgement matrix scores and relative weight of each entry， after passing consistency test and then isometric expansion of the relative weight of the entries to get the weight of each entry and assign the value. ResultsA total of 35 articles were included， 45 entries were obtained after the initial screening. After the clinical investigation， 12 entries were not suitable by the discrete trend method， 23 entries not suitable by correlation coefficient method， 13 entries by the internal consistency screening were removed with the Cronbach's alpha coefficient rising， and 10 entries not suitable by the factor analysis method. Twenty-two entries were retained after objective screening by the combined use of the four statistical methods. The positive coefficients of experts in the three rounds of Delphi method of expert consultation were 96.67%， the coefficients of expert authority were 0.834， 0.856， and 0.867， and the coefficients of co-ordination were 0.126， 0.326， and 0.312， respectively. After consulting with clinical experts， and three rounds of Delphi method survey and hierarchical analysis method weight assignment， the diagnostic scale entries of turbid toxin syndrome were finally established. Primary symptoms： dark red or purple and dusky tongue， yellowish greasy or dry coating （10 points）； sticky and unpleasant stools （8 points）； disharmony of tastes including halitosis， sticky and greasy taste in the mouth， dry mouth and bitter taste in the mouth （6 points）； unfavourable or yellowish or red urination （5 points）； and dark complexion （4 points）. Secondary symptoms： heavy body （3 points）； dizziness （3 points）； profuse， sticky， foul-smelling secretions （2 points）； wiry and slippery， or slippery， or slippery and rapid pulse （2 points）； feeling of hardness in the abdomen （1 point）. ConclusionUsing Delphi method combined with the hierarchical analysis method， combining qualitative and quantitative study， a diagnostic scale of turbid toxin syndrome was initially developed.

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.
Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy* ; Humans ; SARS-CoV-2 ; Treatment Outcome