Objective To investigate the CT and MRI features of Langerhans cell histiocytosis (LCH) with multiple spinal involvement.Methods The CT and MRI data of 13 patients with multiple LCH lesions in spine confirmed by pathology were retrospectively analyzed.All of 13 cases underwent CT examination (1 case underwent enhanced scanning) and 12 cases underwent MR examination (6 cases underwent enhanced scanning).Results In 13 cases,there were 8 cases of single central lesions invading the adjacent vertebrae and 5 cases of multiple central lesions.There were 19 core spinal lesions and 15 adjacent invading lesions in a total of 34 vertebrae lesions.Eighteen core lesions (18/19,94.74 ％) had different degrees and shape of vertebral compression.A total of 34 abnormal vertebrae were found in 13 cases by CT,which were manifested as osteolytic bone destruction.Eighteen cortical bones of 19 core vertebrae were incomplete,and a paravertebral soft-tissue masses were observed.There were 33 vertebrae lesions in 12 patients who underwent MR examination,including 18 core spinal lesions and 15 adjacent invading lesions.The lesions displayed equal,slightly lower or low signal on T1WI,slightly higher or high signal on T2WI and high signals on fat suppression sequences.A paravertebral soft-tissue masses were observed in 17 core spinal lesions (17/18,94.44％).Conclusion CT and MRI manifestations of spinal multiple LCH have certain characteristics.The level of diagnosis and differential diagnosis should be improved by deepen understanding of the disease image performance,but the diagnosis still depends on the pathology.

Objective To study the CT and MRI features of the chordoma in the mobile spine.Methods The CT and MRI fea-tures were retrospectively analyzed in twenty-four cases of chordoma in the mobile spine.Results In all the twenty-four cases,bone lesions were solitary in eight cases and multiple in sixteen cases,mostly occurred in cervical,occasionally occurred in thoracic or lum-bar vertebra.Both vertebral body and part appendix were involved in all cases.CT imaging showed that all the lesions mainly mani-fested as osteolytic bone destruction,peripheral osteosclerosis and the cortical bone were incomplete.Soft-tissue mass involved para-vertebral and intraspinal.Five lesions appeared vertebrae compression.Eight lesions appeared intervertebral foramen expansion.Le-sions appeared honeycomb or annular enhancement after contrast media injection.Lesions were presented as heterogeneous slightly hypo-isointensity on T1 WI,hyperintensity on T2 WI.Low signal fibrous septa within the tumors were seen.Lesions appeared hon-eycomb enhancement after Gd-DTPA injection.Conclusion CT and MRI findings of chordoma in the mobile spine can be regarded as characteristic,which are helpful for clinical diagnosis.

Objective:To explore the value of X-ray signs with applying low dose of contrast agent to confirm successful puncture in direct shoulder MR arthrography.Methods:In total 669 patients who underwent shoulder MR arthrography in Peking University Third Hospital from January 2016 to August 2018 were retrospectively analyzed. All patients received the anterior approach puncture in shoulder arthrography. X-ray films were taken after 1-2 ml contrast agent was injected. Six X-ray signs of contrast agent distribution were recorded. MR arthrography findings were used to confirm whether the puncture was success. Kappa analysis was used to verify the consistency between each 2 signs. The accuracy rate of each X-ray sign to confirm the successful puncture was calculated. X-ray signs were paired to define the best diagnostic index of successful puncture.Results:Successful puncture was performed in arthrographies for all 669 cases .The displaying rates of six signs were as follows. Contrast agent distribution at overlapping humeral head away from the needle was 66.8% (447/669), in axillary recess was 64.7% (433/669), in glenohumeral space was 93.9% (628/669), in subscapular bursa was 69.8% (467/669), in sheath of long head tendon of biceps brachii (LHBT) was 1.9% (13/669), between LHBT and supraspinatus tendon was 17.2% (115/669). Consistency of each 2 signs was poor (Kappa<0.2), in which the poorest consistency was found between contrast agent overlapping humeral head away from the needle and contrast agent in glenohumeral space (Kappa=-0.115). With combining the above 2 signs, the accuracy rate for defining successful puncture was 100% (669/669).Conclusion:In direct shoulder arthrography by anterior approach, X-ray signs with low dose of contrast agent can be regard as the method to confirm successful puncture. The accuracy rate of the signs of contrast agent distribution at overlapping humeral head away from the needle or in glenohumeral space to define a successful puncture is 100%.

OBJECTIVETo investigate the correlation of serum osteoprotegerin (OPG) with the progression of nonalcoholic fatty liver disease (NAFLD) and the noninvasive prediction and diagnosis of nonalcoholic steatohepatitis (NASH).

METHODSA total of 136 patients with NAFLD were enrolled, and their tissue samples for liver biopsy and serum samples obtained at 1 week after liver biopsy were collected; 83 healthy subjects without the symptoms of fatty liver disease proved by ultrasound examination were enrolled as controls. The physiological indicators including height, body weight, and waist circumference were measured, and body mass index was calculated. The biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT, alkaline phosphatase, gamma-glutamyl transferase, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Double-antibody sandwich enzyme-linked immunosorbent assay was used to determine the serum level of OPG. The rank sum test, chi-square test, t-test, one-way analysis of variance, Spearman correlation analysis, least significant difference test, and receiver operating characteristic (ROC) curve were applied for statistical analysis of various data.

RESULTSSerum OPG level was correlated with AST and TG (P < 0.05), and was highly correlated with hepatocyte fatty degeneration, ballooning degeneration, intralobular inflammation, portal inflammation, and fibrosis degree (P < 0.01). With the increasing NAFLD activity score (NAS), serum OPG level decreased, and there was a highly negative correlation between them (r = -0.928, P < 0.01). Serum OPG level was significantly lower in NASH patients than non-NASH patients. The area under the ROC curve of serum OPG level was 0.963, and according to the Youden index, its optimal sensitivity and specificity were 96.1% and 97.4%, respectively, at an optimal cut-off value of 242.96 ng/L, which suggested a high diagnostic power.

CONCLUSIONIn NASH patients, serum OPG level decreases significantly. Serum OPG level can be used as an independent predictive factor to evaluate NASH and its severity, as well as a noninvasive diagnostic index for NASH.

Alanine Transaminase ; blood ; Alkaline Phosphatase ; blood ; Aspartate Aminotransferases ; blood ; Biopsy ; Body Mass Index ; Case-Control Studies ; Cholesterol ; blood ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Humans ; Inflammation ; pathology ; Liver ; pathology ; Non-alcoholic Fatty Liver Disease ; blood ; diagnosis ; Osteoprotegerin ; blood ; ROC Curve ; Triglycerides ; blood ; gamma-Glutamyltransferase ; blood

As a powerful tool to advance drug discovery, molecular imaging may provide new insights into the process of drug effect and therapy at cellular and molecular levels. When compared with other detection methods, fluorescence-based strategies are highly attractive and can be used to illuminate pathways of drugs' transport, with multi-color capacity, high specificity and good sensitivity. The conjugates of fluorescent molecules and therapeutic agents create exciting avenues for real-time monitoring of drug delivery and distribution, both in vitro and in vivo. In this short review, we discuss recent developments of small molecule-based fluorophore-drug conjugates, including non-cleavable and cleavable ones, that are capable of visualizing drug delivery.

Objective:To investigate the clinical, imaging, etiological and prognostic features of patients with infarctions in different locations of the medulla oblongata.Methods:Patients with acute medullary infarction hospitalized at Tianjin Huanhu Hospital from July 2017 to July 2022 were included. The risk factors, clinical manifestation, stroke mechanism and 90-day prognosis of these patients were analyzed retrospectively.Results:Among the 256 patients enrolled, 150 (58.6%) had lateral medullary infarction (LMI), 106 (41.4%) had medial medullary infarction (MMI). The most frequent clinical manifestation of patients with LMI was dizziness (84.7%,127/150). And motor disorders (83.0%,88/106) was the most frequent clinical manifestation of patients with MMI. LMI lesions were mostly located in the middle (42.7%,64/150) and MMI lesions were mostly located in the upper (60.4%,64/106) medulla oblongata, with statistically significant difference (χ 2=47.53, P<0.001). Large artery atherosclerosis (LAA) was the main stroke mechanism in LMI and MMI [57.3%(86/150) vs 56.6%(60/106)]. Early neurological deterioration was more common in MMI (25.5%,27/106) and less common in LMI (7.3%,11/150), with statistically significant difference (χ 2=16.17, P<0.001). At discharge, more patients with MMI showed poor prognosis in short term [45.3% (48/106) vs 24.0% (36/150), with statistically significant difference (χ 2=12.76, P<0.001)] and even long term at 90-day follow-up [33.0% (35/106) vs 12.7% (19/150), also with statistically significant difference (χ 2=15.48, P<0.001)] than those with LMI. A total of 10 patients (4.0%, 10/256) developed respiratory failure during hospitalization, including 7 patients with LMI (4.7%, 7/150) and 3 patients with bilateral MMI (2.8%,3/106). Early neurological deterioration ( OR=3.38, 95% CI 1.25-9.10, P=0.016) and LAA (compared with small artery occlusion) ( OR=3.08, 95% CI 1.13-8.37, P=0.028) were independent risk factors for poor prognosis in MMI. Age ( OR=1.01, 95% CI 1.01-1.17, P=0.026) and early neurological deterioration ( OR=20.19, 95% CI=2.63-155.06, P=0.004) were independently correlated with poor outcome in LMI. Conclusions:LMI and MMI had similar etiology and significant differences in clinical manifestations, early neurological deterioration and prognosis. Further classification of medullary infarction was of great significance for diagnosis, treatment and prognosis evaluation.