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Background Autism spectrum disorder (ASD) is associated with altered brain development, but it is unclear which specific structural changes may serve as potential diagnostic markers, particularly in young children at the age when symptoms become fully established. Furthermore, such brain markers need to meet the requirements of precision medicine and be accurate in aiding diagnosis at an individual rather than only a group level. Objective This study aimed to identify and model brain-wide differences in structural connectivity using diffusion tensor imaging (DTI) in young ASD and typically developing (TD) children. Methods A discovery cohort including 93 ASD and 26 TD children and two independent validation cohorts including 12 ASD and 9 TD children from three different cities in China were included. Brain-wide (294 regions) structural connectivity was measured using DTI (fractional anisotropy, FA) together with symptom severity and cognitive development. A connection matrix was constructed for each child for comparisons between ASD and TD groups. Pattern classification was performed on the discovery dataset and the resulting model was tested on the two independent validation datasets. Results Thirty-three structural connections showed increased FA in ASD compared to TD children and associated with both autistic symptom severity and impaired general cognitive development. The majority (29/33) involved the frontal lobe and comprised five different networks with functional relevance to default mode, motor control, social recognition, language and reward. Overall, classification achieved very high accuracy of 96.77% in the discovery dataset, and 91.67% and 88.89% in the two independent validation datasets. Conclusions Identified structural connectivity differences primarily involving the frontal cortex can very accurately distinguish novel individual ASD from TD children and may therefore represent a robust early brain biomarker which can address the requirements of precision medicine.

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignant tumors of the human digestive system. Due to its insidious onset, many patients have already lost the opportunity for radical resection upon tumor diagnosis. In recent years, neoadjuvant treatment for patients with borderline resectable PDAC has been recommended by multiple guidelines to increase the resection rate of radical surgery and improve the postoperative survival. However, further developments are required to accurately assess the tumor response to neoadjuvant therapy and to select the population suitable for such treatment. Reductions in drug toxicity and the number of neoadjuvant cycles are also critical. At present, the clinical evaluation of neoadjuvant treatment is mainly based on several serological and imaging indicators; however, the unique characteristics of PDAC and the insufficient sensitivity and specificity of the markers render this system ineffective. The imaging evaluation system, magnetic resonance imaging (MRI), has its own unique imaging advantages compared with computed tomography (CT) and other imaging examinations. One key advantage is the ability to reflect the changes more rapidly in tumor tissue components, such as the degree of fibrosis, microvessel density, and tissue hypoxia. It can also perform multiparameter quantitative analysis of tumor tissue and changes, attributing to its increasingly important role in imaging evaluation, and potentially the evaluation of neoadjuvant treatment of pancreatic cancer, as several current articles have studied. At the same time, owing to the complexity of MRI and some of its limitations, its wider application is limited. Compared with CT imaging, few relevant studies have been conducted. In this review article, we will investigate and summarize the advantages, limitations, and future development of MRI in the evaluation of neoadjuvant treatment of PDAC. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

To evaluate the efficacy and safety of salvianolate in elderly patients with unstable angina pectoris (UAP). A prospective double-blind randomized placebo-controlled multicenter trial in elderly patients with UAP from 13 third-grade class-A hospitals in China was performed. A total of 318 patients were randomly allocated in a 1:1 ratio to an experimental group (160 patients) and a control group (158 patients). The experimental group was treated with salvianolate for 14 days on the basis of conventional medicine, and the control group was given a placebo for 14 days with the same criteria. Follow-up was lasted 28 days in both groups. The primary endpoint was biweekly frequency of angina pectoris attacks. The secondary endpoints included biweekly dosage of nitroglycerin, the Seattle Angina Questionnaire, angina pectoris severity and duration, myocardial injury markers, high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as major adverse cardiovascular events (MACEs). Safety was assessed according to adverse events and serious adverse events. Baseline characteristics were similar between treatment groups. Compared with those in the control group, the frequency of biweekly angina attacks (2.92 vs . 4.08, P=0.025), the biweekly dosage of nitroglycerin, as well as the severity and duration of angina attacks (P

Conventional MRI may not be ideal for predicting cervical spondylotic myelopathy (CSM) prognosis. In this study, we used radiomics in predicting postoperative recovery in CSM. We aimed to develop and validate radiomic feature-based extra trees models.There were 151 patients with CSM who underwent preoperative TOn internal and external validations, AUCs of the radiomic and clinical-radiomic models, and radiological and clinical-radiological models ranged from 0.71 to 0.81 (significantly 0.5) and 0.40 to 0.55, respectively. Wavelet-LL first-order variance was the most important feature in the radiomic model.Radiomic features, especially wavelet-LL first-order variance, contribute to meaningful predictive models for CSM prognosis.• Conventional MRI features may not be ideal in predicting prognosis. • Radiomics provides greater predictive efficiency in the recovery from cervical spondylotic myelopathy.

Artificial intelligence (AI) represents the latest wave of computer revolution and is considered revolutionary technology in many industries including healthcare. AI has been applied in medical imaging mainly due to the improvement of computational learning,big data mining,and innovations of neural network architecture. AI can improve the efficiency and accuracy of imaging diagnosis and reduce medical cost;also,it can be used to predict the disease risk. In this article we summarize and analyze the application of AI in musculoskeletal imaging.

Objective To investigate the clinical value of diffusion-weighted imaging (DWI) for evaluating the activity of sacroiliitis in ankylosing spondylitis (AS).Methods Totally 73 AS patients were prospectively enrolled and divided into active group (n=43) and chronic group (n=30) according to Bath ankylosing spondylitis disease activity index (BASDAI) scores and laboratory findings. Conventional magnetic resonance imaging (MRI) and DWI were performed in all subjects. Apparent diffusion coefficient (ADC) values of subchondral lesions in sacroiliac joint were independently measured by two radiologists,and the relative ADC (rADC) values were calculated. ADC and rADC values were compared between active and chronic groups. The efficiencies of ADC and rADC values for differentiating the activity of sacroiliitis were analyzed. In addition,the correlation coefficients of ADC values,rADC values,and BASDAI scores were calculated.Results The ADC and rADC values in the active group were (0.667±0.122)×10

To clarify the clinical features, surgical strategies, and outcomes of intraosseous schwannoma (IOS) of the mobile spine. We retrospectively reviewed patients with primary benign spinal schwannoma who underwent surgery in our orthopedic department. A total of 101 patients with primary benign schwannoma located in the mobile spine underwent surgery in our orthopedic department from 2005 to 2015. Twenty-five patients presented with aggressive features. Twenty patients were regularly followed up, twelve with lesions in the cervical spine, six with lesions in the thoracic region, and two with lesions in the lumbar spine. Preoperative CT-guided biopsy was performed in fourteen cases; the accuracy of diagnosis was 100%, and IOS is not histologically different from conventional schwannoma. The computed tomography (CT) scan revealed expansile and osteolytic bone destruction in all these cases, with six patients having pathological fracture. On T2-weighted magnetic resonance imaging, the lobulated schwannomas showed heterogeneous signal intensity and significant heterogeneous enhancement on post-contrast images. Gross total resection was performed in seventeen patients and subtotal resection in three. Tumor-involved nerve roots resection were documented to decrease local recurrence in fourteen cases. The visual analog scale score decreased from 5.66 ± 1.79 preoperatively to 1.16 ± 1.77 at the final follow-up. No local recurrence was noticed at the final follow-up. CT-guided biopsy is effective for the preoperative diagnosis of spinal IOS. Total resection is the optimal treatment for IOS, whereas subtotal resection could be an alternative choice for high-risk cases. These slides can be retrieved under electronic supplementary material.

Objective To assess the diagnostic performance of magnetic resonance imaging (MRI) in the grading of osteochondritis dissecans (OCD) of the knee.Methods Totally 47 patients with OCD of the knee confirmed by arthroscopy were retrospectively enrolled in this study.The OCD lesions were classified into four stages according to classification system of the International Cartilage Repair Society.Two radiologists analyzed all MRI findings independently,and the results were compared with those of arthroscopy.Sensitivity,specificity,and accuracy were calculated.Kappa value were calculated to quantify inter-observer agreement of the diagnostic OCD grade between two doctors by MRI.Specificity,sensitivity,and accuracy of MRI criteria indicating instability for detection of OCD instability were calculated.Results Of these 47 patients with 48 OCD lesions,stages Ⅰ,Ⅱ,Ⅲ,and Ⅲ lesions were detected in 4,8,16,and 20 patients,respectively.The specificity,sensitivity,and accuracy for the diagnosis of OCD stability were 75.0% (83.3%),88.9% (86.1%),and 85.4% (85.4%) for observer l (2),and the agreement of OCD grade between these two readers was substantial with a Kappa value of 0.82.The specificity,sensitivity,and accuracy of MRI criteria for the detection of OCD instability including high T2 signal intensity at the interface between the OCD and the underlying bone,multiple cysts or a single cyst of5 mm in diameter surrounding OCD lesions,high T2 signal intensity cartilage fracture line traversing the articular cartilage,and osteochondral defect were 83.3%,80.6%,and 81.3%;75.0%,72.2%,and 72.9%;66.7%,69.4%,and 68.8%;100%,86.1%,and 89.6%,respectively. Conclusions Osteochondral defect is the most specific MRI sign for diagnosing instable OCD of the knee,whereas osteochondral fracture line has the lowest accuracy.MRI is a useful method to evaluate the grade and stability of OCD of the knee.目的 评价磁共振(MR)成像检查评估膝关节剥脱性骨软骨炎(OCD)分级及稳定性的能力。方法由2名放射诊断医师独立回顾性分析47例经关节镜证实的膝关节OCD患者的术前MR图像,按照OCD国际软骨修复协会分类标准将OCD病变分成4级,与关节镜结果进行对照,计算MR评价OCD稳定性的特异度、敏感度和准确度,计算Kappa值,评价2名医师之间MR诊断OCD分级的一致性。计算提示膝关节OCD不稳定的MR征象诊断不稳定OCD的特异度、敏感度及准确度。结果 47例患者中,48个OCD病灶,Ⅰ、Ⅱ、Ⅲ、Ⅲ级OCD分别为4、8、16、20例,2名医师MR术前诊断OCD稳定性的特异度、敏感度、准确度分别为75.0%(83.3%)、88.9%(86.1%)、85.4%(85.4%),2名医师诊断OCD分级的一致性较好(Kappa=0.82)。提示膝关节OCD不稳定的MR征象:病灶与母体骨交界面线状高信号、病灶邻近骨质多发囊变影或出现大囊变(直径5 mm)、累及全层的软骨骨折线、累及全层的软骨缺损诊断膝关节OCD稳定性的特异度、敏感度、准确度分别为83.3%、80.6%、81.3%;75.0%、72.2%、72.9%;66.7%、69.4%、68.8%;100%、86.1%、89.6%。结论 软骨缺损是诊断不稳定OCD最特异的MR征象,而软骨骨折线的准确率最低。膝关节MR检查是评价OCD稳定性及分级比较可靠的方法。.

Background context Vertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity. Purpose To evaluate the safety and efficiency of the present diagnostic methods and treatment choices. Study design A retrospective study of aggressive VHs with neurologic deficit. Patients sample A total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001. Outcome measures We routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images. Methods Trocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective. Results This series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21–72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24–133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy. Conclusions In aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.

We sought to verify the efficacy and safety of RFA in spinal OO and osteoblastomas (OB) (Enneking Stage 2, S2). We retrospectively reviewed patients treated in our hospital. Surgical resection was indicated for Enneking Stage 3 OB. RFA indications for spinal OO and OB (S2) were no neurological deficits, complete bone cortex around the lesion on computed tomography (CT), and cerebrospinal fluid between a lesion and the spinal cord/nerve root on magnetic resonance imaging. Abundant cerebrospinal fluid (more than 1.0 mm) between the lesion and nerve root/spinal cord was preferred to prevent neurological damage by heat. Otherwise, surgery was recommended. The minimum follow-up was 24 months. Ten patients were treated with CT-guided percutaneous RFA, including three with OB and seven with OO. No patients had neurological deficits or scoliosis. In OO patients, the average visual analog scale (VAS) scores were 7.6/10 (range 6–10) before RFA. In OB cases, the VAS scores were 8, 7, and 9 before RFA. Nine patients had a one-stage biopsy and then RFA, and one patient had a two-stage procedure (biopsy before RFA). The average RFA time for OO was 10 min (range 4–12). In the three OB cases, the RFA time was 12, 12, and 24 min. The time of the whole produce was 98 min (range 65–130 min). All 10 patients were followed-up. The average follow-up time of OO was 46.6 months (range 24–66). Six patients were free of pain, except one who suffered occasional pain with VAS 2/10. The three OB cases were free of pain at 24, 26, and 26 months. CT-guided percutaneous RFA is a safe and effective treatment for spinal OO and S2 OB, especially in lesions with no neurological deficits and intact cortical bone. Cerebrospinal fluid around the lesion is an appropriate indication for percutaneous RFA.

Study design A retrospective study of cervical Langerhans cell histiocytosis (LCH). Objective To evaluate the safety and efficiency of the present diagnosis and treatment strategy. Summary of background data The diagnosis and treatment protocols are still controversial for the rarity of cervical LCH. Methods Thirty patients with cervical LCH were diagnosed in the past 10 years. Biopsy was routinely performed to establish the final diagnosis before treatment. Immobilization was usually the first choice. Low-dose radiotherapy was suggested for cases with solitary marked bony erosion and/or soft tissue extension, and chemotherapy for cases with multiple lesions. Surgery was preserved for suspected malignancy, neurologic deficits, severe deformity, and/or instability. Results The mean age at diagnosis was 14.2 (range: 1.5-41) years old. Neck pain (96.7%) was the most common symptom, followed by restricted motion (70%), neurologic symptoms (36.7%), and torticollis (30%). Four cases had multiple lesions. Fourteen cases had atlantoaxial lesion and 16 cases were subaxial. The lesion extended to paravertebral soft tissue in 40% cases, to epidural space in 30%, to pedicle and/or transverse process in 56.3%. One case had endplate destruction. The accuracy of percutaneous needle biopsy under CT guidance was 91.2%. Eighteen patients had conservative treatment and 12 underwent operation. Three cases involving C2 vertebral body had fixed atlantoaxial anterior dislocation. Another 3 cases with atlantoaxial lateral mass destruction had spontaneous fusion. Eighteen patients had conservative treatment (1 only by immobilization, 13 by radiotherapy, 2 by chemotherapy, and 2 by combined chemotherapy and radiotherapy) and 12 underwent operation. All the initial symptoms were resolved, and there was no recurrence. From retrospective view, the surgical procedure might be avoided in 60% cases. Twenty-five cases had an average 61.6-month follow-up. In cases with severe bony collapse, the vertebral height ratio increased from 20.0% to 44.9% and the lateral mass height ratio from 22.2% to 56.8%. Conclusion Cervical LCH lesions often extend to paravertebral soft tissue, epidural space, pedicles, and even to the endplate and lamina. Needle biopsy under CT guidance is safe and effective. The prognosis of cervical LCH is generally fair. Conservative treatment is usually enough and surgery should be reserved for major neurologic defects like myelopathy or monoparesis.

Langerhans cell histiocytosis (LCH), formerly known as histiocytosis X, is a rare disorder (approximately 1:1,500,000 inhabitants) characterized by clonal proliferation and excess accumulation of pathologic Langerhans cells causing local or systemic effects. The exact etiology of LCH is still unknown. LCH could affect patients of any age, although most present when they are children. The most frequent sites of the bony lesions are the skull, femur, mandible, pelvis and spine. A variety of treatment modalities has been reported, but there was no evidence suggesting that any one treatment was more advantageous than another. We present an adult with LCH of the atlas. A 26-year-old young man presented with a 2-month history of neck pain and stiffness. CT revealed osteolytic lesion in the left lateral mass of atlas with compression fracture. Histopathological diagnosis was Langerhans cell histiocytosis by percutaneous needle biopsy under CT guidance. The patient underwent conservative treatment, including Halo-vest immobilization and radiotherapy. At 7-year follow-up, the patient was asymptomatic except for mild motion restriction of the neck. CT revealed a significant reconstruction of the C1 lateral mass.

To explore the value of multiple b-value diffusion-weighted imaging (DWI) for differentiation of benign and malignant pulmonary masses.Thirty-eight patients were examined by routine sequences and DWI pulse sequence. DWI was acquired through a single-shot echo-planar imaging combined with a respiratory-triggered mode and parallel acquisition. Nine b values ranging from 0 to 1500 s/mm(2) (0, 50, 100, 150, 200, 400, 600, 1000, 1500 s/mm(2)) were used. The intravoxel incoherent motion model was applied to estimate pure diffusion coefficient D, perfusion-related diffusion coefficient D(*), and perfusion fraction f. Mann-Whitney U test was used to compare all measured parameters between benign and malignant groups. The diagnostic performance of the related parameters was evaluated with receiver operating characteristics (ROC) analysis.Of these 38 patients, 30 were pathologically confirmed and 8 were diagnosed based on clinical data. There were 23 lung malignant masses and 15 benign lesions. A significant reduction of D was found in malignant group than in benign group (Z=3.308, P=0.001), while no significant differences in D(*)(Z=1.646, P=0.100) and f(Z=1.254, P=0.210) were observed between the two groups. The area under the ROC curve for D value (0.839) was largest. When the cutoff value was selected as 0.90×10(-3) mm(2)/s, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of diagnosing malignant masses were 95.7%, 80.0%, 90.9%, 91.7%, and 88.9%,respectively.The D value in multiple b-value DWI has certain significance in differentiating the benign and malignant pulmonary masses and has the best diagnostic efficiency.

To explore the image quality of different tube voltage on digital chest radiograph for contrast detail phantom (CDRAD2.0) and occupational exposed workers.The CDRAD2.0 phantom DR images of high KV and different tube voltages were analyzed by 3 readers, image quality figure (IQF) were calculated and compared; at the same time 136 exposed workers were examined with high-kV and DR chest radiograph of different tube voltages. Contrast to high-KV images, 10 anatomic sites were scored .The image differences were compared between DR and high-kV.On CDRAD2.0 phantom, the IQF value of DR images in 3 readers were minimum in the condition of 120 kV, average value was 22.25. The analysis of variance in model with random effects, the mean IQF value of different tube voltage DR image had a significant difference (F = 13.775, P0.01); By Dunnett t-tests analysis, the mean IQF value of DR image in 120 kV and high kilovoltage had no difference (t = -0.58, P = 0.979); On clinical cases, the DR image of 120 kV showed the closest anatomy to the high KV, the mean had no significant difference with 0 (P0.05) with single sample t test.On the CDRAD2.0 phantom or clinical exposed workers, the DR image quality of 120 kV tube voltage equals to high-KV basically.

To investigate the effect of different processing parameters of digital radiography (DR) on the image quality of digital chest radiograph in dust-exposed workers.One hundred and five dust-exposed workers underwent both high-KV radiography and DR to obtain chest radiographs; the image processing parameters were set by the conventional processing method for digital chest radiograph (method A) and the processing method based on the special requirements of occupational diseases (method B). With the high-KV chest radiograph as the reference, the image qualities at 10 anatomic sites of DR image were graded. The images acquired by DR and high-KV radiography were compared, and the DR images acquired by methods A and B were also compared.For method A, the scores at the 10 anatomic sites of DR image were mostly 0 and +1, accounting for over 88%, and the mean score was 0.23 ∼ 0.65, there was a significant difference between the mean score of DR image and the score of high-KV image (P0.001). For method B, the scores at the 10 anatomic sites of DR image were mostly 0, accounting for over 65%, and the mean score was -0.01∼ +0.02 except at the pleura and chest wall; there was no significant difference between the mean score of DR image and the score of high-KV image (P0.05). There were significant differences in the scores at the 10 anatomic sites between the DR images acquired by methods A and B (P0.01).The DR images acquired based on different processing parameters are different. The quality of DR image acquired by the processing method based on the special requirements of occupational diseases is similar to that of high-KV image at the anatomic sites.

Seventeen patients with head and neck recurrent carcinoma underwent (125)I seed implantation under CT or ultrasound guidance. The actuarial D90 of the (125)I seeds implanted was 90-160 Gy (median, 126 Gy). Median follow-up was 10 months (range, 3-48 months). The median local control time was 16 months; the 1- and 2-year local control rates were 66.5% and 49.9%, respectively. The 1- and 2-year survival rates were 51.3% and 38.5%, respectively (median, 16 months). None of the patients experienced grade 4 toxicity. (125)I seed implantation was a feasible and effective salvage treatment for patients with recurrent head and neck cancers.

To detect the frequency of hyperdense middle cerebral artery sign (HMCAS) among patients with severe ischemic attack (baseline NIHSS score ≥ 10) in the middle cerebral artery (MCA) territory within 3 hours after onset and compare the baseline characteristics and 90-day outcomes between the HMCAS (+) and HMCAS (-) groups.A total of 43 patients were evaluated with baseline clinical characteristics, laboratory tests and brain CT/MRI. Follow-up evaluation at the end of 90 days included the modified Rankin Scale (mRS), the Bathel Index (BI) and death.Ten out of forty-three (23.3%) patients were HMCAS (+).The 24-hour NIHSSS of HMCAS (+) group was significantly higher than that of HMCAS (-) group (20.2 ± 5.4 vs. 14.8 ± 7.2, P= 0.037). The follow-up scanning confirmed that all HMCAS (+) patients had larger MCA territory infarction and the ratio of large MCA territory infarction was significantly higher than that of HMCAS (-) group (100% vs. 39.1%, P = 0.001). There were no significant differences in age, gender, risk factors, time intervals, laboratory tests, 90-day functional outcomes between the two groups.The HMCAS (+) patients had notable deterioration 24 hours after onset and had more severe MCA infarction. HMCAS detected by non-enhanced CT at admission should be considered as an alarming sign among patients with severe neurological deficit of MCA territory infarction.

This study evaluated the feasibility, efficacy and safety of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma.Two patients suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia. Lesions located in sacral vertebrae and cervical vertebrae, which were adjacent to nerve root and spinal canal respectively. Tumors were treated under 90°C radiofrequency temperature lasting 4 minutes by an electrode placement. Visual analog scale was used to evaluate the pain improvement.No complications were observed pre- and post-operation. Patients recovered to normal activities immediately and achieved complete pain relief in 24 hours. No symptoms were recurrent in 5 months and 4 months follow up. Mild scoliosis has been recovered in case 2.CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe, effective and has more clinical benefits. The long-term outcome needs further observation.

Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities. A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information. Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement. Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.

To investigate the characteristics of epidemiological distribution of the ossification of the ligamentum flavum (OLF) in the thoracic spine including the incidence, segmental distribution, and shape.Chest spiral computed tomography scans of 993 cases (male 506, female 487, mean age 60 years, range 5-102 years) who presented due to chest symptoms were analyzed with axial slices combined with sagittal slices. The conditions of OLF in the thoracic spine, including segments, thickness, location, and dural sac compression, were recorded. Prevalence was standardized according to the "Age Structure of Population in Beijing 2008".Among the population investigated, the standardized prevalence rate was 63.9 %. The standardized prevalence rate for males (68.5 %) was higher than that for females (59.0 %). The highest prevalence rate of OLF was in the 50-59 years age group (79.2 %); however, high density originated it can be found in individuals aged 10-19 years. The comparison of different thoracic segments showed that T10-11 (44.0 %) and T11-12 (41.6 %) had the highest prevalence rates.The prevalence of ossification of the ligamentum flavum was highest in the 50-59 years group, but also occurred in early years. OLF occurs more frequently in the lower than in the upper and middle thoracic regions and its prevalence increases with aging.

To investigate the association of multi-modality neuroimaging features and cognitive function in mild cognitive impairment (MCI) and Alzheimer's disease (AD).Nine individuals with amnestic MCI (aMCI), fifteen patients with mild probable AD, and eleven age-controlled cognitively normal controls (NC) were recruited. All participants were administered with mini-mental status examination (MMSE) and Cognitive assessment screening instrument (CASI) to assess general cognitive function. Optimized voxel-based morphometry (VBM) was used for the analysis with 3-D high resolution anatomical images. Values of fractional anisotropy (FA) and mean apparent diffusivity coefficient (ADC) were measured from different brain regions on diffusion-tensor images (DTI). The relationship between structural atrophy and DTI-based measurements in the selected brain regions was examined.The scores of MMSE and CASI were correlated with the volumetric changes in such areas as temporal, frontal and parietal lobes, and cingulate gyrus and hippocampal gyrus (P0.001). The scores of MMSE and CASI were positively correlated with FA values, and negatively with ADC values in the white-matter-affected regions including temporal, frontal, parietal lobes, cingulate gyrus, and parahippocampal gyrus (P0.05).Cognitive decline was associated with atrophy and white matter microstructural alterations in temporal, frontal, parietal lobes, cingulate gyrus, and parahippocampal gyrus in MCI and AD. Multi-modality imaging technique may be important in elucidating the brain mechanism of cognitive impairment.

To stress the clinical and radiologic presentation and treatment outcome of Langerhans cell histiocytosis (LCH) with multiple spinal involvements. A total of 42 cases with spinal LCH were reviewed in our hospital and 5 had multifocal spinal lesions. Multiple spinal LCH has been reported in 50 cases in the literature. All cases including ours were analyzed concerning age, sex, clinical and radiologic presentation, therapy and outcome. Of our five cases, three had neurological symptom, four soft tissue involvement and three had posterior arch extension. Compiling data from the eight largest case series of the spinal LCH reveals that 27.2% multiple vertebrae lesions. In these 55 cases, there were 26 female and 29 male with the mean age of 7.4 years (range 0.2–37). A total of 182 vertebrae were involved including 28.0% in the cervical spine, 47.8% in thoracic and 24.2% in the lumbar spine. Extraspinal LCH lesion was documented in 54.2% cases, visceral involvement in 31.1% and vertebra plana in 50% cases. Paravertebral and epidural extension were not documented in most cases. Pathological diagnosis was achieved in 47 cases including 8 open spine biopsy. The treatment strategy varied depending on different hospitals. One patient died, two had recurrence and the others had no evidence of the disease with an average of 7.2 years (range 1–21) of follow-up. Asymptomatic spinal lesions could be simply observed with or without bracing and chemotherapy is justified for multiple lesions. Surgical decompression should be reserved for the uncommon cases in which neurologic compromise does not respond to radiotherapy or progresses too rapidly for radiotherapy.

Background A preliminary assessment was conducted of the feasibility, efficacy, and morbidity of 125I seed implantation for recurrent head and neck carcinoma after surgery and external beam radiotherapy.

The recurrent carcinoma has been difficult to manage after surgery and radiotherapy, extensive resection of locally recurrent rectal cancer is associated with significant morbidity and mortality. Re-irradiation, even in combination with chemotherapy has shown very short survival. We assess the feasibility and efficacy of CT-guided interstitial permanent brachytherapy with (125)I or (103)Pd seeds for recurrent rectal cancer after multiple treatments. Fifteen patients with locally recurrent rectal carcinoma received (125)I or (103)Pd seed implants under CT guidance. The minimal peripheral dose of seed implants was 110-165 Gy (median 150 Gy). Two weeks after seed implantation, a 50 Gy of stereotactic radiotherapy was given to one patient; four patients received 2-4 cycles of chemotherapy. A median follow-up was 8 months (range 4-50 months). The duration of pain-free survival was 0-50 months (median 7 months). Local control was maintained for 3-50 months (median 7 months). The 1- and 2-year local controls were 16.2 and 8.1%, respectively. Eleven patients died: two (18.2%) of local recurrence, seven (63.6%) of local recurrence and metastases, and two (18.2%) of metastases. Four patients (26.7%) survived the median survival was 9 months. The 1- and 2-year actuarial overall survival rates were 42.9% and 10.7%, respectively. One patient (7.6%) experienced a grade 4 toxic event; there was no associated neuropathy. CT-guided radioactive seed implantation is feasible and safe as a salvage or palliative pain relief treatment for patients with recurrent rectal cancers after surgery and radiotherapy.

To assess the feasibility, efficacy, and morbidity of (125)I seeds interstitial permanent implant as salvage therapy for re-recurrent rectal cancer.From September 2003 to October 2007, (125)I seeds implant procedures were performed under CT or ultrasound guidance for thirteen patients with locally re-recurrent rectal carcinoma. The minimal peripheral doses (MPD) of (125)I seeds implanted ranged from 120 to 160 Gy, with a median MPD of 140 Gy to total decay. Three patients also received two to four cycles of chemotherapy after seed implantation.After a median follow-up of 10 months (range 3-45), the pain-free interval was 0-14 months with a median of 7 months (95% CI: 3-11 months). The response rate of pain relief was 46.2% (6/13). Local control was 3-14 months with a median of 7 months (95% CI: 3.5-10.5 months). The 1- and 2-year local control rates were 14.4% and 0%, respectively. Three (23.1%) patients died of local recurrence; seven (53.8%) patients died of local recurrence and metastases; one (7.7%) patient died of metastases. Two (15.4%) patients survived to follow-up. At the time of analysis, the median survival was 10 months (95% CI: 3.9-16.1 months). The 1- and 2-year actuarial overall survival rates were 46.2% and 11.5%, respectively. Two (15.4%) patients experienced a grade 4 toxic event. Seed migration to the pelvic wall was observed in one (7.7%) patient. There was no associated neuropathy.(125)I seed implantation is feasible, effective, and safe as a salvage or palliative treatment for patients with re-recurrent rectal cancer.