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Purpose: Cysteine cathepsin B (CTS-B) is a crucial enzyme that is overexpressed in numerous malignancies and contributes to the invasion and metastasis of cancer. Therefore, this study set out to develop and evaluate an activity-based multi-modality theranostic agent targeting CTS-B for cancer imaging and therapy. Methods: A CTS-B activity-based probe, BMX2, was synthesized and labeled efficiently with 68Ga and 90Y to produce 68Ga-BMX2 for multi-modality imaging and 90Y-BMX2 for radiation therapy. The affinity and specificity of the BMX2 binding with the CTS-B enzyme were determined by fluorescent western blot using recombined active human CTS-B enzyme (rh-CTS-B) and four cancer cell lines including HeLa, HepG2, MCF7, and U87MG with CA074 as CTS-B inhibitor for control. Confocal laser scanning microscope imaging and cell uptake measurement was also performed. Then in vivo PET imaging and fluorescence imaging were acquired on HeLa xenografts. Finally, the therapeutic effect of 90Y-BMX2 was tested. Results: BMX2 could be specifically activated by rh-CTS-B and stably bound to the enzyme. The binding of BMX2 with CTS-B has a time-dependent and enzyme concentration-dependent manner. Although CTS-B expression varied between cell lines, all showed significant uptake of BMX2 and 68Ga-BMX2. In vivo optical and PET imaging showed high tumor uptake of BMX2 and 68Ga-BMX2 and accumulated for more than 24 hours. The 90Y-BMX2 could significantly inhibit HeLa tumor growth. Conclusion: The development of 68Ga/90Y-BMX2, a radioactive and fluorescent dual modality theranostic agent, demonstrated an effective theranostic approach for PET diagnostic imaging, fluorescence imaging, and radionuclide therapy of cancers, which may have a potential for clinical translation for cancer theranostic in the future.

Rationale: Epithelioid hemangioendothelioma (EHE) is a rare low-to-intermediate grade malignant vascular neoplasm. We report a primary splenic EHE with diffused metastasis who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). Our case emphasizes that EHE should be considered a differential diagnose of 18F-FDG-avid splenic malignancies. Patient concerns: A 39-year-old man presented with abdominal distension and chest distress for 20 days and lumbago for 2 days. Transthoracic echocardiography suggested a large amount of pericardial effusion. Contrast-enhanced CT imaging showed splenomegaly with multiple low-density nodules with ring enhancement. A large irregular mass was also found in the right superior mediastinum with heterogeneous density and enhancement. 18F-FDG PET/CT imaging revealed splenomegaly, filled with intense hypermetabolic nodules and masses. And multiple regions of increased 18F-FDG uptake were observed in the mediastinum, left pleura, and bones. Diagnosis: EHE of the spleen. Interventions: Half a month after the diagnosis was confirmed, the patient then underwent chemotherapy, Docetaxel combined with carboplatin, and Endu were administrated every 3 weeks. Outcomes: During the 6-month follow-up period, the patient has finished 4 cycles of chemotherapy combined with 2 months of targeted drug. Efficacy assessment is partial remission through CT imaging, and clinical symptoms of patient improved significantly. Lessons: Primary splenic EHE is extremely rare, especially with diffuse systemic metastasis. Our report suggested that EHE should be considered a differential diagnosis of 18F-FDG-avid splenic malignancies. Furthermore, 18F-FDG PET/CT plays critical role in staging and accessing disease extent of EHE.

To determine the clinicopathological and imaging features in 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET/CT) for paraganglioma of testis, and to increase the diagnostic accuracy. Methods: A case of paraganglioma of testis with multiple lymph node and lung metastasis were reported. PET/CT and pathological findings in the case were retrospectively analyzed. Results: The patient presented with high blood pressure, high level of catecholamine, and urinary vanillylmandelic acid. The patient underwent 18F-FDG PET/CT, which showed the features including the right testis nodule with a star lesion nearby, the right spermatic cord, the lymphadenopathy of bilateral inguinal and retroperitoneum, the posterior basal segment of right lung nodule, and a lot of brown adipose tissues (BAT) in the whole body with intense FDG uptake. 18F-FDG PET/CT showed that the intense FDG uptake of the BAT disappeared after the excision of the right testis and metastasis of paraganglioma. Conclusion: PET/CT shows great value in localization diagnose, clinical staging and curative evaluation. PET/CT plays a helpful role in revealing the BAT with 18F-DG avidity in the patients with paraganglioma with elevated blood pressure, high level catecholamine, and urinary vanillylmandelic acid.目的：探讨睾丸异位嗜铬细胞瘤的18F-氟-2-脱氧葡萄糖(18F-fluroro-2-deoxyglucose，18F-FDG)正电子发射断层成像-计算机断层成像(positron emission tomography and computed tomography，PET/CT)特点，以提高对其诊断水平。方法：报告1例病理确诊为异位嗜铬细胞瘤并多发淋巴结及肺转移的患者资料。结果：患者有典型的血压升高症状，血儿茶酚胺及尿香草扁桃酸值显著升高。PET/CT检查发现患者右侧睾丸糖代谢增高的软组织结节，邻近伴1个子灶，右侧精索可见糖代谢增高的肿块，双侧腹股沟区及腹膜后多发糖代谢增高的淋巴结，右肺下叶后基底段糖代谢增高的结节，全身多处可见糖代谢弥漫性增高的棕色脂肪影；右侧睾丸异位嗜铬细胞瘤原发灶与转移灶切除后PET/CT检查则可见棕色脂肪组织糖代谢增高表现消失。结论：PET/CT检查对异位嗜铬细胞瘤原发灶的定位诊断、临床分期与疗效评估有着较好的价值，而棕色脂肪组织的18F-FDG摄取增高对异位嗜铬细胞瘤的定性诊断具有一定的提示作用。.

Rationale: Malignant hepatic epithelioid hemangioendotheliom (HEH) is a rare vascular tumor of endothelial origin, with multiple metastases to the spleen. This report describes a diffuse HEH with splenic metastasis on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) images and delayed mutifocal bone metastasis after liver transplantation (LTx). Patient concerns: A 30-year-old male was admitted to our hospital with a complaint of abdominal distension, fatigue, and anorexia for 2 months. Diagnoses: Mild to moderate FDG uptake in the whole liver, and multifocal FDG uptake in the spleen were observed on 18F-FDG PET/CT scan. Ultrasound guided liver biopsy was performed, and a diagnosis of HEH was confirmed. Interventions: The patient underwent LTx and splenectomy. Outcomes: The patient developed low back pain due to unknown etiology, 3 months after surgery. A follow-up 18F-FDG PET/CT scan demonstrated multifocal bone destruction. Unfortunately, the patient died 12 months after surgery. Lessons: It is noteworthy that despite liver transplantation for the treatment of HEH, there may be a risk of recurrence. For these patients with extrahepatic lesions, adjuvant chemotherapy may be a useful alternative treatment method for the prevention of recurrence.

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions. Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10–L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10–T11 to L1–L2 were included for further analysis. The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10–T11, 1.20 mm at T11–T12, 1.23 mm at T12–L1, and 1.34 mm at L1–L2 (P