Search

Introduction: Assessing local invasion is essential for determining stage of cN0 head and neck squamous cell carcinoma (HNSCC). We aimed to evaluate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) in HNSCC characterization and compare it with conventional imaging., Methods: This multicentral study included 278 consecutive newly diagnosed cN0 HNSCC patients recruited from ACRIN 6685 (American College of Radiology Imaging Network) dataset. Four board-certified nuclear radiologists interpreted preoperative PET/CT, MRI, and CT examinations of patients. Imaging results were compared to pathological reference tests through area under curve (AUC), sensitivity, specificity, and receiver operating characteristic (ROC) curve using Stata 18 and Medcalc 22.017., Results: PET/CT demonstrated 23.5 %, 24.7 %, and 51.6 % upstaging, downstaging, and same staging in T staging of patients in comparison to histopathological evaluation, respectively. When evaluating N status, PET/CT showed 25.7 % upstaging, 20.3 % downstaging, and 53.9 % same staging. An optimal SUV max cut-off value of 10.9 was determined to predict early-stage (T1, T2) and advanced-stage (T3, T4) HNSCC tumors with an AUC of 0.709 (95 % CI = 0.648-0.766). This cut-off value also predicted N0 and N+ patients with an AUC of 0.670 (95 % CI = 0.606-0.729). Sensitivity and specificity of PET/CT, MRI, and CT for bone invasion, muscle invasion, nerve invasion, cartilage invasion, superficial tissue invasion, overall invasion, and fixed vocal cord were calculated., Conclusion: Our findings support the valuable accuracy of 18F-FDG PET/CT in staging HNSCC patients. Also, 18F-FDG PET/CT outperformed conventional imaging in characterization of HNSCC tumors., Implications for Practice: By offering an in-depth investigation in imaging of HNSCC tumors, this study contributes to evidence-based clinical decision-making., Competing Interests: Conflict of interest statement None., (Copyright © 2025 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Objectives: Thyroid cancer (TC) is commonly recognized as the most prevalent type of malignancy affecting the endocrine system. This study aimed to assess the incidence of TC and its trends in the Iranian population., Methods: The incidence rate of TC in Iran was determined using data from the Iranian National Population-based Cancer Registry (INPCR). The INPCR registered all new cancer cases through various diagnostic methods, including pathology reports, clinical and paraclinical data, and death registry reports., Results: From 2014 to 2018, a total of 27,530 cases of TC were recorded. Among these cases, 21,932 (79.7%) were female, and 5,598 (20.3%) were male. The age-standardized incidence rate (ASR) of TC was 6.17 (95% confidence interval [CI]: 6.09-6.25) per 100,000 person-years, showing an upward trend from 4.61 (95% CI: 4.45-4.77) per 100,000 population in 2014 to 8.17 (95% CI: 7.97-8.37) in 2018. The ASR of TC in women was nearly 3.7 times higher than that in men (9.79 vs. 2.59 per 100,000 person-years). The ASR of TC was highest in younger age groups among women (40-50 years) compared to men, who had higher rates in older age groups (65-75 years). Papillary thyroid carcinoma (PTC), including its follicular variant, was the predominant histological type of TC in the Iranian population, accounting for 82.19% ( n  = 22,627) of cases, followed by follicular thyroid carcinoma (FTC) ( n  = 859; 3.12%)., Conclusions: Our data suggest that thyroid cancer rate has increased in Iran though comprehending the underlying reasons for this phenomenon requires further research., Competing Interests: Competing interestsThe authors declare no competing interests., (© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objective: This study aims to develop and validate a predictive model for thyroid nodule malignancy risks using clinical and ultrasonography features and a machine learning (ML) approach., Methods: This retrospective study is based on the clinical and ultrasound characteristics of 1035 thyroid nodules (845 benign and 190 malignant) to develop and validate the risk prediction model. Employing multiple logistic regression, key features were selected in developing the model. Eight ML algorithms were evaluated for predicting the risks of malignancy. Finally, the predictive ability of the best-performing algorithm was compared against American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) and American Thyroid Association (ATA) guidelines., Results: Based on AUC criteria (88.3, 95% CI: 81.2-94.2), sensitivity (84.2, 95% CI: 71.1-94.7), specificity (92.3, 95% CI: 88.2-95.9), positive predictive value, (71.4, 95% CI: 60.4-83.3) and negative predictive value (96.3, 95% CI: 93.5-98.8), the XGBoost algorithm exhibited superior performance over the other ML algorithms and ACR TI-RADS and ATA. These criteria were obtained for ACR TI-RADS at 54.2%, 63.2%, 48.5%, 21.1%, and 84.8%, while for ATA, they were 44.3%, 76.3%, 27.2%, 18.4%, and 81.6%. In addition, the unnecessary fine-needle aspiration (FNA) rate with ACR TI-RADS and ATA was 43% and 63%, respectively-significantly higher than the 7% obtained with XGBoost., Conclusions: This study demonstrated the capability of ML approaches in enhancing the accuracy of predicting thyroid malignancy risks as well as their potential benefits in optimizing healthcare resources by reducing unnecessary FNA rates. Using the proposed model through a web-based tool can facilitate clinical judgments in thyroid nodule management and personalized treatment., Key Points: Question Current risk assessment systems have limitations, with high unnecessary FNA rates compared to machine learning (ML) models. Findings The XGBoost algorithm was compared to other ML algorithms, ACR TI-RADS, and ATA and demonstrated superior performance. Clinical relevance This study demonstrated the capability of ML approaches in enhancing the accuracy of predicting thyroid malignancy. The proposed web-based tool to facilitate the prediction of thyroid nodule risk is available at https://aimedlab.ir/tnr ., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Nooshin Shirzad. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: No study subjects or cohorts have been previously reported. Methodology: Retrospective Performed at one institution, (© 2025. The Author(s), under exclusive licence to European Society of Radiology.)

Purpose: To evaluate the diagnostic value of ultrasound elastography (USE) for characterizing hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC)., Methods: The protocol was pre-registered a priori at ( https://osf.io/namvk/ ). Using PubMed, Web of Science, Embase, and Cochrane Library, we found studies up to April 20, 2024 by searching HCC, ICC, and USE as keywords. Parameters of USE were directly compared between HCC and ICC patients using random-effects bivariate model on STATA 17.0, MedCalc 20.0, and Psychometrica. Trim & fill method and sensitivity analysis were also performed., Results: Eighteen studies were included with 1057 patients, consisting of 863 HCC lesions, 188 ICC lesions, and 6 mixed lesions. The pooled E mean values of HCC and ICC were 28.3 (CI = 19.8 to 36.8) and 44.0 (CI = 20.9 to 67.2). HCC tumors were 34.3% softer than ICC while peritumoral tissue in HCC lesions was 75% stiffer than ICC lesions based on E mean . The strain value index (tumoral-to-peritumoral ratio) in HCC patients was 49.4% less than that of ICC patients. USE demonstrated a pool sensitivity of 87% (CI = 73-95%), specificity of 82% (CI = 65-92%), positive likelihood ratio of 4.8 (CI = 2.2 to 10.3), negative likelihood ratio of 0.16 (CI = 0.07 to 0.37), and diagnostic odds ratio of 31 (CI = 7 to 127) in differentiation of ICC from HCC., Conclusion: By evaluating tumoral and pre-tumoral stiffness, along with strain value index, USE may provide a valuable quantitative diagnostic tool for accurately differentiating HCC and ICC., Competing Interests: Declarations. Informed consent: Not applicable. Animal study: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To evaluate the staging performance of positron emission tomography/magnetic resonance imaging (PET/MRI) for confirmed esophageal cancer based on the TNM classification system as well as compare it to other alternative modalities (e.g., endoscopic ultrasonography (EUS), computed tomography (CT), MRI, and PET/CT) in a full head-to-head manner., Methods: Protocol was pre-registered a priori at ( http://osf.io/6qj5m/ ). We searched PubMed, Web of Science, Embase, and Cochrane Library for studies until September 10, 2024. The risk of bias was assessed using Modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C). The classification performance of PET/MRI in T, N, and M staging of esophageal cancer and resectability status were evaluated and compared to other relative modalities. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used for certainty evaluation., Results: Nine studies were included with 245 esophageal cancer patients. For T, N, and M staging, PET/MRI showed 9.1%, 2.0%, and 10.7% upstaging than the histopathological evaluation while these numbers were 19.4%, 12.4%, and 5.3% for downstaging. For direct comparison with PET/CT, PET/MRI showed 0.7% and 5.6% less downstaging and upstaging for N staging and 2.5% and 4.0% for M staging. As for predicting resectability status, pre-ADCmean and post-ADCmean were promising, unlike other parameters (i.e., ΔADCmean, pre-SUVmax, post-SUVmax, and ΔSUVmax)., Conclusion: With protocol adjustments, PET/MRI might be utilized in the future for preoperative staging of esophageal cancer., Clinical Trial Number: N/A., Competing Interests: Declarations. Human ethics and consent to participate: All participants in included studies provided written informed consents. We adhered to the principles outlined in the Declaration of Helsinki. Institutional review board of the Tehran University of Medical Science approved our systematic review. Animal study: N/A. Consent for publication: N/A. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Testicular torsion is a urological emergency requiring timely intervention to prevent irreversible damage, infertility, or orchiectomy., Objective: To investigate the protective effects of lithium against testicular torsion/detorsion (T/D) damage in a rat model., Methods: Seventy-two adult rats were randomly assigned to six groups: Group I: sham-operated control; Group II: lithium treatment with sham surgery; Groups III-VI: 4-h ischemia by 720° counterclockwise testis twisting, followed by 24-h reperfusion. Two hours before the onset of reperfusion, rats in Groups III-VI received vehicle or varying doses of lithium chloride (12, 30, or 60 mg/kg). We assessed oxidative stress, inflammation, and nitrosative stress biomarkers, glycogen synthase kinase-3β (GSK-3β) levels, and conducted histopathological examinations., Results: Lithium showed remarkable protective effects against T/D injury, with 60 mg/kg being most effective. This dosage significantly reduced malondialdehyde, interleukin-6, tumor necrosis factor-α, and nitric oxide metabolite levels by 44 %, 78 %, 55 %, and 65 % compared to the vehicle group, respectively. It also inhibited GSK-3β by promoting Ser9 phosphorylation. Histopathological analysis revealed lithium treatment was effective in minimizing testicular damage, restoring testicular weight, and preserving the structural integrity of seminiferous tubules., Conclusion: Despite previous reports of lithium toxicity in testicular tissue, lithium treatment serves as a promising option to prolong the therapeutic window for intervention and protect against ischemia-reperfusion injury following surgical correction of testicular torsion., Competing Interests: Declarations of interest None., (Copyright © 2025 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: Primary hepatocellular carcinoma (HCC) represents a substantial global health challenge. Early diagnosis of HCC is crucial for improved patient outcomes. The aim of this study was to assess qualitative and quantitative diagnostic performance of PET/CT using 11 C-acetate and [18F]-fluorodeoxyglucose (FDG) in detection of primary HCC and to determine if 11 C-acetate added to [18F]-FDG alleviates the low sensitivity rate mentioned in guidelines., Methods: Protocol was pre-registered at https://osf.io/2vcb9 . We searched PubMed, Web of Science, Embase, and the Cochrane Library for included studies. Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the risk of bias. Possible sources of statistical heterogeneity were explored. Additionally, mentioned three PET/CT tests were evaluated for their diagnostic performance in differentiating HCC from its differential diagnoses. Grades of Recommendation, Assessment, Development, and Evaluation was used to assess quality of generated evidence., Results: Twenty-four studies were analyzed. Qualitative dual-tracer PET/CT demonstrated 92.0% per-lesion sensitivity, and a significantly higher direct sensitivity difference of 30% to conventional CT, 44.7% to [18F]-FDG, and 12.0% to 11 C-acetate. Regarding differentiation rate, [18F]-FDG was superior to 11 C-acetate in poorly differentiated lesions while 11 C-acetate was superior in well-differentiated lesions. Regarding size, dual tracer combination solved the high missing rate of HCC lesions in 1-2 cm and 2-5 cm groups but could not help in size < 1 cm., Conclusion: Dual-tracer PET/CT utilizing 11 C-acetate and [18F]-FDG represents a sensitive method for detecting primary HCC. By concurrently quantifying or qualifying the uptake of 11 C-acetate and [18F]-FDG, this multimodal approach enables precise localization of intrahepatic lesions., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest for this article., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)