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Background: There is a limited number of studies reporting the performance of European Thyroid Imaging Reporting and Data System (EU-TIRADS) guideline in identifying thyroid nodule malignancy. We aimed to evaluate diagnostic accuracy of EU-TIRADS regardless of thyroid nodule size. Methods: During August 2019-November 2021, subjects with thyroid nodules were prospectively included. Sonographic characteristics were recorded and scored as per EU-TIRADS guideline. Finally, fine-needle aspiration (FNA) was performed, and cytological findings were reported. Results: Totally, 1266 thyroid nodules from 984 subjects were assessed, of which 295 nodules were smaller than 10 mm and 971 nodules were 10 mm or larger. Among nodules <10 mm, prevalence rates of malignancy for EU-TIRADS classes 2-5 were 0.0%, 3.7%, 20.6%, and 40.9%, respectively; these rates among nodules ≥10 mm were 2.3%, 4.0%, 19.3%, and 43.2%, respectively. The accuracy values of EU-TIRADS class 5 and EU-TIRADS class 4 or 5 in diagnosis of malignancy for nodules <10 mm were 86.4% and 79.7%, respectively; these rates for nodules ≥10 mm were 83.8% and 76.3%, respectively. Hypoechogenicity, microcalcification, ill-defined and irregular margins were predictors for malignancy regardless of thyroid nodule size. Conclusion: EU-TIRADS could provide an acceptable malignancy risk stratification that is helpful for better distinguishing benignity from malignancy, as well as preventing unnecessary FNA biopsies, in thyroid nodules irrespective of their size. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta is one of the known causes of maternal mortality and morbidity. If diagnosed before delivery, appropriate actions can be taken. The aim of this study was to investigate the role of scaling combination of risk factors in predicting placenta accreta spectrum (PAS). Methods: In this cross-sectional study, 120 pregnant women with two criteria and more of placenta previa in their ultrasound, underwent MRI. Clinical scores (history of surgery, cesarean section, previa, etc.) and paraclinical scores (ultrasound and MRI) were recorded and combined. In cases of hysterectomy, pathological examination was performed. The results were compared and analyzed using SPSS Version 22. The significance level was less than 0.05. Results: Of the120 studied patients, 90 (75%) women were diagnosed with placenta previa in which, 32(36%) patients had placenta accreta and 12 patients had placenta accreta without placenta previa. The mean ultrasound score in women without and with placenta accreta were 0.05±0.32 and 2.43±1.83 (p<0.001). The mean MRI score in women without and with placenta accreta were 0.05±0.27 and 2.07±2.02, respectively. The cut-off point, sensitivity and specificity were 0.50, 100% and 93.4%, respectively. The mean clinical score without and with placenta accreta were 1.97±1.32 and 4.89±3.21, respectively. The cut-off point, sensitivity and specificity were 2.50, 70% and 80%, respectively. The cut-off point of combination score, sensitivity and specificity were 3.50, 89%, 83%. Conclusion: The results of the present study showed that the most specific test to confirm the definitive diagnosis of placenta accreta is paraclinical score, alone. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare the diagnostic accuracy of mammography and ultrasonography and their breast imaging-reporting and data system (BI-RADS) classification versus breast core needle biopsy (CNB) findings in distinguishing the breast masses. Methods: This cross-sectional study was conducted during 2016-2018 on female patients who were referred to a radiology center in Babol, northern Iran, for routine screening and/or for CNB. Patients underwent sonography and mammography by a senior radiologist. The breast lesions were also evaluated according to BI-RADS classification. CNB was performed on the breast masses by the same radiologist and pathological procedures were performed by an expert pathologist. Descriptive statistics were used to analyze the data. Results: In total, 213 breast masses were finally assessed, of which 107 (50.2 %) masses were benign and 106 (49.8 %) masses were malignant. The sensitivity for mammography and ultrasound alone was 72.6% and 68.9%, respectively. This rate for combined mammography and ultrasound was 84.9%. About BI-RADS classification, 28 masses were classified as BI-RADS 3, 99 as BI-RADS 4A, 4 as BI-RADS 4B, 18 as BI-RADS 4C, and 64 as BI-RADS 5. BI-RADS 4A had the highest sensitivity (70.1%) among BI-RADS categories. The highest specificity pertained to BI-RADS 3 and 5 (100%) among BI-RADS categories. Also, the highest accuracy was related to BI-RADS 5 (80.3%). Conclusion: The results of the present study showed that combined mammography and ultrasound had a higher rate of accuracy than mammography or ultrasound alone. Furthermore, the imaging methods BI-RADS classification had an acceptable positive predictive value. [ABSTRACT FROM AUTHOR]

In recent years, with the introduction of 64-slice CT and dual-source CT technology, coronary CT angiography (CCTA) has emerged as a useful diagnostic imaging modality as a non-invasive assessment of coronary heart disease. CT produces a larger radiation dose than other imaging tests and cardiac CT involves higher radiation dose with the advances in the spatial and temporal resolution. The aims of this study are patient dose assessment and establishment of national diagnostic reference level for CCTA in Iran. A questionnaire was sent to CCTA centers. Data for patient and CT protocols were obtained. The volumetric CT dose index (CTDIvol), dose length product (DLP) and total DLP were considered in the 32 cm standard body phantom. Calculation of estimated effective dose (ED) was obtained by multiplying the DLP by a conversion factor [k = 0.014 mSv (mGy·cm)-1]. Mean value of CTDIvol and DLP for CCTA was 50 mGy and 825 mGy·cm. The third quartile (75th) of the distribution of mean CTDIvol (66.54 mGy) and DLP (1073 mGy·cm) values was expressed as the diagnostic reference level (DRL) for CCTA in Iran. The median of ED was 10.26 mSv and interquartile range of ED was 7.08-15.03 mSv. A large variety in CTDIvol and DLP among CT scanner and different sites due to variability in CT parameter is noted. It seems that training could help to reduce patient's dose. [ABSTRACT FROM AUTHOR]

Background: Cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) are frequently used in dental and maxillofacial problems. This study aimed to assess the genotoxicity and cytotoxicity effects of CBCT and MDCT radiographies on exfoliated buccal epithelial cells during dental examinations. Methods: This prospective experimental study was conducted at Babol University of Medical Sciences (Babol, Iran) from March 2021 to April 2021. Buccal mucosa smears were collected bilaterally pre-exposure and 12 days after CBCT or MDCT examinations. To compare the frequency of micronuclei and other cytotoxic cellular changes such as pyknosis, karyolysis, and karyorrhexis, the paired sample t test and Wilcoxon test were used. In addition, independent sample t test, Mann-Whitney, and Chi square tests were used to investigate the differences between the imaging methods and between men and women. All statistical analyses were performed using the SPSS software, and P≤0.05 was considered statistically significant. Results: The current study included 60 adult patients (30 patients in each group), ranging in age from 21 to 50 years. The micronuclei and the other cytotoxic cellular changes increased significantly after CBCT and MDCT radiographic examinations on the 12th day compared to the pre-exposure results (P<0.001). MDCT had statistically higher cytotoxic and genotoxic effects than CBCT (9.4%, 23.1%, and 40% higher values in micronucleus frequency, the mean frequency of micronuclei, and other cytotoxic changes, respectively). There were no significant differences between men and women in the two examination methods (P=0.46 and P=0.49, respectively). Conclusion: Dental examinations with CBCT and MDCT can increase cytotoxicity and chromosomal damage in both men and women. Due to its lower radiation toxicities, CBCT can be recommended as an alternative to MDCT for dental examinations. [ABSTRACT FROM AUTHOR]

Background: There is a limited number of studies reporting the performance of European Thyroid Imaging Reporting and Data System (EU-TIRADS) guideline in identifying thyroid nodule malignancy. We aimed to evaluate diagnostic accuracy of EU-TIRADS regardless of thyroid nodule size., Methods: During August 2019-November 2021, subjects with thyroid nodules were prospectively included. Sonographic characteristics were recorded and scored as per EU-TIRADS guideline. Finally, fine-needle aspiration (FNA) was performed, and cytological findings were reported., Results: Totally, 1266 thyroid nodules from 984 subjects were assessed, of which 295 nodules were smaller than 10 mm and 971 nodules were 10 mm or larger. Among nodules <10 mm, prevalence rates of malignancy for EU-TIRADS classes 2-5 were 0.0%, 3.7%, 20.6%, and 40.9%, respectively; these rates among nodules ≥10 mm were 2.3%, 4.0%, 19.3%, and 43.2%, respectively. The accuracy values of EU-TIRADS class 5 and EU-TIRADS class 4 or 5 in diagnosis of malignancy for nodules <10 mm were 86.4% and 79.7%, respectively; these rates for nodules ≥10 mm were 83.8% and 76.3%, respectively. Hypoechogenicity, microcalcification, ill-defined and irregular margins were predictors for malignancy regardless of thyroid nodule size., Conclusion: EU-TIRADS could provide an acceptable malignancy risk stratification that is helpful for better distinguishing benignity from malignancy, as well as preventing unnecessary FNA biopsies, in thyroid nodules irrespective of their size., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Medical Ultrasound.)

Background: Frequent waves of corona virus disease (COVID-19) and lack of specific drugs against that, warrant studies to reduce the morbidity and mortality of this pandemic disease. In this study, we investigated the association between influenza vaccination and the severity and outcome of COVID-19 disease in Iranian patients living in the North., Methods: This retrospective case-control study was performed on186 patients with COVID-19 infection between March and April, 2020. Patients with positive PCR were divided into two groups of case and control; Patients with moderate to severe and normal to mild lung involvement, respectively. The lung opacities in all of the 5 lobes were evaluated on chest CT images using a CT severity scoring system. The history of influenza vaccination during the fall of 2019-2020 was determined by a phone call. Statistical analysis was done using the chi-square test, student's t-test, and logistic regression. The significance level was p<0.05., Results: The mean age of patients was 54.67±15.05years. Most patients had pulmonary manifestations including ground-glass opacity (57%), consolidation (80%) and pleural effusion (3.2%). Adjusting for age, gender, and history of underlying disease, vaccination is an effective factor in the severity of pulmonary involvement (AOR=0.39; 95%CI: (0.21, 0.73); P=0.003). Furthermore, the chance of ICU admission decreased via influenza vaccination (OR=0.21, P=0.001)., Conclusion: The results showed that the severity of COVID-19 pulmonary involvement and outcome as ICU admission, and severe symptoms in patients with history of influenza vaccination were significantly lower than those without history of vaccination. This strategy can be used to prevent and reduce the complications of COVID-19., Competing Interests: The authors declare that there is no conflict of interests

Background: There are some uncertainties among the risk factors of vascular calcification in the hemodialysis patients. This study was planned to examine the association between abdominal aortic calcification and concerned biochemical parameters in hemodialysis patients., Methods: In this cross- sectional study, 84 stable hemodialysis patients admitted on hemodialysis section of Shahid Beheshti Hospital in 2013 were enrolled after obtaining informed consent. Pre-dialysis venous blood samples were taken from patients to determine the amount of intact parathyroid hormone (iPTH), alkaline phosphatase (Alk.P), C - reactive protein (CRP), calcium (Ca) and phosphorus (P). Patients underwent abdominal CT scanning and ACI (ACI) was calculated. Statistical analysis was performed using SPSS Version 20. Chi-square, Kruskal Wallis and One Way ANOVA tests were used. P-values < 0.05 were considered significant., Results: The average age of participants was 50.15±17.03 years (18-83 y/o).A statistically significant correlation was observed between ACI and ALK-P serum levels (p=0.01). It was found that ACI had a significant relationship with phosphorus in women (p=0.01). ALK-P serum levels in men also had a significant relationship with ACI (p=0.02). In addition, there was a significant correlation between ACI and history of cerebro-cardiovascular disease and also duration of dialysis (p=0.004 and 0.0001, respectively)., Conclusions: In patients with longer duration of dialysis, and patients with a history of cardiovascular and cerebrovascular events, ACI levels were significantly higher. ALK-P and phosphorus were correlated with aortic calcification in males and females respectively. No significant correlation was found between iPTH serum levels and aortic calcification., Competing Interests: None declared.

In recent years, with the introduction of 64-slice CT and dual-source CT technology, coronary CT angiography (CCTA) has emerged as a useful diagnostic imaging modality as a non-invasive assessment of coronary heart disease. CT produces a larger radiation dose than other imaging tests and cardiac CT involves higher radiation dose with the advances in the spatial and temporal resolution. The aims of this study are patient dose assessment and establishment of national diagnostic reference level for CCTA in Iran. A questionnaire was sent to CCTA centers. Data for patient and CT protocols were obtained. The volumetric CT dose index (CTDIvol), dose length product (DLP) and total DLP were considered in the 32 cm standard body phantom. Calculation of estimated effective dose (ED) was obtained by multiplying the DLP by a conversion factor [k = 0.014 mSv (mGy·cm)-1]. Mean value of CTDIvol and DLP for CCTA was 50 mGy and 825 mGy·cm. The third quartile (75th) of the distribution of mean CTDIvol (66.54 mGy) and DLP (1073 mGy·cm) values was expressed as the diagnostic reference level (DRL) for CCTA in Iran. The median of ED was 10.26 mSv and interquartile range of ED was 7.08-15.03 mSv. A large variety in CTDIvol and DLP among CT scanner and different sites due to variability in CT parameter is noted. It seems that training could help to reduce patient's dose., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Rhabdomyosarcoma (RMS) is one of the common malignant tumors in infants and children, but it is extremely rare in the kidney. In this paper, we present a case of RMS the kidney of a child., Case Presentation: A 6-month old girl presented with agitation, low fever and abdominal distention which started 5 days ago. On physical examination, the infant had a large and firm soft tissue mass in the palpation of her abdomen. Plain abdominal x-ray, sonography and CT scan showed soft tissue mass and Doppler ultrasound demonstrated regions of vascular flow in mass. The abdominal mass was replaced and on pathological examination and immunohistochemistry the diagnosis was embryonal RMS., Conclusion: Rhabdomyosarcoma of the kidney should be considered in the differential diagnosis of children with huge abdominal mass.