BACKGROUNDAlthough photon-counting computed tomography (PCCT) has demonstrated superior dose efficiency and image quality compared with conventional energy-integrating detector computed tomography (EID-CT) in theory and in some clinical fields, systematic evaluations of its performance in abdominal imaging, particularly comprehensive studies incorporating both radiation dose and image quality, remain very limited.AIMTo compare radiation dose and image quality between PCCT and conventional EID-CT in abdominal imaging, and to evaluate the potential of PCCT for low-dose, high-quality clinical applications.METHODSEighty participants were included, comprising 40 subjects who underwent prospective abdominal PCCT and 40 subjects retrospectively matched who underwent routine abdominal EID-CT. Radiation dose parameters [computed tomography dose index (CTDIvol), dose-length product, and effective dose] were recorded. Objective image quality was assessed using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), dose-normalized metrics [SNR/(CTDIvol)1/2 and CNR/(CTDIvol)1/2], noise ratio, and excellent image index. Subjective image quality was evaluated by two experienced radiologists using a five-point Likert scale. Intergroup comparisons were performed using appropriate parametric or nonparametric statistical tests.RESULTSCompared with EID-CT, PCCT achieved an approximate 50% reduction in CTDIvol, dose-length product, and effective dose (all P < 0.001). PCCT demonstrated significantly higher SNR, CNR, SNR/(CTDIvol)1/2, CNR/(CTDIvol)1/2, and excellent image index, along with a lower noise ratio, indicating superior noise uniformity (all P < 0.001). Subjective assessment showed that 77.5% of PCCT images were rated as excellent (Likert score = 5), compared with 10.0% in the EID-CT group (P < 0.001).CONCLUSIONPCCT provides substantially improved dose efficiency and image quality compared with conventional EID-CT in abdominal imaging, supporting its potential role in low-dose clinical computed tomography protocols.

BACKGROUNDDiffusion-weighted magnetic resonance imaging (DWI) has emerged as a non-contrast functional imaging technique for renal mass characterization. Its role in differentiating histopathological subtypes of renal cell carcinoma (RCC) remains an area of active investigation.AIMTo evaluate the role of DWI and apparent diffusion coefficient (ADC) values in differentiating histopathological subtypes of RCC.METHODSIn this prospective observational study, 127 patients with histopathologically proven RCC who underwent preoperative magnetic resonance imaging (MRI) including DWI were analyzed. Diffusion-weighted imaging was performed using b values of 0 second/mm2 and 1000 seconds/mm2, and ADC maps were generated. ADC values were measured from solid tumor components and compared among RCC subtypes. Statistical analysis included subgroup comparisons and receiver operating characteristic curve analysis to assess the ability of ADC values to differentiate clear cell RCC (ccRCC) from non-ccRCC.RESULTSOf the 127 RCCs, 97 (76.4%) were ccRCC, 24 (18.9%) papillary RCC, and 6 (4.7%) chromophobe RCC. The mean ADC value of ccRCC [(1.391 ± 0.271) × 10-3 mm2/second] was significantly higher than that of papillary RCC [(0.876 ± 0.293) × 10-3 mm2/second; P < 0.001] and chromophobe RCC [(1.059 ± 0.369) × 10-3 mm2/second; P = 0.04]. No significant difference was observed between papillary and chromophobe RCC (P = 0.396). When grouped, ccRCC demonstrated a significantly higher mean ADC value compared with non-ccRCC [(1.391 ± 0.271) × 10-3 mm2/second vs (0.915 ± 0.312) × 10-3 mm2/second; P < 0.001]. Receiver operating characteristic analysis yielded an area under the curve of 0.889 (95% confidence interval: 0.804-0.975). An ADC threshold of 1.08 × 10-3 mm2/second achieved 90% sensitivity and 83% specificity for identifying ccRCC.CONCLUSIONDWI with quantitative ADC analysis reliably differentiates clear cell from non-ccRCC and demonstrates significant correlation with RCC subtype and tumor grade. DWI serves as a valuable adjunct to conventional MRI, particularly in patients with contraindications to contrast administration.

BACKGROUNDEarly detection of cervical remodeling is vital for predicting preterm birth (PTB). Conventional morphologic indices, such as cervical length (CL) and anterior cervical angle (ACA), demonstrate limited diagnostic accuracy. Elastic imaging of the cervix (E-cervix) elastography offers functional biomechanical insights by quantifying cervical strain and stiffness. However, a systematic comparison of its diverse parameters alongside traditional indices is currently lacking. Identifying the most effective ultrasound-based markers is essential for improving mid-trimester risk stratification and facilitating timely clinical interventions to improve perinatal outcomes.AIMTo evaluate and compare the diagnostic performance of E-cervix parameters, CL, and ACA for PTB.METHODSPubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched up to December 1, 2025. Studies reporting diagnostic accuracy of E-cervix parameters, CL, or ACA for PTB were included. A Bayesian network meta-analysis estimated pooled sensitivity, specificity, and diagnostic odds ratios (DOR). The comparative performance was ranked using the advantage index. Heterogeneity was assessed via Cochran’s Q and I2 statistics, with meta-regression exploring potential modifiers.RESULTSFifteen studies involving 1965 pregnancies (570 PTB cases) were included. The multi-parametric combined model demonstrated the highest diagnostic performance, with an area under the curve of 0.91, sensitivity of 0.83, specificity of 0.83, and a DOR of 26.23. Among individual parameters, ACA (DOR: 13.65) and the E-cervix hardness ratio (DOR: 7.71) significantly outperformed conventional CL (DOR: 3.58). Subgroup analysis revealed that the combined model was particularly effective in singleton pregnancies (sensitivity: 0.837, specificity: 0.882). No significant publication bias was detected except for elasticity contrast index.CONCLUSIONE-cervix elastography provides superior diagnostic value compared to conventional CL measurement. The integration of biomechanical and morphological data via multi-parametric models offers the most precise risk stratification for PTB.

BACKGROUNDTimely identification and monitoring of lung disease progression are key components of effective management in patients with cystic fibrosis (CF). Pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans are commonly used to assess disease progression in these patients. Determining which modality provides the most sensitive and reliable assessment is crucial for establishing effective disease monitoring guidelines, particularly in India, where national guidelines are lacking.AIMTo assess the progression of lung disease in patients with CF using a combination of HRCT and PFTs.METHODSA total of 32 patients with CF were prospectively enrolled from the outpatient clinic and followed longitudinally. Clinical and physiological parameters, including age, spirometric indices, and HRCT based Bhalla scores, were evaluated at baseline and after one-year follow-up. Paired comparisons between baseline and follow-up HRCT scores, as well as baseline and follow-up PFT parameters, were performed using a two-tailed paired t-test to assess statistically significant changes over the follow-up period. Pearson correlation coefficient (r) was used to evaluate the relationship between HRCT scores and spirometric parameters at each individual time point (baseline and follow-up). A P value < 0.05 was considered statistically significant.RESULTSOf the 32 patients, 18 were female and 14 were male, with a mean age of 86.33 months (range: 48-192 months). The mean Bhalla score demonstrated a statistically significant increase from 5.50 at baseline to 8.25 at one-year follow-up (P < 0.001), representing an average percentage increase of 50%. In contrast, spirometric parameters, including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC showed a non-significant decline of 2.9%-5.2% over the study period (P > 0.05).CONCLUSIONDespite significant radiological progression of structural lung damage detected by HRCT, pulmonary function parameters remained relatively stable. These findings suggest that PFTs may be less sensitive in detecting progressive structural deterioration in CF, underscoring the value of HRCT as a sensitive tool for disease monitoring and early detection of worsening lung disease.

BACKGROUNDConventionally, rectal endometriotic nodules have been considered as poorly vascularized. However, new, more sensitive, Doppler techniques have been developed recently for assessing microvascularization. These new techniques might allow microvascularity in these lesions.AIMTo compare the vascularization of rectal endometriotic nodules using microvascular (MV) flow and conventional power Doppler.METHODSThirty consecutive women diagnosed with deep endometriosis involving the rectum were recruited for this prospective study. All women underwent transvaginal ultrasound using a Samsung V8 ultrasound system (Samsung Medison, Co., Ltd., Seoul, South Korea). The scanning protocol was performed according to the International Deep Endometriosis Analysis consensus. Endometriotic lesions involving the rectum were identified as hypoechoic lesions with blurred margins. Then, power Doppler was activated and the vascularization of the lesion was assessed. Immediately after, the MV-Flow™ with the LumiFlow™ was activated and the vascularization was assessed again. Vascularization assessment was undertaken based on the subjective examiner’s impression, using the vascular score proposed by International Ovarian Tumor Analysis group.RESULTSThe vascular score using conventional power Doppler was score 1 in 87% (n = 26) and score 2 in 13% (n = 4) of the lesions, respectively. The vascular score using MV-Flow™ was score 1 in 6% (n = 2), score 2 in 27% (n = 8), score 3 in 40% (n = 12) and score 4 in 27% (n = 8) of the cases. Grouping cases into score 1-2 vs score 3-4, there was a statistically significant difference with score 3-4 when using MV-Flow™ (67% vs 0%, P < 0.01).CONCLUSIONThis study shows that many rectal endometriotic nodules exhibit more vascularization than previously thought when using MV-Flow™.

BACKGROUNDThe fossa of Rosenmüller (RF) is a herniation of nasopharyngeal mucosa through a defect between the skull base and the superior-most fibers of the superior constrictor muscle. Its anatomy and relationships help explain symptoms commonly seen in nasopharyngeal disorders, as well as potential pathways for direct disease extension. This retrospective study aims to assess RF anatomy using two- and three-dimensional measurements and to evaluate these findings according to demographic parameters.AIMTo assess the anatomy of RF via two- and three-dimensional measurements and evaluate the findings according to demographic parameters.METHODSCone-beam computed tomography images from 500 Turkish patients were retrospectively assessed by two observers, each performing measurements twice. Images were acquired using a Planmeca Promax 3D Max system (Planmeca, Helsinki, Finland) (70-90 kVp; 9-10 mA; exposure time 10-15 seconds). Measurements included RF depth, width, angle, and volume. Patient age and sex were recorded. Volume measurements were performed using 3D Doctor software (Able Software Corp., Lexington, United States). The Mann-Whitney U test was used to assess differences between groups. Intraclass correlation coefficients were calculated to evaluate intra- and inter-observer agreement. Statistical significance was set at P < 0.05.RESULTSThe mean width was 4.21 ± 1.43 mm (median: 4.16; range: 1.17-11.09), and the mean depth was 12.82 ± 3.39 mm (median: 12.84; range: 4.79-25.86). The mean angle relative to the sagittal plane was 52.34° ± 9.11° (median: 51.40; range: 9.28-79.90). Volumetric analysis demonstrated a mean RF volume of 334.78 ± 329.93 mm3 (median: 210.67; range: 29.31-1632.76), indicating substantial interindividual variability. No statistically significant sex-related differences were identified in width (female: 4.20 ± 1.46 mm; male: 4.24 ± 1.41 mm; P = 0.885), depth (female: 12.82 ± 3.39 mm; male: 12.80 ± 3.44 mm; P = 0.973), or angle (female: 51.66° ± 9.75°; male: 53.52° ± 7.88°; P = 0.296). Similarly, volumetric measurements did not differ significantly between females and males (307.26 ± 304.78 mm3vs 383.26 ± 368.99 mm3, respectively; P = 0.336). Intraclass correlation coefficients demonstrated excellent intra- and inter-observer agreement for all measurements (P < 0.001).CONCLUSIONCone-beam computed tomography may provide useful information for assessing the RF.

We read with great interest the study by Yang and Li in World Journal of Radiology entitled “Deep learning-based imaging model to predict early hematoma enlargement and hospital mortality in spontaneous intracerebral hemorrhage”. The advantages and disadvantages of computed tomography, magnetic resonance imaging, and deep-learning models in predicting hematoma expansion and mortality risk in patients with spontaneous intracerebral hemorrhage are discussed in this article. Manual image interpretation remains irreplaceable in emergency settings; however, its subjectivity and limitations limit its ability to predict hematoma expansion and mortality risk. Deep learning models significantly improve prediction accuracy through automated analysis and feature extraction, providing robust support for clinical decision making. However, the data requirements and complexity of these models hinder their widespread adoption. Future research should focus on optimizing model architectures, reducing data dependency, and strengthening multicenter validation to enhance their clinical applicability. Moreover, a hybrid evaluation system that combines the strengths of conventional and deep-learning approaches has the potential to enable more precise early intervention strategies for spontaneous intracerebral hemorrhage patients.

Tardigrades exhibit remarkable resistance to ionizing and ultraviolet radiation, tolerating exposures far beyond the lethal limits for most organisms. Among the tardigrade-derived molecules implicated in this resilience, damage suppressor (Dsup) is the most well-characterized and demonstrates clear radioprotective activity. This mini-review summarizes the molecular mechanisms underlying tardigrade radiation resistance and discusses their potential medical applications. Dsup associates with chromatin, reducing hydroxyl-radical-induced DNA strand breaks and limiting ultraviolet-mediated pyrimidine dimer formation. Human cells expressing Dsup exhibit decreased DNA damage by approximately 40% and enhanced survival following irradiation, indicating that essential protective mechanisms of tardigrades can be functional in mammalian systems. These findings support the exploration of Dsup-based strategies to mitigate radiation-induced cellular injury, improve preservation of biological materials, and enhance resilience in high-radiation environments such as radiotherapy or space missions. Further mechanistic studies of Dsup, DNA repair pathways, and antioxidative systems, along with in vivo evaluations, are essential to fully elucidate the molecular basis of tardigrade radiation resistance. Collectively, these mechanisms provide valuable insights that may guide the development of novel approaches for medical radioprotection.

Medullary thyroid carcinoma (MTC) arises from thyroid C-cells and secretes calcitonin. Conventional anatomical imaging frequently fails to identify small lesions and biochemically recurrent tumors, necessitating phenotype-guided positron emission tomography (PET) evaluation. This article summarizes three mainstream PET tracers - 18F-fluorodihydroxyphenylalanine (FDOPA), gallium-68-labelled somatostatin receptor (SSTR) analogues, and 18F-fluorodeoxyglucose (FDG) - across initial staging, biochemical recurrence, and restaging settings. Meta-analyses confirm 18F-FDOPA achieves the highest sensitivity for recurrent or persistent MTC, with detection improved by elevated calcitonin levels and shorter doubling times. Increased FDG uptake indicates aggressive, dedifferentiated disease, while SSTR PET shows lower overall detection rates in MTC but remains valuable for assessing bone involvement and selecting candidates for PRRT. Current guidelines recommend a biology-driven imaging strategy: 18F-FDOPA is the first-choice tracer for biochemical recurrence when available; FDG is reserved for high-grade progressive disease, and SSTR PET guides pre-PRRT evaluation. Routine PET is not recommended for initial staging, though selective use is reasonable in high-risk patients combined with conventional imaging. This study proposes an evidence-based imaging algorithm for radiologists according to serum markers, tracer advantages and theranostic needs. Further prospective trials, standardized SSTR thresholds and investigations of novel tracers are still required to fill existing research gaps.

Radiation therapy (RT) has advanced substantially since the introduction of the first medical linear accelerator, progressing through successive generations of technological innovation that have improved treatment precision, efficiency, and patient safety. This review provides a comprehensive overview of the evolution of RT technologies-from early linear accelerators to contemporary clinical systems-and examines ongoing research shaping the future of radiotherapy. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, covering peer-reviewed publications from the era of the first linear accelerator to the present. Studies addressing historical milestones, technological developments, clinical implementation, and emerging research directions in RT were included. The literature demonstrates continuous advancement from early accelerator models to modern high-precision platforms integrating image guidance, adaptive radiotherapy, and motion management. Recent developments include automation, artificial intelligence–driven workflows, magnetic resonance-guided radiotherapy, and biologically informed modeling to enable personalized treatment. Ongoing investigations focus on real-time tumor tracking, radiobiology-guided planning, artificial intelligence-based clinical decision support, and next-generation delivery systems. From its origins to today’s state-of-the-art systems, RT has undergone transformative growth. Sustained research and rigorous clinical validation remain essential to effectively integrate emerging innovations and enhance patient outcomes.