Category: Statistics

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12442-6. Online ahead of print.

NO ABSTRACT

PMID:41762263 | DOI:10.1007/s00330-026-12442-6

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12382-1. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the prevalence of adrenal vein involvement in primary and metastatic adrenal lesions and to determine if morphological changes in tumor shape precede venous extension.

MATERIALS AND METHODS: This retrospective, single-center observational study evaluated 102 patients: 28 adrenal cortical carcinoma (ACC) patients, and 74 non-ACC cancer patients that presented adrenal metastasis (82 metastatic adrenal lesions). Two readers reviewed cross-sectional imaging to assess tumor size, laterality, venous invasion, and the presence of the “edge sign.” Surgical and histopathological confirmation was the reference standard for ACCs, while for metastases, sequential imaging or PET-CT results showing hypermetabolism were used in 70.7% of cases and histopathology in 29.3% of cases.

RESULTS: Of the 28 ACC patients, 82.1% were female, with balanced laterality. Metastases primarily originated from the lung (24.4%), colorectal (13.4%), and breast (12.2%) cancers and had a left-sided dominance (61.7%). Venous extension was present in 14.6% of metastases and 21.4% of ACCs, a non-significant difference (p = 0.40). The “edge sign” was more frequently observed in metastatic lesions than in ACCs, 26.8 × 17.8%, although this difference has not reached statistical significance (p = 0.34). In multivariate analysis, both mean size and the “edge sign” were independent predictors of adrenal and renal vein extension. Interobserver agreement was almost perfect for venous extension (κ = 0.9256) and substantial for the edge sign (κ = 0.7844).

CONCLUSION: Venous extension was less prevalent in metastatic adrenal lesions compared to ACCs. The edge sign may precede venous extension, especially in metastatic cases, indicating the nature of the lesion. These findings potentially may alter disease management, expediting the decision for surgery; however, prospective multicenter studies are needed to confirm their clinical impact.

KEY POINTS: Question What is the prevalence of venous extension in malignant adrenal lesions-whether primary or secondary-and how can early involvement be recognized on imaging? Finding Adrenal vein involvement occurred similarly in ACCs (21.4%) and metastases (14.6%). Early extension may be preceded by the adrenal edge sign in 25% of cases. Clinical relevance Adrenal vein involvement occurs in both primary and metastatic adrenal lesions, with a tendency to be more prevalent in adrenocortical carcinomas. The ‘edge sign’ may precede venous extension in malignant lesions, aiding both diagnosis and therapeutic planning.

PMID:41762262 | DOI:10.1007/s00330-026-12382-1

Eur Radiol. 2026 Feb 28. doi: 10.1007/s00330-026-12389-8. Online ahead of print.

ABSTRACT

OBJECTIVES: The selection of ultrasound (US) plane for evaluating the taller-than-wide (TTW) shape remains controversial. This study aimed to determine whether the diagnostic value of TTW criteria differs when used alone or in combination with other US features, and to identify the optimal TTW criterion across four major Thyroid Imaging Reporting and Data Systems (TIRADS: Chinese (C)-TIRADS, American College of Radiology (ACR)-TIRADS, European (EU)-TIRADS and Korean (K)-TIRADS).

MATERIALS AND METHODS: Preoperative US images of thyroid nodules were reviewed retrospectively. Four TTW criteria were defined as follows: transverse plane only (T-only), longitudinal plane only (L-only), both planes (Dual-plane), and either one or both planes (Single- or dual-plane). Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI) for malignancy prediction and fine-needle aspiration (FNA) guidance.

RESULTS: Among 1125 nodules, 558 (49.6%) were benign and 567 (50.4%) were malignant. Using the TTW shape alone, Single- or dual-plane achieved the highest AUC for malignancy (0.813). Within TIRADS, Dual-plane demonstrated the highest AUCs in C-TIRADS (0.884) and EU-TIRADS (0.874) and improved reclassification, whereas in ACR-TIRADS and K-TIRADS, Dual-plane and Single- or dual-plane performed similarly and outperformed the T-only and L-only. For FNA guidance, the Dual-plane also showed improvements in C-TIRADS and ACR-TIRADS.

CONCLUSION: The optimal TTW US plane differs when applied alone versus when combined with other suspicious US features. Within the TIRADS, assessment of the TTW shape in both transverse and longitudinal planes achieves superior accuracy and contributes to improving malignancy diagnosis and FNA decision-making.

KEY POINTS: Question Which TTW criterion provides the best diagnostic performance for malignancy risk stratification and FNA guidance across the four major TIRADS? Findings Dual-plane TTW yielded the best performance in C-TIRADS and EU-TIRADS, and improved FNA guidance in C-TIRADS and ACR-TIRADS versus other TTW criteria. Clinical relevance The stricter criterion not only improves the malignancy diagnosis but also provides better guidance for biopsy, offering valuable evidence for refining future guideline recommendations and standardizing the evaluation of thyroid nodules.

PMID:41762261 | DOI:10.1007/s00330-026-12389-8

World J Urol. 2026 Feb 28;44(1):212. doi: 10.1007/s00345-026-06312-5.

ABSTRACT

PURPOSE: Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists.

METHODS: An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10-17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics.

RESULTS: Of 2,078 members, 222 (11%) responded, mostly aged 30-45 years. Retrograde urethrography (26%), uroflowmetry (90%), and cystourethroscopy (61%) were used for diagnosis, with academic urologists employing these more often (p < 0.05). Blind dilatation with metal bougies (47%) exceeded plastic dilators over guidewire (23%) or disposable catheters (26%). Material preference was unrelated to experience (p = 0.39), but non-metal methods were more common in academic centers (p = 0.04). For 1-2 cm primary bulbar strictures, 7% chose urethroplasty, while 72% preferred Direct Vision Internal Urethrotomy (DVIU) with dilatation. Academic urologists performed more urethroplasties (p = 0.01). In recurrent cases, 76.5% performed DVIU ≥ 4 times, and 79.3% recommended periodic post-DVIU dilatation.

CONCLUSIONS: Urologists’ approaches to urethral strictures often deviate from guidelines. Retrograde urethrography use is low, metal bougies dominate dilatation, and urethroplasty is underused, favoring repeated DVIU and dilatation. Academic urologists adhere more to guideline recommendations than non-academic peers.

PMID:41762243 | DOI:10.1007/s00345-026-06312-5

Diagnosis (Berl). 2026 Mar 2. doi: 10.1515/dx-2025-0152. Online ahead of print.

ABSTRACT

OBJECTIVES: Clinical prediction requires formalizing uncertainty into a statistical model. However, persistent confusion between prediction and inference, and between traditional (stepwise) and modern (penalized) development strategies, leads to unstable, poorly calibrated, and overfit models. A structured statistical framework is essential.

METHODS: This article is a structured, didactic tutorial that explains the core concepts of clinical prediction models. It covers the definition of a prediction model, the fundamental strategies for its construction, and the essential framework for its evaluation, illustrated through an applied example using real-world clinical data.

RESULTS: The tutorial illustrates model development using the GUSTO-I dataset (N = 40,830). Penalized methods (LASSO and Elastic Net) successfully identified clinical signals while eliminating engineered noise variables. The LASSO model (λ_1se) achieved excellent discrimination (AUC 0.818; 95 % CI: 0.803-0.832) and overall accuracy (Brier score 0.058). Calibration analysis revealed a slope of 1.28 and intercept of 0.63, identifying conservative bias and systematic risk underestimation inherent to λ_1se selection. Decision curve analysis confirmed significant clinical utility across relevant probability thresholds.

CONCLUSIONS: This guide equips clinicians with a rigorous methodological framework for the critical appraisal and interpretation of modern clinical prediction models.

PMID:41762231 | DOI:10.1515/dx-2025-0152

Scand J Gastroenterol. 2026 Feb 28:1-10. doi: 10.1080/00365521.2026.2636062. Online ahead of print.

ABSTRACT

BACKGROUND: Neurological and psychiatric morbidity has been associated with celiac disease but has been scarcely studied in dermatitis herpetiformis (DH), a cutaneous manifestation of celiac disease. Hence, this cohort study aimed to investigate neurological and psychiatric morbidity in patients with DH and celiac disease.

METHODS: The study comprised 368 DH patients and 1,072 celiac disease patients without DH and their 1,099 and 3,197 refences, matched 1:3 on age, sex, calendar period and place of residence. Their neurological and psychiatric morbidity was studied using the Care Register for Health Care and international classification of diseases codes. Hazard ratios (HR) were calculated using Cox proportional hazard model.

RESULTS: In DH the risk for any neurological disease was not statistically significantly increased (HR 1.27; 95% CI 0.94-1.71), but Alzheimer’s disease and extrapyramidal diseases were found to be more common in DH when compared with their references. In contrast, in celiac disease excess risks for any neurological disease (HR 1.31; 95% CI 1.09-1.56) and particularly for migraine and headaches were detected. The risk for any psychiatric disease was found to be decreased in DH (HR 0.65; 95% CI 0.47-0.90), as were the risks for anxiety and substance abuse. In celiac disease, increased risks for any psychiatric disease (HR 1.20; 95% CI 1.01-1.42), depression, and anxiety disorders were noted.

CONCLUSIONS: The neurological and psychiatric morbidity of patients with DH and celiac disease patients without DH seems to differ, but the reasons for this varying disease burden remain yet unidentified.

PMID:41761874 | DOI:10.1080/00365521.2026.2636062

J Intern Med. 2026 Feb 28. doi: 10.1111/joim.70079. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy and safety of extended interval (Q3-4W) enzyme replacement therapy (ERT) versus standard biweekly (Q2W) ERT in clinically stable type 1 Gaucher disease (GD) patients.

METHODS: We emulated a target trial with a sequential trial design, using data from the French Gaucher Disease Registry. Eligible patients were treated for ≥2 years biweekly without clinical events. Every 3 months, switchers to Q3-4W were matched to Q2W patients by age, sex, referral center follow-up, disease history (bone events, anemia, thrombocytopenia, splenectomy, and hepatosplenomegaly), and dose of ERT. The primary outcome was a composite of GD-related events (bone events, anemia, and thrombocytopenia). A 10% non-inferiority margin was prespecified. Secondary outcomes were biomarker changes and economic analyses.

RESULTS: Among 280 eligible GD patients, 63 switched to Q3-4W and were matched to a total of 215 Q2W patients, followed for an average of 6.3 years. No significant difference in the risk of clinical events was observed between groups (hazard ratio: 0.98 [95% confidence intervals (CI): 0.54-1.51]). During follow-up, absolute risk difference remained below the 10% non-inferiority threshold at all timepoints. Biomarkers remained stable or slightly decreased in the Q3-4W group. The dosing interval extension led to an average reduction of 55 infusions per patient, corresponding to approximately €450,000 saved per patient over 6 years.

CONCLUSION: In stable GD1 patients, extending ERT administration to every 3-4 weeks was non-inferior to the standard biweekly regimen, supporting personalized spacing strategies that may improve quality of life and reduce healthcare costs.

PMID:41761869 | DOI:10.1111/joim.70079

Eur Eat Disord Rev. 2026 Feb 28. doi: 10.1002/erv.70094. Online ahead of print.

ABSTRACT

OBJECTIVE: The early response effect, defined as a reliable symptomatic improvement during the initial phase of treatment, is the most robust predictor of recovery following eating disorder treatment. This study aimed to investigate which symptom domains mostly influence the early response effect.

METHODS: Data from N = 232 adult patients (90.8% females; mean age = 29.97, SD = 10.67) treated in an outpatient eating disorder psychotherapy service were randomly partitioned into training (N = 161) and test (N = 71) samples. A Bayesian network model was developed in the training sample, modelling early changes (sessions 1-4) and interactions among symptoms measured by the Eating Disorder Examination Questionnaire (EDE-Q). A variable selection approach was applied to include only the most important variables in the model (i.e., reliable predictors of recovery). The trained model was externally validated by applying it to predict post-treatment recovery status in the test sample. Prediction accuracy was evaluated using the AUC statistic.

RESULTS: The model identified a network of six interrelated eating disorder symptoms which were the most important predictors of recovery. The model was reliable in predicting recovery status and showed good generalisability to a test sample (training AUC = 0.81 vs. test AUC = 0.77). Early changes in six areas (ranked by importance) reliably predict recovery after therapy: [1] avoidance of body exposure; [2] feelings of ‘fatness’; [3] preoccupation with food, eating or calories; [4] fear of losing control over eating; [5] dissatisfaction with body shape; [6] dietary rules.

DISCUSSION: The identification of early response domains associated with eventual recovery could help to inform targeted interventions strategies for patients with eating disorders. Future replication is warranted in more diverse and larger samples, including the applicability of these findings to different diagnostic groups.

PMID:41761864 | DOI:10.1002/erv.70094

J Neurotrauma. 2026 Feb 28:8977151261424705. doi: 10.1177/08977151261424705. Online ahead of print.

ABSTRACT

Cavum septum pellucidum (CSP) is a common neuroimaging finding linked to repetitive head trauma, yet its relationship to blast exposure among the military population remains elusive. Here, we investigated whether lifetime exposure to different types of blast is associated with CSP morphology among Special Operations Forces (SOF) personnel. We retrospectively analyzed 323 SOF members from the Comprehensive Brain Health and Trauma Program at Home Base who completed high-resolution 3T MRI and the Blast Exposure Threshold Survey (BETS), which quantifies lifetime exposure to explosive weapons across five blast exposure count categories (BEC1-BEC5). CSP grade and length were assessed using validated criteria on coronal 3D T1-weighted Magnetization Prepared Rapid Gradient Echo scans. A CSP length-to-septum length ratio (CSP ratio) was calculated to adjust for anatomical variation. BEC1-BEC5 were log-transformed to correct skewness and are referred to as log-BEC1-5.Variance inflation factor analysis indicated low multicollinearity among predictors (log-BEC1-5 and age), and variable selection using Least Absolute Shrinkage and Selection Operator regression identified log-BEC5 (exposure to large explosives) as the only retained predictor. In fully adjusted models, only log-BEC5 remained significantly associated with CSP measures and was therefore the focus of subsequent analyses.Participants were stratified by BEC5 = 0 vs. BEC5 > 0, and associations with CSP measures were assessed using group comparisons, multivariable regression, and dose-response models.Among 323 participants (mean age 42.7 ± 8.8 years), 273 (84%) reported any BEC5 exposure. SOF members with BEC5 > 0 had significantly greater CSP presence (42.1% vs. 22.0%, p = 0.007) and longer CSP length (median 3 mm vs. 2 mm, p = 0.002). In age-adjusted models, BEC5 > 0 was associated with greater odds of CSP presence (OR = 2.58, 95% CI 1.26-5.25, p = 0.009) and a 1.45 mm increase in CSP length (p = 0.004). In continuous models, each one-unit increase in log-BEC5 was associated with a 0.31 mm increase in CSP length (p = 0.008) and a 0.0059 increase in CSP ratio (p = 0.008).These findings indicate a statistically significant association between cumulative exposure to heavy explosives and CSP enlargement, suggesting that CSP may serve as a potential imaging marker of blast-related neurotrauma.

PMID:41761850 | DOI:10.1177/08977151261424705

Brain Inj. 2026 Feb 28:1-19. doi: 10.1080/02699052.2026.2636708. Online ahead of print.

ABSTRACT

AIM: This systematic review and meta-analysis critically evaluates preclinical evidence on leptin’s efficacy and mechanistic actions in rodent models of focal cerebral ischemia.

METHOD: Comprehensive searches of PubMed, EMBASE, Scopus, and Google Scholar (1995-2024) identified 17 eligible studies (n = 1,383 animals), following PRISMA 2020 guidelines and PROSPERO registration (CRD42023461569). Data extraction and risk of bias assessment (SYRCLE tool) were conducted independently by dual reviewers. Pooled standardized mean differences (SMD) were calculated using a random-effects model.

RESULTS: Leptin administration significantly reduced infarct volume (SMD = -2.76; 95% CI: -3.65 to -1.86; p < 0.001) and ameliorated neurological deficits (SMD = -4.37; 95% CI: -5.80 to -2.95; p < 0.001), with pronounced effects in murine models. Mechanistically, leptin mitigated apoptosis – indicated by lowered cleaved Caspase-3 and TUNEL-positive cells – and promoted the upregulation of proteins involved in neuroprotection, including BCL-2, p-STAT, TRPV1, and the leptin receptor.

CONCLUSION: Although this meta-analysis demonstrates the promising neuroprotective properties of leptin, the substantial heterogeneity among studies and the resulting lower certainty of evidence highlight the critical need for future research employing standardized methodologies, rigorous study designs, and sufficient statistical power to validate these findings and support their translation into clinical settings.

PMID:41761843 | DOI:10.1080/02699052.2026.2636708