Background/Objectives: Guidelines for the risk stratification of thyroid nodules are based on certain well-recognized sonographic features of nodules. However, significant variations in reported sensitivity and specificity values are observed due to the overlap of imaging characteristics between benign and malignant nodules. Additionally, differences in ultrasound (US) equipment and the varying experience levels of radiologists performing the imaging procedures contribute to these discrepancies. Inevitably, there are also interobserver differences. The aim of this study was to investigate interobserver agreement on these criteria using the international thyroid imaging reporting and data system (I-TIRADS) thyroid evaluation framework, independently assessed by three residents and one consultant. Methods: We included 393 patients who underwent ultrasound-guided fine needle aspiration biopsy (FNAB) within four months. In each case, longitudinal and transverse video images of the thyroid gland, neck chain, and biopsied nodules were recorded. The evaluations of the parameters defined in the I-TIRADS dictionary were then performed by a radiologist with 15 years of experience and radiology assistants with 3, 3, and 2 years of experience, respectively, blinded to the images, pathology data, and patient demographics. The parameters evaluated included composition, echogenicity, margin, direction of growth, calcification, extension beyond the thyroid, and lymph node. An interobserver comparison between the US lexicon classifications of thyroid nodules was then performed. Results: The results of our study showed that the highest level of consensus was observed in the ‘mixed predominantly cystic’ classification, indicating a solid consistency between the assessors (κ = 0.729). Conversely, the subcategories ‘Solid’, ‘Mixed Predominantly Solid’ and ‘Spongiform’ showed moderate agreement, while the “Pure Cyst” subcategory exhibited the lowest level of agreement among the assessors (κ = 0.292). Agreement among the three radiology assistants was strong concerning the evaluation of nodule composition, growth direction, and lymph node assessment. In contrast, a moderate level of consensus was noted regarding the assessment of extrathyroidal extension, margins, and echogenicity. Notably, the parameter exhibiting moderate agreement across all readers was the presence of echogenic foci or calcifications. Conclusions: the reproducibility observed in the parameters defined within the lexicon supports its potential to enhance consistency and interobserver agreement in thyroid nodule assessment.

Background: This proof-of-concept study examined the association between CT-derived sarcopenia indices and achievement of Patient Acceptable Symptom State (PASS) in a metabolically homogeneous subgroup of patients with psoriatic arthritis (PsA) receiving biologic therapy. Methods: We retrospectively analyzed 26 PsA patients without diabetes, hypertension, or thyroid disorders who were treated with TNF or IL-17 inhibitors and underwent opportunistic CT imaging at the L2 vertebral level. Body composition parameters included total abdominal muscle area (TAMA), subcutaneous adipose tissue (SAT), and sarcopenia index (SI = TAMA/height²). PASS achievement at 12 weeks was assessed retrospectively. Receiver operating characteristic (ROC) analysis was performed. Results: Fourteen patients achieved PASS. Compared with non-achievers, these patients had significantly higher TAMA, SAT, and SI values (all p < 0.05). ROC analysis identified an SI threshold of 4657.5 cm²/m² (sensitivity 78.6%, specificity 83.3%, p = 0.003). Conclusions: In this metabolically homogeneous PsA subgroup, higher CT-derived muscle mass measures were associated with PASS achievement at 12 weeks. These findings are hypothesis-generating and require validation in larger prospective cohorts.

Background: Transcatheter aortic valve implantation (TAVI) is increasingly performed for severe aortic stenosis with improving procedural success rates; however, post-procedural complications remain a significant clinical challenge. Growing evidence suggests that sarcopenia may adversely affect morbidity and mortality in this patient population. Methods: This retrospective, single-center cohort study included 171 patients undergoing elective TAVI (January 2018-February 2024). Muscle area (MA), visceral, subcutaneous (SATA), and total adipose tissue area (TATA) were measured at the L3 vertebral level from pre-procedural computed tomography angiography (CTA). Primary endpoints were all-cause and cardiac mortality; secondary endpoints were permanent cardiac conduction defect, permanent pacemaker implantation (PPI), and hospital stay. Results: The cohort comprised 95 women (55.5%) and 76 men (44.5%), median age 78.9 years, society of thoracic surgeons score 6.30 (IQR = 4.37-9.33). Over 21.8 ± 17.9 months, 43 patients (25.1%) died, including 12 cardiac deaths (7.0%). Lower MA and MA/body mass index (BMI) ratio were independently associated with cardiac mortality in men (adjusted odds ratio [OR] = 0.935, P = .016 and OR = 0.983, P = .042). Permanent cardiac conduction defect occurred in 44 patients (27.7%); lower SATA and TATA were independent predictors in women (OR = 0.990, P = .031 and OR = 0.994, P = .024). Permanent pacemaker implantation was required in 30 patients (18.6%); adipose tissue parameters were associated with PPI in women on univariate analysis but did not retain significance after multiple adjustment. Conclusion: Pre-procedural CTA-derived body composition assessment may contribute to the prediction of mortality and morbidity in TAVI patients without additional cost or radiation exposure. The association of lower MA with cardiac mortality in men, and of reduced adipose tissue with conduction disturbances in women, suggests that sex-specific body composition parameters may provide prognostic value beyond conventional risk scores.

Background/Objectives: Standardizing thyroid nodule assessment remains a major challenge in clinical practice and radiology education. Traditional categorical risk stratification systems (RSSs) often yield high interobserver variability, particularly among trainees. This study evaluated the reproducibility, educational utility, and experience-dependent performance of the parameter-based International Thyroid Imaging Reporting and Data System (I-TIRADS) lexicon compared to established categorical RSSs (ACR, EU, and K-TIRADS). Methods: In this prospective validation study, 105 thyroid nodules stratified across Bethesda categories were evaluated by seven radiologists: one senior expert (as reference standard) and six residents categorized into three distinct experience levels (Junior, Intermediate, Senior). To simulate real-time clinical practice and eliminate 2D static image bias, comprehensive dynamic video clips were utilized for all cases. Interobserver agreement and intergroup consistency were quantified using Fleiss’ and Cohen’s kappa (κ) statistics. Results: Parameter-based I-TIRADS descriptors—specifically composition (κ = 0.510) and direction of growth (κ = 0.498)—demonstrated significantly higher overall reliability compared to final categorical RSS classifications (ACR: κ = 0.220, EU: κ = 0.215, K-TIRADS: κ = 0.196). Crucially, the reproducibility advantage of the I-TIRADS lexicon became markedly more pronounced with advancing clinical experience: senior observers achieved substantial to near-perfect consensus for core descriptors (up to κ = 0.826), whereas agreement for traditional RSS categories remained limited. I-TIRADS facilitated a steeper learning curve, allowing even junior trainees to achieve reliable consensus on objective sonographic parameters. Conclusions: The parameter-based I-TIRADS provides superior interobserver consistency compared to traditional categorical RSSs by reducing subjective evaluative drift, accelerating the radiologic learning curve, and offering a highly reproducible framework for both clinical practice and residency education.