This study explores the efficacy of texture analysis by using preoperative multi-slice spiral computed tomography (MSCT) to non-invasively determine the grade of cellular differentiation in head and neck squamous cell carcinoma (HNSCC). In a retrospective study, MSCT scans of patients with HNSCC were analyzed and classified based on its histological grade as moderately differentiated, well-differentiated, or poorly differentiated. The location of the tumor was categorized as either in the bone or in soft tissues. Segmentation of the lesion areas was conducted, followed by texture analysis. Eleven GLCM parameters across five different distances were calculated. Median values and correlations of texture parameters were examined in relation to tumor differentiation grade by using Spearman’s correlation coefficient and Kruskal–Wallis and Dunn tests. Forty-six patients were included, predominantly female (87%), with a mean age of 66.7 years. Texture analysis revealed significant parameter correlations with histopathological grades of tumor differentiation. The study identified no significant age correlation with tumor differentiation, which underscores the potential of texture analysis as an age-independent biomarker. The strong correlations between texture parameters and histopathological grades support the integration of this technique into the clinical decision-making process.

Background: Texture analysis (TA) has shown promise in characterizing intratumoral heterogeneity from imaging data. We add to the literature that shows its capability to differentiate oropharyngeal cancers based on HPV status. Methods: Multislice CT analysis was done in 120 patients with confirmed OP SCC: a single 5 mm region of interest was placed on three consecutive homogeneous CT slices per patient. Texture features were extracted by using gray-level co-occurrence matrices averaged per patient. HPV status (via p16 IHC and molecular confirmation) and differentiation grade (i.e., good, moderate, and poor) were recorded. Non-parametric statistical tests assessed differences between subgroups. Results: Seven texture parameters (i.e., angular second moment, contrast, sum of squares, sum entropy, entropy, inverse difference moment, and difference variance) differed significantly between HPV+ and HPV− tumors (all p < 0.05). HPV+ tumors exhibited increased heterogeneity and complexity on CT imaging. No texture feature correlated with histological grade. Conclusions: This study adds to the growing evidence that CT-based TA can assess HPV status in OP SCC. TA may be promising, though it requires further validation as an adjunctive method integrating into radiomics workflows to develop predictive models for diagnosis, prognosis, and treatment planning.

Radiotherapy is a fundamental component in the management of head and neck malignancies, but its non-selective effects on surrounding normal tissues can result in significant oral complications. The oral cavity and oropharynx contain several radiosensitive structures, including mucosa, salivary glands, and alveolar bone, which are susceptible to both acute and late toxicities resulting in mucositis, xerostomia, and osteoradionecrosis. Although dentomaxillofacial diagnostic imaging, such as intraoral radiography, panoramic imaging and cone-beam computed tomography (CBCT), delivers radiation doses several orders of magnitude lower than therapeutic exposures, its biological impact on previously irradiated tissues remains underexplored. Even low-dose X-rays may act as secondary stressors, reactivating oxidative and inflammatory pathways in tissues with compromised repair capacity. In this review, we examine the radiobiological and dosimetric implications of using diagnostic ionizing imaging in patients undergoing or recently having completed head and neck radiotherapy. We summarize current evidence on potential additive effects of low-dose imaging, emphasizing the importance of justification, timing, and protocol optimization. Finally, we discuss radioprotective strategies (e.g., dose modulation, field limitation, and integration of modern low-dose imaging technologies) designed to reduce unnecessary exposure, thus enhancing tissue preservation and ensuring diagnostic safety in this vulnerable patient population

Background: Temporomandibular disorders (TMD) may be accompanied by adaptive and degenerative remodelling of the mandibular condyle. Although computed tomography (CT) depicts established osseous changes, quantitative assessment of trabecular bone may provide additional information on local bone organization that is not captured by morphological evaluation alone. Texture analysis offers a means of characterising these differences within the condylar trabecular compartment. Objective: To investigate whether CT texture analysis can detect differences in condylar trabecular bone among patients with TMD with and without subchondral cysts and asymptomatic controls, with particular attention to peri‐cystic trabecular bone in condyles presenting subchondral cysts. Methods: In this retrospective study, 250 CT examinations were screened, and 116 patients met the inclusion criteria. Participants were allocated into three groups: TMD with subchondral cysts (TMD + Cyst; n = 60), TMD without subchondral cysts ( n = 16) and asymptomatic controls ( n = 40). Eleven grey‐level co‐occurrence matrix texture features were extracted from manually defined trabecular bone regions of interest on three central sagittal slices. In the TMD + Cyst group, the ROI was positioned adjacent to the cyst, whereas in cyst‐free condyles it was placed in the superior subchondral trabecular bone. Group comparisons were performed using the Kruskal–Wallis test with Dunn's post hoc test, false discovery rate correction and adjustment for age and gender. Receiver operating characteristic analysis evaluated the discriminatory performance of significant texture features. Results: Four texture features remained significantly different among the groups after false discovery rate correction and adjustment for age and gender: Correlation (Correlat), Sum of Squares (SumOfSqs), Sum Variance (SumVarnc) and Sum Entropy (SumEntrp) ( p < 0.05). In exploratory ROC analyses, Correlat showed the highest AUC for TMD + Cyst versus controls (AUC = 0.855). In contrast, none of the four significant texture features showed discriminatory performance statistically distinguishable from chance for TMD without Cyst versus Control, with AUCs ranging from 0.537 to 0.611 and all 95% confidence intervals including 0.5. Significant pairwise differences for the four texture features were observed between the TMD + Cyst and Control groups, whereas no significant pairwise differences were found between the TMD without Cyst and Control groups. Conclusion: CT texture analysis detected quantitative differences in condylar trabecular bone among patients with TMD with and without subchondral cysts and asymptomatic controls. The findings indicate differences in trabecular texture particularly between peri‐cystic bone in the TMD + Cyst group and subchondral bone in asymptomatic controls. Because the ROIs were biologically selected but not anatomically matched across groups, the findings should be interpreted as exploratory and do not establish a temporal sequence of trabecular remodelling leading to cyst formation.