Negaur Iranpour, MD

All Publications

• Quantitative radiomics and qualitative LI-RADS imaging descriptors for non-invasive assessment of β-catenin mutation status in hepatocellular carcinoma. Abdominal radiology (New York) Arefan, D., D'Ardenne, N. M., Iranpour, N., Catania, R., Yousef, J., Chupetlovska, K., Moghe, A., Sholosh, B., Thangasamy, S., Borhani, A. A., Singhi, A. D., Monga, S. P., Furlan, A., Wu, S. 2024

  Abstract

  Gain-of-function mutations in CTNNB1, gene encoding for β-catenin, are observed in 25-30% of hepatocellular carcinomas (HCCs). Recent studies have shown β-catenin activation to have distinct roles in HCC susceptibility to mTOR inhibitors and resistance to immunotherapy. Our goal was to develop and test a computational imaging-based model to non-invasively assess β-catenin activation in HCC, since liver biopsies are often not done due to risk of complications.This IRB-approved retrospective study included 134 subjects with pathologically proven HCC and available β-catenin activation status, who also had either CT or MR imaging of the liver performed within 1 year of histological assessment. For qualitative descriptors, experienced radiologists assessed the presence of imaging features listed in LI-RADS v2018. For quantitative analysis, a single biopsy proven tumor underwent a 3D segmentation and radiomics features were extracted. We developed prediction models to assess the β-catenin activation in HCC using both qualitative and quantitative descriptors.There were 41 cases (31%) with β-catenin mutation and 93 cases (69%) without. The model's AUC was 0.70 (95% CI 0.60, 0.79) using radiomics features and 0.64 (0.52, 0.74; p = 0.468) using qualitative descriptors. However, when combined, the AUC increased to 0.88 (0.80, 0.92; p = 0.009). Among the LI-RADS descriptors, the presence of a nodule-in-nodule showed a significant association with β-catenin mutations (p = 0.015). Additionally, 88 radiomics features exhibited a significant association (p < 0.05) with β-catenin mutations.Combination of LI-RADS descriptors and CT/MRI-derived radiomics determine β-catenin activation status in HCC with high confidence, making precision medicine a possibility.

  View details for DOI 10.1007/s00261-024-04344-2

  View details for PubMedID 38782785

  View details for PubMedCentralID 8343080

• Application of PET/MRI in Gynecologic Malignancies. Cancers Ebrahimi, S., Lundstrom, E., Batasin, S. J., Hedlund, E., Stalberg, K., Ehman, E. C., Sheth, V. R., Iranpour, N., Loubrie, S., Schlein, A., Rakow-Penner, R. 2024; 16 (8)

  Abstract

  The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.

  View details for DOI 10.3390/cancers16081478

  View details for PubMedID 38672560

• Liver Imaging Reporting and Data System (LI-RADS) v2018: diagnostic value of ancillary features favoring malignancy in hypervascular observations ≥ 10 mm at intermediate (LR-3) and high probability (LR-4) for hepatocellular carcinoma. European radiology Cannella, R., Vernuccio, F., Sagreiya, H., Choudhury, K. R., Iranpour, N., Marin, D., Furlan, A. 2020; 30 (7): 3770-3781

  Abstract

  This study was conducted in order to assess the diagnostic accuracy of LI-RADS v2018 ancillary features (AFs) favoring malignancy applied to LR-3 and LR-4 observations on gadoxetate-enhanced MRI.In this retrospective dual-institution study, we included consecutive patients at high risk for hepatocellular carcinoma (HCC) imaged with gadoxetate disodium-enhanced MRI between 2009 and 2014 fulfilling the following criteria: (i) at least one LR-3 or LR-4 observation ≥ 10 mm; (ii) nonrim arterial phase hyperenhancement; and (iii) confirmation of benignity or malignancy by pathology or imaging follow-up. We compared the distribution of AFs between HCCs and benign observations and the diagnostic performance for the diagnosis of HCC using univariate and multivariate analyses. Significance was set at p value < 0.05.Two hundred five observations were selected in 155 patients (108 M, 47 F) including 167 (81.5%) LR-3 and 38 (18.5%) LR-4. There were 126 (61.5%) HCCs and 79 (28.5%) benign lesions. A significantly larger number of AFs favoring malignancy were found in LR-3 and LR-4 lesions that progressed to HCC compared to benign lesions (p < 0.001 and p = 0.003, respectively). The most common AFs favoring malignancy in HCCs were hepatobiliary phase (HBP) hypointensity (p < 0.001), transitional phase hypointensity (p < 0.001), and mild-moderate T2 hyperintensity (p < 0.001). Sensitivity and specificity of AFs for the diagnosis of HCC ranged 0.8-76.2% and 86.1-100%, respectively. HBP hypointensity yielded the highest sensitivity but also the lowest specificity and was the only AF remaining independently associated with the diagnosis of HCC at multivariate logistic regression analysis (OR 14.83, 95% CI 5.81-42.76, p < 0.001).Among all AFs, HBP hypointensity yields the highest sensitivity for the diagnosis of HCC.• LR-3 and LR-4 observations diagnosed as HCC have a significantly higher number of ancillary features favoring malignancy compared to observations proven to be benign. • The presence of three or more ancillary features favoring malignancy has a high specificity (96.2%) for the diagnosis of HCC. • Among all ancillary features favoring malignancy, hepatobiliary phase hypointensity yields the highest sensitivity, but also the lowest specificity for the diagnosis of HCC.

  View details for DOI 10.1007/s00330-020-06698-9

  View details for PubMedID 32107603

• Lymphoepithelial cyst of pancreas: spectrum of radiological findings with pathologic correlation. Abdominal radiology (New York) Borhani, A. A., Fasanella, K. E., Iranpour, N., Zureikat, A. H., Singhi, A. D., Furlan, A., Dasyam, A. K. 2017; 42 (3): 877-883

  Abstract

  The purpose of the study was to investigate imaging features as well as pathologic and clinical findings of lymphoepithelial cyst (LEC) of pancreas.Ten patients with surgically resected and pathologically proven LEC, found in a single institution database between 2000 and 2015, were evaluated in a retrospective fashion. Patients' demographics, clinical presentation, co-morbidities, imaging features, cytology and histopathology results, and serum/aspirate biomarkers levels were recorded.Eighty percent of patients were male with median age of 59. All lesions were exophytic, with median size of 36 mm. 80% were classified as complex cystic lesions, showing enhancing septa or enhancing rim without measurable enhancing solid component. 80% were located in tail or body. In one patient with MRI, the lesion was mildly T1 hyperintense and markedly T2 hyperintense. All cases were anechoic or hypoechoic on EUS, and majority of them showed posterior acoustic enhancement. Of patients with available fluid aspirate analysis, 3 out of 4 had CEA level > 192 ng/mL and 1 out of 3 had elevated (>250 IU/ml) amylase level. Four out of 7 patients had elevated serum CA 19-9 levels (>37 U/mL); one patient with a value of 361 U/mL had co-existing pancreatic adenocarcinoma.Round shape, mild complexity, and exophytic location in pancreatic body and tail can be suggestive of LECs. These features however are not specific and may be seen with other cystic pancreatic lesions. CT findings should be used in conjunction with EUS, cytology, and tumor marker studies to secure the diagnosis of LEC.

  View details for DOI 10.1007/s00261-016-0932-3

  View details for PubMedID 27738791

• Comparison of true unenhanced and virtual unenhanced (VUE) attenuation values in abdominopelvic single-source rapid kilovoltage-switching spectral CT. Abdominal radiology (New York) Borhani, A. A., Kulzer, M., Iranpour, N., Ghodadra, A., Sparrow, M., Furlan, A., Tublin, M. E. 2017; 42 (3): 710-717

  Abstract

  To assess the agreement between the true non-contrast (TNC) attenuation values of intra-abdominal structures and attenuation values obtained on virtual-unenhanced (VUE) images based on rapid kVp-switching dual-energy CT. The effects of contrast phase and patient characteristics (e.g., BMI, hematocrit, hemoglobin content) on VUE values were also investigated.Ninety four patients who underwent triphasic abdominal CT (liver mass protocol, n = 47; pancreas mass protocol, n = 47) between August 2014 and May 2015 were retrospectively reviewed. Unenhanced series was performed using conventional single-energy mode at 120 kVp. Late arterial and venous phase post-contrast series were obtained utilizing rapid kVp-switching dual-energy CT technique. VUE images were processed off of arterial (VUE-art) and venous (VUE-ven) phase series. Attenuation values of liver, pancreas, kidneys, adrenal glands, muscle, subcutaneous fat, aorta, IVC, and main portal vein were recorded on TNC and VUE sets of images. Attenuation values were compared using univariate linear regression and Student two-tailed paired t test.There was excellent correlation between TNC, VUE-art, and VUE-ven attenuation values across all organs (p < 0.0001). Paired Student t test, however, showed significant difference between TNC and VUE-art attenuation of kidneys, right adrenal gland, paraspinal muscle, and aorta. There was also significant difference between TNC and VUE-ven attenuation of left kidney. Percentage of cases which had >10 HU difference between VUE and TNC for an individual was calculated which ranged between 13% (right kidney) and 42% (right adrenal gland).Although the correlation between VUE and TNC attenuation values was excellent and mean difference between TNC and VUE attenuation values was negligible (ranging between -5.94 HU for paraspinal muscles to 6.2 HU in aorta), intra-patient analysis showed a considerable number of cases which had >10 HU difference between VUE and TNC. VUE-ven generally offered a better approximation of TNC values. Further optimization of post-processing algorithms might be necessary before complete replacement of TNC with VUE images.

  View details for DOI 10.1007/s00261-016-0991-5

  View details for PubMedID 27864600

• The effects of pioglitazone adjuvant therapy on negative symptoms of patients with chronic schizophrenia: a double-blind and placebo-controlled trial. Human psychopharmacology Iranpour, N., Zandifar, A., Farokhnia, M., Goguol, A., Yekehtaz, H., Khodaie-Ardakani, M. R., Salehi, B., Esalatmanesh, S., Zeionoddini, A., Mohammadinejad, P., Zeinoddini, A., Akhondzadeh, S. 2016; 31 (2): 103-12

  Abstract

  The evident central role of inflammation, oxidative stress, and metabolic derangement in pathophysiology of negative symptoms of schizophrenia has opened new insights into probable pharmacological options for these symptoms. Pioglitazone is an antidiabetic agent with anti-inflammatory and antioxidant properties. In this study, we evaluated the efficacy of pioglitazone as an adjunct to risperidone for reduction of negative symptoms in schizophrenia.In this randomized, double-blind, placebo-controlled trial, 40 patients with chronic schizophrenia and a minimum score of 20 on the negative subscale of Positive and Negative Syndrome Scale (PANSS) were randomly allocated to receive risperidone plus either pioglitazone (30 mg/day) or placebo for 8 weeks. Patients' symptoms and adverse events were rated at baseline and weeks 2, 4, 6, and 8. The difference between the two groups in decline of PANSS negative subscale scores was considered as the primary outcome of this study.At the study endpoint, patients in the pioglitazone group showed significantly more improvement in PANSS negative subscale scores (p < 0.001) as well as PANSS total scores (p = 0.01) compared with the placebo group.These findings suggest the probable efficacy of pioglitazone as an augmentation therapy in reducing the negative symptoms of schizophrenia.

  View details for DOI 10.1002/hup.2517

  View details for PubMedID 26856695

• Simvastatin as an adjuvant therapy to fluoxetine in patients with moderate to severe major depression: A double-blind placebo-controlled trial. Journal of psychopharmacology (Oxford, England) Gougol, A., Zareh-Mohammadi, N., Raheb, S., Farokhnia, M., Salimi, S., Iranpour, N., Yekehtaz, H., Akhondzadeh, S. 2015; 29 (5): 575-81

  Abstract

  Statins have been shown to decrease depressive symptoms in certain groups of patients, an effect that is mostly attributed to their anti-inflammatory and neurotransmitter modulatory potentials. We aimed to investigate the antidepressant effects of simvastatin as an adjuvant therapy in patients with moderate to severe depression. In this double-blind placebo-controlled clinical trial, 48 patients were randomly allocated to receive simvastatin or placebo as an adjunct to fluoxetine for six weeks. Patients were evaluated with the Hamilton Depression Rating Scale (HDRS) at baseline and weeks 2, 4 and 6. Probable clinical and laboratory adverse events were also monitored and compared between the two groups. Simvastatin-treated patients experienced significantly more reductions in HDRS scores compared to the placebo group by the end of the trial (p=0.02). Early improvement and response rates were significantly greater in the simvastatin group than the placebo group (p=0.02 and p=0.01, respectively) but remission rate was not significantly different between the two groups (p=0.36). No serious adverse event was reported during this trial. In conclusion, simvastatin seems to be a safe and effective adjuvant therapy for patients suffering from major depressive disorder. However, more confirmatory studies are warranted.

  View details for DOI 10.1177/0269881115578160

  View details for PubMedID 25827645

• Comparing the efficacy and safety of Crocus sativus L. with memantine in patients with moderate to severe Alzheimer's disease: a double-blind randomized clinical trial. Human psychopharmacology Farokhnia, M., Shafiee Sabet, M., Iranpour, N., Gougol, A., Yekehtaz, H., Alimardani, R., Farsad, F., Kamalipour, M., Akhondzadeh, S. 2014; 29 (4): 351-9

  Abstract

  Limited pharmacological options are available for the management of Alzheimer's disease (AD) in severe stages. Cognitive-enhancing properties of saffron, the dried stigma of Crocus sativus L., have been evidenced in different studies. We aimed to compare the efficacy and safety of saffron extract versus memantine in reducing cognitive deterioration of patients with moderate to severe AD.In this randomized double-blind parallel-group study, 68 patients with moderate to severe AD (Mini-Mental State Examination score of 8-14) received memantine (20 mg/day) or saffron extract (30 mg/day) capsules for 12 months. Participants were evaluated every month by Severe Cognitive Impairment Rating Scale (SCIRS) and Functional Assessment Staging (FAST) in addition to recording the probable adverse events.Both treatment groups showed similar outcomes as demonstrated by insignificant effect for time × treatment interaction on SCIRS scores [F(2.95, 194.78) = 2.25, p = 0.08]. There was no significant difference between the two groups in the scores changes from baseline to the endpoint on SCIRS (p = 0.38) and FAST (p = 0.87). The frequency of adverse events was not significantly different between the two groups as well.In addition to its favorable safety profile, 1-year administration of saffron extract capsules showed to be comparable with memantine in reducing cognitive decline in patients with moderate to severe AD. Confirmatory studies with larger sample sizes and longer follow-up periods are warranted.

  View details for DOI 10.1002/hup.2412

  View details for PubMedID 25163440

• Intranasal desmopressin as an adjunct to risperidone for negative symptoms of schizophrenia: a randomized, double-blind, placebo-controlled, clinical trial. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology Hosseini, S. M., Farokhnia, M., Rezaei, F., Gougol, A., Yekehtaz, H., Iranpour, N., Salehi, B., Tabrizi, M., Tajdini, M., Ghaleiha, A., Akhondzadeh, S. 2014; 24 (6): 846-55

  Abstract

  Considering the role of neurohypophyseal peptides in normal development and function of higher cortical processes along with their proven abnormalities in schizophrenic patients, these pathways have recently attracted greater attention as treatment targets for schizophrenia. Desmopressin (DDAVP) is a synthetic analog of vasopressin. This study aimed to evaluate the efficacy and safety of DDAVP nasal spray as an adjunct to risperidone in improving negative symptoms of schizophrenia. In this randomized double-blind placebo-controlled clinical trial, forty patients aged 18-50 years with a DSM IV-TR diagnosis of chronic schizophrenia and a minimum score of 60 on positive and negative syndrome scale (PANSS) were equally randomized to receive DDAVP nasal spray (20mcg/day) or placebo in addition to risperidone for 8 weeks. Patients were partially stabilized and treated with a stable dose of risperidone (5 or 6mg/day) for at least four weeks prior to entry. Participants were rated by PANSS every two weeks and decrease in the PANSS negative subscale score was considered as our primary outcome. By the study endpoint, DDAVP-treated patients showed significantly greater improvement in the negative symptoms (P=0.001) as well as the PANSS total and general psychopathology subscale scores (P=0.005 and P=0.003; respectively) compared to the placebo group. Treatment group was the strongest predictor of changes in negative symptoms (β=-0.48, t=-3.67, P=001). No serious adverse event or fluid/electrolyte imbalance was reported in this trial. In conclusion, DDAVP nasal spray showed to be an effective and safe medication for improving negative symptoms in patients with chronic schizophrenia.

  View details for DOI 10.1016/j.euroneuro.2014.02.001

  View details for PubMedID 24636461

• Do the different reasons for lactation discontinuation have similar impact on future breast problems? Asian Pacific journal of cancer prevention : APJCP Ghadiri, F., Iranpour, N., Yunesian, M., Shadlou, Z., Kaviani, A. 2013; 14 (10): 6147-50

  Abstract

  Breast feeding is considered to be mutually beneficial for both mothers and infants, though the effect of lactation problems on development of breast lesions (whether benign or malignant) is not clear.This study was conducted to identify possible relations between lactation problems and benign and malignant breast disease.308 patients referred to two referral breast clinics in Tehran, the capital city of IR Iran, between January 2008 and January 2011, were recruited. They were interviewed by a standard questionnaire regarding breast feeding problems. The study population was classified in 3 major groups; breast feeding without any problem, unwillingness to breast feed according to whether mothers' preference not to feed or some breast problems like mastitis, and finally insufficient milk that caused the mothers to feed their babies with formula.Recruiting binary logistic regression method, mother's unwillingness to feed her child by breast milk, and also breast problems such as mastitis and abscess during lactation period showed significant relation with both benign and malignant breast diseases (p value<0.01). Surprisingly, inadequate milk was not associated with any of these conditions.We concluded that lactation problems which involve normal milk drainage from the breast may play an important role in whether the mother wll subsequently develope both benign and malignant pathologies. In contrast in the situation that the production of the milk is not sufficient and there are no intentional or unintentional problems in drainage of the produced milk, future problems would not be more common.

  View details for DOI 10.7314/apjcp.2013.14.10.6147

  View details for PubMedID 24289543

• Breast cancer research in Iran; essential data to organize research. Asian Pacific journal of cancer prevention : APJCP Kaviani, A., Ghadiri, F., Iranpour, N., Shadloo, Z., Rabbani, A. 2011; 12 (11): 3129-31

  Abstract

  Considering that breast cancer is one of the most burdensome diseases our societies are facing, and given our lack of knowledge in the research field of the important disease, it is essential that we strategize research policies by identifying defects in research systems in each country. The goal of this study was to explore the published articles in this field and present the data required for the policy makers to re-organize the breast cancer research in Iran.In this descriptive study, Pubmed searches were performed to find all the articles published on the title of breast "cancer", "tumor", "malignancy" and "Iran" from the beginning up to the end of January 2010. Different research categories of the articles were defined and validated by an expert panel. The abstracts of all 180 articles were reviewed and each article was put into the relevant category.Based on the available evidence the majority of articles have focused on molecular science (21%) and genetics (19%), while the remainder belonged to other categories like quality of life (9%), screening protocols (8%), epidemiology (7%), risk factor studies (6%), pathology (6%), patient knowledge and behavior (5%) and other clinical research fields (19%). The most used methodologies are cross-sectional (39%) and case-control (25%). The other articles are designed in formats such as experimental (8%), cohort (6%), case-report (6%), review article (4%) and others methodologies (12%).Despite the increasing body of literature under the title of breast cancer since 2000 from Iran, still there are limited published articles in some important categories with strong levels of evidence of relevance, which calls for extra efforts to reassess the research system policies and budgeting standards.

  View details for PubMedID 22394002