This study aims to construct a survival prognosis prediction model for muscle-invasive bladder cancer based on CT imaging features. A total of 91 patients with muscle-invasive bladder cancer were sourced from the TCGA and TCIA dataset and were divided into a training group (64 cases) and a validation group (27 cases). Additionally, 54 patients with muscle-invasive bladder cancer were retrospectively collected from our hospital to serve as an external test group; their enhanced CT imaging data were analyzed and processed to identify the most relevant radiomic features. Five distinct machine learning methods were employed to develop the optimal radiomics model, which was then combined with clinical data to create a nomogram model aimed at accurately predicting the overall survival (OS) of patients with muscle-invasive bladder cancer. The model's performance was ultimately assessed using various evaluation methods, including the ROC curve, calibration curve, decision curve, and Kaplan-Meier (KM) analysis. Eight radiomic features were identified for modeling analysis. Among the models evaluated, the Gradient Boosting Machine (GBM) In the prediction of OS performed the best. the 2-year AUCs were 0.859, 95% CI (0.767-0.952) for the training group, 0.850, 95% CI (0.705-0.995) for the validation group, and 0.700, 95% CI (0.520-0.880) for the external test group. The 3-year AUCs were 0.809, 95% CI (0.704-0.913) for the training group, 0.895, 95% CI (0.768-1.000) for the validation group, and 0.730, 95% CI (0.569-0.891) for the external test group. The nomogram model incorporating clinical data achieved superior results, the AUCs for predicting 2-year OS were 0.913 (95% CI: 0.83-0.98) for the training group, 0.86 (95% CI: 0.78-0.96) for the validation group, and 0.778 (95% CI: 0.69-0.94) for the external test group; for predicting 3-year OS, the AUCs were 0.837 (95% CI: 0.83-0.98) for the training group, 0.982 (95% CI: 0.84-1.0) for the validation group, and 0.785 (95% CI: 0.75-0.96) for the external test group. The calibration curve demonstrated excellent calibration of the model, while the decision curve and KM analysis indicated that the model possesses substantial clinical utility. The GBM model, based on the radiomic features of enhanced CT imaging, holds significant potential for predicting the prognosis of patients with muscle-invasive bladder cancer. Furthermore, the combined model, which incorporates clinical features, demonstrates enhanced performance and is beneficial for clinical decision-making.

Despite the widespread use of stereotactic radiosurgery (SRS) to treat cerebral arteriovenous malformations (AVMs), this procedure can lead to radiation-induced changes (RICs) in the surrounding brain tissue. Volumetric assessment of RICs is crucial for therapy planning and monitoring. RICs that appear as hyper-dense areas in magnetic resonance T2-weighted (T2w) images are clearly identifiable; however, physicians lack tools for the segmentation and quantification of these areas. This paper presents an algorithm to calculate the volume of RICs in patients with AVMs following SRS. The algorithm could be used to predict the course of RICs and facilitate clinical management. We trained a Mask Region-based Convolutional Neural Network (Mask R-CNN) as an alternative to manual pre-processing in designating regions of interest. We also applied transfer learning to the DeepMedic deep learning model to facilitate the automatic segmentation and quantification of AVM edema regions in T2w images. The resulting quantitative findings were used to explore the effects of SRS treatment among 28 patients with unruptured AVMs based on 139 regularly tracked T2w scans. The actual range of RICs in the T2w images was labeled manually by a clinical radiologist to serve as the gold standard in supervised learning. The trained model was tasked with segmenting the test set for comparison with the manual segmentation results. The average Dice similarity coefficient in these comparisons was 71.8%. The proposed segmentation algorithm achieved results on par with conventional manual calculations in determining the volume of RICs, which were shown to peak at the end of the first year after SRS and then gradually decrease. These findings have the potential to enhance clinical decision-making. Not applicable.

<b>Objective:</b>To development a deep learning（DL） model based on conventional MRI for automatic segmentation and differential diagnosis of nasopharyngeal carcinoma（NPC） and nasopharyngeal lymphoma（NPL）. <b>Methods:</b>The retrospective study included 142 patients with NPL and 292 patients with NPC who underwent conventional MRI at Renmin Hospital of Wuhan University from June 2012 to February 2023. MRI from 80 patients were manually segmented to train the segmentation model. The automatically segmented regions of interest（ROIs） formed four datasets: T1 weighted images（T1WI）, T2 weighted images（T2WI）, T1 weighted contrast-enhanced images（T1CE）, and a combination of T1WI and T2WI. The ImageNet-pretrained ResNet101 model was fine-tuned for the classification task. Statistical analysis was conducted using SPSS 22.0. The Dice coefficient loss was used to evaluate performance of segmentation task. Diagnostic performance was assessed using receiver operating characteristic（ROC） curves. Gradient-weighted class activation mapping（Grad-CAM） was imported to visualize the model's function. <b>Results:</b>The DICE score of the segmentation model reached 0.876 in the testing set. The AUC values of classification models in testing set were as follows: T1WI: 0.78（95%<i>CI</i> 0.67-0.81）, T2WI: 0.75（95%<i>CI</i> 0.72-0.86）, T1CE: 0.84（95%<i>CI</i> 0.76-0.87）, and T1WI+T2WI: 0.93（95%<i>CI</i> 0.85-0.94）. The AUC values for the two clinicians were 0.77（95%<i>CI</i> 0.72-0.82） for the junior, and 0.84（95%<i>CI</i> 0.80-0.89） for the senior. Grad-CAM analysis revealed that the central region of the tumor was highly correlated with the model's classification decisions, while the correlation was lower in the peripheral regions. <b>Conclusion:</b>The deep learning model performed well in differentiating NPC from NPL based on conventional MRI. The T1WI+T2WI combination model exhibited the best performance. The model can assist in the early diagnosis of NPC and NPL, facilitating timely and standardized treatment, which may improve patient prognosis.

Primary graft dysfunction (PGD) is a significant barrier to survival in lung transplant (LTx) recipients. PGD in patients with systemic sclerosis (SSc) remains especially underrepresented in research. We investigated 92 SSc recipients (mean age 51 years ± 10) who underwent bilateral LTx between 2007 and 2020. PGD was defined as grade 3 PGD at 72 h post-LTx. A comprehensive set of CT image features was automatically computed from recipient chest CT scans using deep learning algorithms. Volumetric analysis of recipients' lungs and chest cavity was used to estimate lung-size matching. Four machine learning (ML) algorithms were developed to predict PGD, including multivariate logistic regression, support vector machine (SVM), random forest classifier (RFC), and multilayer perceptron (MLP). PGD was significantly associated with BMI >30 kg/m² (p = 0.009), African American race (p = 0.011), lower Preop FEV1 (p = 0.002) and FVC (p = 0.004), longer waitlist time (p = 0.014), higher lung allocation score (LAS) (p = 0.028), and interstitial lung disease (p = 0.050). From CT analysis, PGD was significantly associated with decreased lung volume (p < 0.001), increased heart-chest cavity volume ratio (p < 0.001), epicardial (p = 0.033) and total heart (p = 0.049) adipose tissue, and five cardiopulmonary features (p < 0.050). Oversized donor allografts estimated using CT analysis were significantly associated with PGD (p < 0.050). The MLP model achieved a maximum AUROC of 0.85 (95% CI: 0.81-0.88) in predicting PGD with four features: Preop FEV1, heart-chest cavity volume ratio, waitlist time, and donor to recipient chest cavity volume ratio. CT-derived features are significantly associated with PGD, and models incorporating these features can predict PGD in SSc recipients.

Cone-beam computed tomography (CBCT) for image-guided radiotherapy (IGRT) during liver stereotactic ablative radiotherapy (SABR) is degraded by respiratory motion artefacts, potentially jeopardising treatment accuracy. Mechanically assisted non-invasive ventilation-induced breath-hold (MANIV-BH) can reduce these artefacts. This study compares MANIV-BH and free-breathing CBCTs regarding image quality, IGRT variability, automatic registration accuracy, and deep-learning auto-segmentation performance. Liver SABR CBCTs were presented blindly to 14 operators: 25 patients with FB and 25 with MANIV-BH. They rated CBCT quality and IGRT ease (rigid registration with planning CT). Interoperator IGRT variability was compared between FB and MANIV-BH. Automatic gross tumour volume (GTV) mapping accuracy was compared using automatic rigid registration and image-guided deformable registration. Deep-learning organ-at-risk (OAR) auto-segmentation was rated by an operator, who recorded the time dedicated for manual correction of these volumes. MANIV-BH significantly improved CBCT image quality ("Excellent"/"Good": 83.4 % versus 25.4 % with FB, p < 0.001), facilitated IGRT ("Very easy"/"Easy": 68.0 % versus 38.9 % with FB, p < 0.001), and reduced IGRT variability, particularly for trained operators (overall variability of 3.2 mm versus 4.6 mm with FB, p = 0.010). MANIV-BH improved deep-learning auto-segmentation performance (80.0 % rated "Excellent"/"Good" versus 4.0 % with FB, p < 0.001), and reduced median manual correction time by 54.2 % compared to FB (p < 0.001). However, automatic GTV mapping accuracy was not significantly different between MANIV-BH and FB. In liver SABR, MANIV-BH significantly improves CBCT quality, reduces interoperator IGRT variability, and enhances OAR auto-segmentation. Beyond being safe and effective for respiratory motion mitigation, MANIV increases accuracy during treatment delivery, although its implementation requires resources.

Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI). This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site. Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; median age 49 years IQR 41; 57), 21.8% (n = 6003; n = 2999/50.0% female, n = 3004/50% male; median age 53 years IQR 46; 60) reported CBP, compared to 78.2% (n = 21,515; n = 9194/42.7% female, n = 12,321/57.3% male; median age 48 years IQR 39; 56) who did not. CBP prevalence was highest in those with low (<500 MET min/week) or high (>5000 MET min/week) self-reported physical activity levels (24.6% (n = 10,892) and 22.0% (n = 3800), respectively) compared to moderate (500-5000 MET min/week) levels (19.4% (n = 12,826); p < 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13-1.30; p < 0.0001) was associated with an increased likelihood of chronic back pain (CBP), whereas higher lean muscle mass (LMM) (OR 0.87 per 2-unit Z-score; 95% CI 0.79-0.95; p = 0.003) was associated with a reduced likelihood of CBP. Stratified analyses confirmed these associations persisted in individuals with osteoarthritis (OA-CBP LMM: 22.9 cm³/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm³/kg/m; InterMAT: 6.96% both p < 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm³/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm³/kg/m; InterMAT: 7.9% p = 0.16 and p = 0.0019). Higher pain intensity (Pain Intensity Numerical Rating Scale ≥4) correlated with lower LMM (2-unit Z-score deviation = OR, 0.63; 95% CI, 0.57-0.70; p < 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13-1.30; p < 0.0001), independent of physical activity, osteoporosis and osteoarthritis. This large, population-based study highlights the associations of InterMAT and LMM with CBP. Given the limitations of the cross-sectional design, our findings can be seen as an impetus for further causal investigations within a broader, multidisciplinary framework to guide future research toward improved prevention and treatment. The NAKO is funded by the Federal Ministry of Education and Research (BMBF) [project funding reference numbers: 01ER1301A/B/C, 01ER1511D, 01ER1801A/B/C/D and 01ER2301A/B/C], federal states of Germany and the Helmholtz Association, the participating universities and the institutes of the Leibniz Association.

To develop a deep learning model based on high-frequency ultrasound images to classify different stages of liver fibrosis in chronic hepatitis B patients. This retrospective multicentre study included chronic hepatitis B patients who underwent both high-frequency and low-frequency liver ultrasound examinations between January 2014 and August 2024 at six hospitals. Paired images were employed to train the HF-DL and the LF-DL models independently. Three binary tasks were conducted: (1) Significant Fibrosis (S0-1 vs. S2-4); (2) Advanced Fibrosis (S0-2 vs. S3-4); (3) Cirrhosis (S0-3 vs. S4). Hepatic pathological results constituted the ground truth for algorithm development and evaluation. The diagnostic value of high-frequency and low-frequency liver ultrasound images was compared across commonly used CNN networks. The HF-DL model performance was compared against the LF-DL model, FIB-4, APRI, and with SWE (external test set). The calibration of models was plotted. The clinical benefits were calculated. Subgroup analysis for patients with different characteristics (BMI, ALT, inflammation level, alcohol consumption level) was conducted. The HF-DL model demonstrated consistently superior diagnostic performance across all stages of liver fibrosis compared to the LF-DL model, FIB-4, APRI and SWE, particularly in classifying advanced fibrosis (0.93 [95% CI 0.90-0.95], 0.93 [95% CI 0.89-0.96], p < 0.01). The HF-DL model demonstrates significantly improved performance in both target patient detection and negative population exclusion. The HF-DL model based on high-frequency ultrasound images outperforms other routinely used non-invasive modalities across different stages of liver fibrosis, particularly in advanced fibrosis, and may offer considerable clinical value.

Purpose To assess the agreement between routine-dose (RD) and lower-dose (LD) contrast-enhanced CT scans, with and without Digital Imaging and Communications in Medicine-based deep learning-based denoising (DLD), in evaluating small renal masses (SRMs) during active surveillance. Materials and Methods In this retrospective study, CT scans from patients undergoing active surveillance for an SRM were included. Using a validated simulation technique, LD CT images were generated from the RD images to simulate 75% (LD75) and 90% (LD90) radiation dose reductions. Two additional LD image sets, in which the DLD was applied (LD75-DLD and LD90-DLD), were generated. Between January 2023 and June 2024, nine radiologists from three institutions independently evaluated 350 CT scans across five datasets for tumor size, tumor nearness to the collecting system (TN), and tumor shape irregularity (TSI), and interobserver reproducibility and agreement were assessed using the 95% limits of agreement with the mean (LOAM) and Gwet AC2 coefficient, respectively. Subjective and quantitative image quality assessments were also performed. Results The study sample included 70 patients (mean age, 73.2 years ± 9.2 [SD]; 48 male, 22 female). LD75 CT was found to be in agreement with RD scans for assessing SRM diameter, with a LOAM of ±2.4 mm (95% CI: 2.3, 2.6) for LD75 compared with ±2.2 mm (95% CI: 2.1, 2.4) for RD. However, a 90% dose reduction compromised reproducibility (LOAM ±3.0 mm; 95% CI: 2.8, 3.2). LD90-DLD preserved measurement reproducibility (LOAM ±2.4 mm; 95% CI: 2.3, 2.6). Observer agreement was comparable between TN and TSI assessments across all image sets, with no statistically significant differences identified (all comparisons <i>P</i> ≥ .35 for TN and <i>P</i> ≥ .02 for TSI; Holm-corrected significance threshold, <i>P</i> = .013). Subjective and quantitative image quality assessments confirmed that DLD effectively restored image quality at reduced dose levels: LD75-DLD had the highest overall image quality, significantly lower noise, and improved contrast-to-noise ratio compared with RD (<i>P</i> < .001). Conclusion A 75% reduction in radiation dose is feasible for SRM assessment in active surveillance using CT with a conventional iterative reconstruction technique, whereas applying DLD allows submillisievert dose reduction. <b>Keywords:</b> CT, Urinary, Kidney, Radiation Safety, Observer Performance, Technology Assessment <i>Supplemental material is available for this article.</i> © RSNA, 2025 See also commentary by Muglia in this issue.