Since its development, virtual monoenergetic imaging (VMI) derived from dual-energy computed tomography (DECT) has been shown to be valuable in many clinical applications. However, DECT-based VMI showed increased noise at low keV levels. In this study, we proposed an unsupervised learning method to generate VMI from DECT. This means that we don't require training and labeled (i.e. high-quality VMI) data. Specifically, DECT images were fed into a deep learning (DL) based model expected to output VMI. Based on the theory that VMI obtained from image space data is a linear combination of DECT images, we used the model output (i.e. the predicted VMI) to recalculate DECT images. By minimizing the difference between the measured and recalculated DECT images, the DL-based model can be constrained itself to generate VMI from DECT images. We investigate whether the proposed DL-based method has the ability to improve the quality of VMIs. The experimental results obtained from patient data showed that the DL-based VMIs had better image quality than the conventional DECT-based VMIs. Moreover, the CT number differences between the DECT-based and DL-based VMIs were distributed within <math xmlns="http://www.w3.org/1998/Math/MathML"><mo>±</mo></math> 10 HU for bone and <math xmlns="http://www.w3.org/1998/Math/MathML"><mo>±</mo></math> 5 HU for brain, fat, and muscle. Except for bone, no statistically significant difference in CT number measurements was found between the DECT-based and DL-based VMIs (p > 0.01). Our preliminary results show that DL has the potential to unsupervisedly generate high-quality VMIs directly from DECT.

Objective: While recent advances in text-conditioned generative models have enabled the synthesis of realistic medical images, progress has been largely confined to 2D modalities such as chest X-rays. Extending text-to-image generation to volumetric Computed Tomography (CT) remains a significant challenge, due to its high dimensionality, anatomical complexity, and the absence of robust frameworks that align vision-language data in 3D medical imaging. Methods: We introduce a novel architecture for Text-to-CT generation that combines a latent diffusion model with a 3D contrastive vision-language pretraining scheme. Our approach leverages a dual-encoder CLIP-style model trained on paired CT volumes and radiology reports to establish a shared embedding space, which serves as the conditioning input for generation. CT volumes are compressed into a low-dimensional latent space via a pretrained volumetric VAE, enabling efficient 3D denoising diffusion without requiring external super-resolution stages. Results: We evaluate our method on the CT-RATE dataset and conduct a comprehensive assessment of image fidelity, clinical relevance, and semantic alignment. Our model achieves competitive performance across all tasks, significantly outperforming prior baselines for text-to-CT generation. Moreover, we demonstrate that CT scans synthesized by our framework can effectively augment real data, improving downstream diagnostic performance. Conclusion: Our results show that modality-specific vision-language alignment is a key component for high-quality 3D medical image generation. By integrating contrastive pretraining and volumetric diffusion, our method offers a scalable and controllable solution for synthesizing clinically meaningful CT volumes from text, paving the way for new applications in data augmentation, medical education, and automated clinical simulation.

This study aimed to evaluate the diagnostic performance of an artificial intelligence (AI)-based platform (Diagnocat) in detecting periapical radiolucencies (PARLs) in cone-beam computed tomography (CBCT) scans of molars. Specifically, we assessed Diagnocat's performance in detecting PARLs in non-root-filled molars and compared its diagnostic performance between preoperative and postoperative scans. This retrospective study analyzed preoperative and postoperative CBCT scans of 134 molars (327 roots). PARLs detected by Diagnocat were compared with assessments independently performed by two experienced endodontists, serving as the reference standard. Diagnostic performance was assessed at both tooth and root levels using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), F1 score, and the area under the receiver operating characteristic curve (AUC-ROC). In preoperative scans of non-root-filled molars, Diagnocat demonstrated high sensitivity (teeth: 93.9%, roots: 86.2%), moderate specificity (teeth: 65.2%, roots: 79.9%), accuracy (teeth: 79.1%, roots: 82.6%), PPV (teeth: 71.8%, roots: 75.8%), NPV (teeth: 91.8%, roots: 88.8%), and F1 score (teeth: 81.3%, roots: 80.7%) for PARL detection. The AUC was 0.76 at the tooth level and 0.79 at the root level. Postoperative scans showed significantly lower PPV (teeth: 54.2%; roots: 46.9%) and F1 scores (teeth: 67.2%; roots: 59.2%). Diagnocat shows promise in detecting PARLs in CBCT scans of non-root-filled molars, demonstrating high sensitivity but moderate specificity, highlighting the need for human oversight to prevent overdiagnosis. However, diagnostic performance declined significantly in postoperative scans of root-filled molars. Further research is needed to optimize the platform's performance and support its integration into clinical practice. AI-based platforms such as Diagnocat can assist clinicians in detecting PARLs in CBCT scans, enhancing diagnostic efficiency and supporting decision-making. However, human expertise remains essential to minimize the risk of overdiagnosis and avoid unnecessary treatment.

Investigate spleen diameter (d) and volume (v) relationship in patients with hematologic malignancies (HM) by determining volumetric thresholds that best correlate to established diameter thresholds for assessing response to treatment. Exploratorily, interrogate the impact of volumetric measurements in response categories and as a predictor of response. Secondary analysis of prospectively collected clinical trial data of 382 patients with HM. Spleen diameters were computed following Lugano criteria and volumes using deep learning segmentation. d and v relationship was estimated using power regression model, volumetric thresholds ([Formula: see text]) for treatment response estimated; threshold search to determine percentual change ([Formula: see text] and minimum volumetric increase ([Formula: see text]) that maximize agreement with Lugano criteria performed. Spleen diameter and volume predictive performance for clinical response investigated using random forest model. [Formula: see text] describes the relationship between spleen diameter and volume. [Formula: see text] for splenomegaly was 546 cm³. [Formula: see text], [Formula: see text], and [Formula: see text] for assessing response resulting in highest agreement with Lugano criteria were 570 cm³, 73%, and 170 cm³, respectively. Predictive performance for response between diameter and volume were not significantly different (P=0.78). This study provides empirical spleen volume threshold and percentual changes that best correlate with diameter thresholds, i.e., Lugano criteria, for assessment of response to treatment in patients with HM. In our dataset use of spleen volumetric thresholds versus diameter thresholds resulted in similar response assessment categories and did not signal differences in predictive values for response.

Accurate preoperative prediction of major pathological response or pathological complete response after neoadjuvant chemo-immunotherapy remains a critical unmet need in resectable non-small-cell lung cancer (NSCLC). Conventional size-based imaging criteria offer limited reliability, while biopsy confirmation is available only post-surgery. We retrospectively assembled 509 consecutive NSCLC cases from four Chinese thoracic-oncology centers (March 2018 to March 2023) and prospectively enrolled 50 additional patients. Three 3-dimensional convolutional neural networks (pre-treatment CT, pre-surgical CT, dual-phase CT) were developed; the best-performing dual-phase model (NeoPred) optionally integrated clinical variables. Model performance was measured by area under the receiver-operating-characteristic curve (AUC) and compared with nine board-certified radiologists. In an external validation set (n=59), NeoPred achieved an AUC of 0.772 (95% CI: 0.650 to 0.895), sensitivity 0.591, specificity 0.733, and accuracy 0.627; incorporating clinical data increased the AUC to 0.787. In a prospective cohort (n=50), NeoPred reached an AUC of 0.760 (95% CI: 0.628 to 0.891), surpassing the experts' mean AUC of 0.720 (95% CI: 0.574 to 0.865). Model assistance raised the pooled expert AUC to 0.829 (95% CI: 0.707 to 0.951) and accuracy to 0.820. Marked performance persisted within radiological stable-disease subgroups (external AUC 0.742, 95% CI: 0.468 to 1.000; prospective AUC 0.833, 95% CI: 0.497 to 1.000). Combining dual-phase CT and clinical variables, NeoPred reliably and non-invasively predicts pathological response to neoadjuvant chemo-immunotherapy in NSCLC, outperforms unaided expert assessment, and significantly enhances radiologist performance. Further multinational trials are needed to confirm generalizability and support surgical decision-making.

To assess the prognostic utility of coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA)-derived quantitative plaque metrics for predicting adverse cardiovascular outcomes. The study enrolled 2404 patients with suspected coronary artery disease (CAD) but without a prior history of CAD. All participants underwent CAC scoring and CCTA, with plaque metrics quantified using an artificial intelligence (AI)-based tool (Cleerly, Inc). Percent atheroma volume (PAV) and non-calcified plaque volume percentage (NCPV%), reflecting total plaque burden and the proportion of non-calcified plaque volume normalized to vessel volume, were evaluated. The primary endpoint was a composite of all-cause mortality and non-fatal myocardial infarction (MI). Cox proportional hazard models, adjusted for clinical risk factors and early revascularization, were employed for analysis. During a median follow-up of 7.0 years, 208 patients (8.7%) experienced the primary endpoint, including 73 cases of MI (3%). The model incorporating PAV demonstrated superior discriminatory power for the composite endpoint (AUC = 0.729) compared to CAC scoring (AUC = 0.706, P = 0.016). In MI prediction, PAV (AUC = 0.791) significantly outperformed CAC (AUC = 0.699, P < 0.001), with NCPV% showing the highest prognostic accuracy (AUC = 0.814, P < 0.001). AI-driven assessment of coronary plaque burden enhances prognostic accuracy for future adverse cardiovascular events, highlighting the critical role of comprehensive plaque characterization in refining risk stratification strategies.

Accurate vertebrae segmentation is crucial for modern surgical technologies, and deep learning networks provide valuable tools for this task. This study explores the application of advanced deep learning-based methods for segmenting vertebrae in computed tomography (CT) images of adolescent idiopathic scoliosis (AIS) patients. In this study, we collected a dataset of 31 samples from AIS patients, covering a wide range of spinal regions from cervical to lumbar vertebrae. High-resolution CT images were obtained for each sample, forming the basis of our segmentation analysis. We utilized 2 popular neural networks, U-Net and Attention U-Net, to segment the vertebrae in these CT images. Segmentation performance was rigorously evaluated using 2 key metrics: the Dice Coefficient Score to measure overlap between segmented and ground truth regions, and the Hausdorff distance (HD) to assess boundary dissimilarity. Both networks performed well, with U-Net achieving an average Dice coefficient of 92.2 ± 2.4% and an HD of 9.80 ± 1.34 mm. Attention U-Net showed similar results, with a Dice coefficient of 92.3 ± 2.9% and an HD of 8.67 ± 3.38 mm. When applied to the challenging anatomy of AIS, our findings align with literature results from advanced 3D U-Nets on healthy spines. Although no significant overall difference was observed between the 2 networks (P > .05), Attention U-Net exhibited an improved Dice coefficient (91.5 ± 0.0% vs 88.8 ± 0.1%, P = .151) and a significantly better HD (9.04 ± 4.51 vs. 13.60 ± 2.26 mm, P = .027) in critical scoliosis sites (mid-thoracic region), suggesting enhanced suitability for complex anatomy. Our study indicates that U-Net neural networks are feasible and effective for automated vertebrae segmentation in AIS patients using clinical 3D CT images. Attention U-Net demonstrated improved performance in thoracic levels, which are primary sites of scoliosis and may be more suitable for challenging anatomical regions.

Imaging is crucial to assess disease extent, activity, and outcomes in inflammatory bowel disease (IBD). Artificial intelligence (AI) image interpretation requires automated exploitation of studies at scale as an initial step. Here we evaluate natural language processing to classify Crohn's disease (CD) on CTE. From our population representative IBD registry a sample of CD patients (male: 44.6%, median age: 50 IQR37-60) and controls (n = 981 each) CTE reports were extracted and split into training- (n = 1568), development- (n = 196), and testing (n = 198) datasets each with around 200 words and balanced numbers of labels, respectively. Predictive classification was evaluated with CNN, Bi-LSTM, BERT-110M, LLaMA-3.3-70B-Instruct and DeepSeek-R1-Distill-LLaMA-70B. While our custom IBDBERT finetuned on expert IBD knowledge (i.e. ACG, AGA, ECCO guidelines), outperformed rule- and rationale extraction-based classifiers (accuracy 88.6% with pre-tuning learning rate 0.00001, AUC 0.945) in predictive performance, LLaMA, but not DeepSeek achieved overall superior results (accuracy 91.2% vs. 88.9%, F1 0.907 vs. 0.874).

Pulmonary hypertension (pH) is a malignant pulmonary circulation disease. Right heart catheterization (RHC) is the gold standard procedure for quantitative evaluation of pulmonary hemodynamics. Accurate and noninvasive quantitative evaluation of pulmonary hemodynamics is challenging due to the limitations of currently available assessment methods. Patients who underwent computed tomographic pulmonary angiography (CTPA) and RHC examinations within 2 weeks were included. The dataset was randomly divided into a training set and a test set at an 8:2 ratio. A radiomic feature model and another two-dimensional (2D) feature model aimed to quantitatively evaluate of pulmonary hemodynamics were constructed. The performance of models was determined by calculating the mean squared error, the intraclass correlation coefficient (ICC) and the area under the precision-recall curve (AUC-PR) and performing Bland-Altman analyses. 345 patients: 271 patients with PH (mean age 50 ± 17 years, 93 men) and 74 without PH (mean age 55 ± 16 years, 26 men) were identified. The predictive results of pulmonary hemodynamics of radiomic feature model integrating 5 2D features and other 30 radiomic features were consistent with the results from RHC, and outperformed another 2D feature model. The radiomic feature model exhibited moderate to good reproducibility to predict pulmonary hemodynamic parameters (ICC reached 0.87). In addition, pH can be accurately identified based on a classification model (AUC-PR =0.99). This study provides a noninvasive method for comprehensively and quantitatively evaluating pulmonary hemodynamics using CTPA images, which has the potential to serve as an alternative to RHC, pending further validation.

Basal ganglia intracranial hemorrhage (bgICH) morphology is associated with postoperative functional outcomes. We hypothesized that bgICH spatial representation modeling could be automated for functional outcome prediction after minimally invasive surgical (MIS) evacuation. A training set of 678 computed tomography head and computed tomography angiography images from 63 patients were used to train key-point detection and instance segmentation convolutional neural network-based models for anatomic landmark identification and bgICH segmentation. Anatomic landmarks included the bilateral orbital rims at the globe's maximum diameter and the posterior-most aspect of the tentorial incisura, which were used to define a universal stereotactic reference frame across patients. Convolutional neural network models were tested using volumetric computed tomography head/computed tomography angiography scans from 45 patients who underwent MIS bgICH evacuation with recorded modified Rankin Scales within one year after surgery. bgICH volumes were highly correlated (R2 = 0.95, P < .001) between manual (median 39-mL) and automatic (median 38-mL) segmentation methods. The absolute median difference between groups was 2-mL (IQR: 1-6 mL). Median localization accuracy (distance between automated and manually designated coordinate frames) was 4 mm (IQR: 3-6). Landmark coordinates were highly correlated in the x- (medial-lateral), y- (anterior-posterior), and z-axes (rostral-caudal) for all 3 landmarks (R2 range = 0.95-0.99, P < .001 for all). Functional outcome (modified Rankin Scale 4-6) was predicted with similar model performance using automated (area under the receiver operating characteristic curve = 0.81, 95% CI: 0.67-0.94) and manually (area under the receiver operating characteristic curve = 0.84, 95% CI: 0.72-0.96) constructed spatial representation models (P = .173). Computer vision models can accurately replicate bgICH manual segmentation, stereotactic localization, and prognosticate functional outcomes after MIS bgICH evacuation.