Thoracolumbar stump ribs are one of the essential indicators of thoracolumbar transitional vertebrae or enumeration anomalies. While some studies manually assess these anomalies and describe the ribs qualitatively, this study aims to automate thoracolumbar stump rib detection and analyze their morphology quantitatively. To this end, we train a high-resolution deep-learning model for rib segmentation and show significant improvements compared to existing models (Dice score 0.997 vs. 0.779, p-value < 0.01). In addition, we use an iterative algorithm and piece-wise linear interpolation to assess the length of the ribs, showing a success rate of 98.2%. When analyzing morphological features, we show that stump ribs articulate more posteriorly at the vertebrae (-19.2 +- 3.8 vs -13.8 +- 2.5, p-value < 0.01), are thinner (260.6 +- 103.4 vs. 563.6 +- 127.1, p-value < 0.01), and are oriented more downwards and sideways within the first centimeters in contrast to full-length ribs. We show that with partially visible ribs, these features can achieve an F1-score of 0.84 in differentiating stump ribs from regular ones. We publish the model weights and masks for public use.

In recent years, deformable medical image registration techniques have made significant progress. However, existing models still lack efficiency in parallel extraction of coarse and fine-grained features. To address this, we construct a new pyramid registration network based on feature and deformation field (FF-PNet). For coarse-grained feature extraction, we design a Residual Feature Fusion Module (RFFM), for fine-grained image deformation, we propose a Residual Deformation Field Fusion Module (RDFFM). Through the parallel operation of these two modules, the model can effectively handle complex image deformations. It is worth emphasizing that the encoding stage of FF-PNet only employs traditional convolutional neural networks without any attention mechanisms or multilayer perceptrons, yet it still achieves remarkable improvements in registration accuracy, fully demonstrating the superior feature decoding capabilities of RFFM and RDFFM. We conducted extensive experiments on the LPBA and OASIS datasets. The results show our network consistently outperforms popular methods in metrics like the Dice Similarity Coefficient.

This study presents an unsupervised, motion-resolved reconstruction framework for high-resolution, free-breathing pulmonary magnetic resonance imaging (MRI), utilizing a three-dimensional Gaussian representation (3DGS). The proposed method leverages 3DGS to address the challenges of motion-resolved 3D isotropic pulmonary MRI reconstruction by enabling data smoothing between voxels for continuous spatial representation. Pulmonary MRI data acquisition is performed using a golden-angle radial sampling trajectory, with respiratory motion signals extracted from the center of k-space in each radial spoke. Based on the estimated motion signal, the k-space data is sorted into multiple respiratory phases. A 3DGS framework is then applied to reconstruct a reference image volume from the first motion state. Subsequently, a patient-specific convolutional neural network is trained to estimate the deformation vector fields (DVFs), which are used to generate the remaining motion states through spatial transformation of the reference volume. The proposed reconstruction pipeline is evaluated on six datasets from six subjects and bench-marked against three state-of-the-art reconstruction methods. The experimental findings demonstrate that the proposed reconstruction framework effectively reconstructs high-resolution, motion-resolved pulmonary MR images. Compared with existing approaches, it achieves superior image quality, reflected by higher signal-to-noise ratio and contrast-to-noise ratio. The proposed unsupervised 3DGS-based reconstruction method enables accurate motion-resolved pulmonary MRI with isotropic spatial resolution. Its superior performance in image quality metrics over state-of-the-art methods highlights its potential as a robust solution for clinical pulmonary MR imaging.

Reorienting cardiac positron emission tomography (PET) images to the transaxial plane is essential for cardiac PET image analysis. This study aims to design a convolutional neural network (CNN) for automatic reorientation and evaluate its generalizability. An artificial intelligence (AI) method integrating U-Net and the differentiable spatial to numeric transform module (DSNT-U) was proposed to automatically position three feature points (P_apex, P_base, and P_RV), with these three points manually located by an experienced radiologist as the reference standard (RS). A second radiologist performed manual location for reproducibility evaluation. The DSNT-U, initially trained and tested on a [¹¹C]acetate dataset (training/testing: 40/17), was further compared with a CNN-spatial transformer network (CNN-STN). The network fine-tuned with 4 subjects was tested on a [¹³N]ammonia dataset (n = 30). The performance of the DSNT-U was evaluated in terms of coordinates, volume, and quantitative indexes (pharmacokinetic parameters and total perfusion deficit). The proposed DSNT-U successfully achieved automatic myocardial reorientation for both [¹¹C]acetate and [¹³N]ammonia datasets. For the former dataset, the intraclass correlation coefficients (ICCs) between the coordinates predicted by the DSNT-U and the RS exceeded 0.876. The average normalized mean squared error (NMSE) between the short-axis (SA) images obtained through DSNT-U-based reorientation and the reference SA images was 0.051 ± 0.043. For pharmacokinetic parameters, the R² between the DSNT-U and the RS was larger than 0.968. Compared with the CNN-STN, the DSNT-U demonstrated a higher ICC between the estimated rigid transformation parameters and the RS. After fine-tuning on the [¹³N]ammonia dataset, the average NMSE between the SA images reoriented by the DSNT-U and the reference SA images was 0.056 ± 0.046. The ICC between the total perfusion deficit (TPD) values computed from DSNT-U-derived images and the reference values was 0.981. Furthermore, no significant differences were observed in the performance of the DSNT-U prediction among subjects with different genders or varying myocardial perfusion defect (MPD) statuses. The proposed DSNT-U can accurately position P_apex, P_base, and P_RV on the [¹¹C]acetate dataset. After fine-tuning, the positioning model can be applied to the [¹³N]ammonia perfusion dataset, demonstrating good generalization performance. This method can adapt to data of different genders (with or without MPD) and different tracers, displaying the potential to replace manual operations.

To evaluate spectrum bias in stroke MRI analysis by excluding cases with uncertain acute ischemic lesions (AIL) and examining patient, imaging, and lesion factors associated with these cases. This single-center retrospective observational study included adults with brain MRIs for suspected stroke between January 2020 and April 2022. Diagnostic uncertain AIL were identified through reader disagreement or low certainty grading by a radiology resident, a neuroradiologist, and the original radiology report consisting of various neuroradiologists. A commercially available deep learning tool analyzing brain MRIs for AIL was evaluated to assess the impact of excluding uncertain cases on diagnostic odds ratios. Patient-related, MRI acquisition-related, and lesion-related factors were analyzed using the Wilcoxon rank sum test, χ2 test, and multiple logistic regression. The study was approved by the National Committee on Health Research Ethics. In 989 patients (median age 73 (IQR: 59-80), 53% female), certain AIL were found in 374 (38%), uncertain AIL in 63 (6%), and no AIL in 552 (56%). Excluding uncertain cases led to a four-fold increase in the diagnostic odds ratio (from 68 to 278), while a simulated case-control design resulted in a six-fold increase compared to the full disease spectrum (from 68 to 431). Independent factors associated with uncertain AIL were MRI artifacts, smaller lesion size, older lesion age, and infratentorial location. Excluding uncertain cases leads to a four-fold overestimation of the diagnostic odds ratio. MRI artifacts, smaller lesion size, infratentorial location, and older lesion age are associated with uncertain AIL and should be accounted for in validation studies.

BackgroundIn glioblastoma (GBM), promoter methylation of the O6-methylguanine-DNA methyltransferase (MGMT) is associated with beneficial chemotherapy but has not been accurately evaluated based on radiological and pathological sections. To develop and validate an MRI and pathology image-based deep learning radiopathomics model for predicting MGMT promoter methylation in patients with GBM. MethodsA retrospective collection of pathologically confirmed isocitrate dehydrogenase (IDH) wild-type GBM patients (n=207) from three centers was performed, all of whom underwent MRI scanning within 2 weeks prior to surgery. The pre-trained ResNet50 was used as the feature extractor. Features of 1024 dimensions were extracted from MRI and pathological images, respectively, and the features were screened for modeling. Then feature fusion was performed by calculating the normalized multimode MRI fusion features and pathological features, and prediction models of MGMT based on deep learning radiomics, pathomics, and radiopathomics (DLRM, DLPM, DLRPM) were constructed and applied to internal and external validation cohorts. ResultsIn the training, internal and external validation cohorts, the DLRPM further improved the predictive performance, with a significantly better predictive performance than the DLRM and DLPM, with AUCs of 0.920 (95% CI 0.870-0.968), 0.854 (95% CI 0.702-1), and 0.840 (95% CI 0.625-1). ConclusionWe developed and validated cross-scale radiology and pathology models for predicting MGMT methylation status, with DLRPM predicting the best performance, and this cross-scale approach paves the way for further research and clinical applications in the future.

Alzheimers Disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and memory loss. In 2024, in the US alone, it affected approximately 1 in 9 people aged 65 and older, equivalent to 6.9 million individuals. Early detection and accurate AD diagnosis are crucial for improving patient outcomes. Magnetic resonance imaging (MRI) has emerged as a valuable tool for examining brain structure and identifying potential AD biomarkers. This study performs predictive analyses by employing machine learning techniques to identify key brain regions associated with AD using numerical data derived from anatomical MRI scans, going beyond standard statistical methods. Using the Random Forest Algorithm, we achieved 92.87% accuracy in detecting AD from Mild Cognitive Impairment and Cognitive Normals. Subgroup analyses across nine sex- and age-based cohorts (69-76 years, 77-84 years, and unified 69-84 years) revealed the hippocampus, amygdala, and entorhinal cortex as consistent top-rank predictors. These regions showed distinct volume reductions across age and sex groups, reflecting distinct age- and sex-related neuroanatomical patterns. For instance, younger males and females (aged 69-76) exhibited volume decreases in the right hippocampus, suggesting its importance in the early stages of AD. Older males (77-84) showed substantial volume decreases in the left inferior temporal cortex. Additionally, the left middle temporal cortex showed decreased volume in females, suggesting a potential female-specific influence, while the right entorhinal cortex may have a male-specific impact. These age-specific sex differences could inform clinical research and treatment strategies, aiding in identifying neuroanatomical markers and therapeutic targets for future clinical interventions.

Timely intervention for Alzheimers disease (AD) requires early detection. The development of immunotherapies targeting amyloid-beta and tau underscores the need for accessible, time-efficient biomarkers for early diagnosis. Here, we directly applied our previously developed MRI-based deep learning model for AD to the large Chinese SILCODE cohort (722 participants, 1,105 brain MRI scans). The model -- initially trained on North American data -- demonstrated robust cross-ethnic generalization, without any retraining or fine-tuning, achieving an AUC of 91.3% in AD classification with a sensitivity of 95.2%. It successfully identified 86.7% of individuals at risk of AD progression more than 5 years in advance. Individuals identified as high-risk exhibited significantly shorter median progression times. By integrating an interpretable deep learning brain risk map approach, we identified AD brain subtypes, including an MCI subtype associated with rapid cognitive decline. The models risk scores showed significant correlations with cognitive measures and plasma biomarkers, such as tau proteins and neurofilament light chain (NfL). These findings underscore the exceptional generalizability and clinical utility of MRI-based deep learning models, especially in large and diverse populations, offering valuable tools for early therapeutic intervention. The model has been made open-source and deployed to a free online website for AD risk prediction, to assist in early screening and intervention.

To develop an early budget impact analysis of and inform future research on the national adoption of a commercially available AI application to support clinicians reviewing radiographs for suspected fractures across NHS emergency departments in England. A decision tree framework was coded to assess a change in outcomes for suspected fractures in adults when AI fracture detection was integrated into clinical workflow over a 1-year time horizon. Standard of care was the comparator scenario and the ground truth reference cases were characterised by radiology report findings. The effect of AI on assisting ED clinicians when detecting fractures was sourced from US literature. Data on resource use conditioned on the correct identification of a fracture in the ED was extracted from a London NHS trust. Sensitivity analysis was conducted to account for the influence of parameter uncertainty on results. In one year, an estimated 658,564 radiographs were performed in emergency departments across England for suspected wrist, ankle or hip fractures. The number of patients returning to the ED with a missed fracture was reduced by 21,674 cases and a reduction of 20, 916 unnecessary referrals to fracture clinics. The cost of current practice was estimated at £66,646,542 and £63,012,150 with the integration of AI. Overall, generating a return on investment of £3,634,392 to the NHS. The adoption of AI in EDs across England has the potential to generate cost savings. However, additional evidence on radiograph review accuracy and subsequent resource use is required to further demonstrate this.

Timely intervention and improved prognosis for breast cancer patients rely on early metastasis risk detection and accurate treatment predictions. This study introduces an advanced multimodal MRI and AI-driven 3D deep learning model, termed the 3D-MMR-model, designed to predict recurrence risk in non-metastatic breast cancer patients. We conducted a multicenter study involving 1199 non-metastatic breast cancer patients from four institutions in China, with comprehensive MRI and clinical data retrospectively collected. Our model employed multimodal-data fusion, utilizing contrast-enhanced T1-weighted imaging (T1 + C) and T2-weighted imaging (T2WI) volumes, processed through a modified 3D-UNet for tumor segmentation and a DenseNet121-based architecture for disease-free survival (DFS) prediction. Additionally, we performed RNA-seq analysis to delve further into the relationship between concentrated hotspots within the tumor region and the tumor microenvironment. The 3D-MR-model demonstrated superior predictive performance, with time-dependent ROC analysis yielding AUC values of 0.90, 0.89, and 0.88 for 2-, 3-, and 4-year DFS predictions, respectively, in the training cohort. External validation cohorts corroborated these findings, highlighting the model's robustness across diverse clinical settings. Integration of clinicopathological features further enhanced the model's accuracy, with a multimodal approach significantly improving risk stratification and decision-making in clinical practice. Visualization techniques provided insights into the decision-making process, correlating predictions with tumor microenvironment characteristics. In summary, the 3D-MMR-model represents a significant advancement in breast cancer prognosis, combining cutting-edge AI technology with multimodal imaging to deliver precise and clinically relevant predictions of recurrence risk. This innovative approach holds promise for enhancing patient outcomes and guiding individualized treatment plans in breast cancer care.