The growing volume of medical imaging data has increased the need for automated diagnostic tools, especially for musculoskeletal injuries like rib fractures, commonly detected via CT scans. Manual interpretation is time-consuming and error-prone. We propose OrthoInsight, a multi-modal deep learning framework for rib fracture diagnosis and report generation. It integrates a YOLOv9 model for fracture detection, a medical knowledge graph for retrieving clinical context, and a fine-tuned LLaVA language model for generating diagnostic reports. OrthoInsight combines visual features from CT images with expert textual data to deliver clinically useful outputs. Evaluated on 28,675 annotated CT images and expert reports, it achieves high performance across Diagnostic Accuracy, Content Completeness, Logical Coherence, and Clinical Guidance Value, with an average score of 4.28, outperforming models like GPT-4 and Claude-3. This study demonstrates the potential of multi-modal learning in transforming medical image analysis and providing effective support for radiologists.

This study aimed to evaluate the diagnostic performance of ChatGPT-4o, a large language model developed by OpenAI, in challenging cases of oral and maxillofacial diseases presented in the <i>Clinicopathologic Conference</i> section of the journal <i>Oral Surgery</i>, <i>Oral Medicine</i>, <i>Oral Pathology</i>, <i>Oral Radiology</i>. A total of 123 diagnostically challenging oral and maxillofacial cases published in the aforementioned journal were retrospectively collected. The case presentations, which included detailed clinical, radiographic, and sometimes histopathologic descriptions, were input into ChatGPT-4o. The model was prompted to provide a single most likely diagnosis for each case. These outputs were then compared to the final diagnoses established by expert consensus in each original case report. The accuracy of ChatGPT-4o was calculated based on exact diagnostic matches. ChatGPT-4o correctly diagnosed 96 out of 123 cases, achieving an overall diagnostic accuracy of 78%. Nevertheless, even in cases where the exact diagnosis was not provided, the model often suggested one of the clinically reasonable differential diagnoses. ChatGPT-4o demonstrates a promising ability to assist in the diagnostic process of complex maxillofacial conditions, with a relatively high accuracy rate in challenging cases. While it is not a replacement for expert clinical judgment, large language models may offer valuable decision support in oral and maxillofacial radiology, particularly in educational or consultative contexts. Not applicable.

Glioma, the most common primary intracranial tumor, poses significant challenges to precision diagnosis and treatment due to its heterogeneity and invasiveness. With the introduction of the 2021 WHO classification standard based on molecular biomarkers, the role of imaging in non-invasive subtyping and therapeutic monitoring of gliomas has become increasingly crucial. While conventional MRI shows limitations in assessing metabolic status and differentiating tumor recurrence, positron emission tomography (PET) combined with radiomics and artificial intelligence technologies offers a novel paradigm for precise diagnosis and treatment monitoring through quantitative extraction of multimodal imaging features (e.g., intensity, texture, dynamic parameters). This review systematically summarizes the technical workflow of PET radiomics (including tracer selection, image segmentation, feature extraction, and model construction) and its applications in predicting molecular subtypes (such as IDH mutation and MGMT methylation), distinguishing recurrence from treatment-related changes, and prognostic stratification. Studies demonstrate that amino acid tracers (e.g., ¹⁸F-FET, ¹¹C-MET) combined with multimodal radiomics models significantly outperform traditional parametric analysis in diagnostic efficacy. Nevertheless, current research still faces challenges including data heterogeneity, insufficient model interpretability, and lack of clinical validation. Future advancements require multicenter standardized protocols, open-source algorithm frameworks, and multi-omics integration to facilitate the transformative clinical translation of PET radiomics from research to practice.

Medical image synthesis presents unique challenges due to the inherent complexity and high-resolution details required in clinical contexts. Traditional generative architectures such as Generative Adversarial Networks (GANs) or Variational Auto Encoder (VAEs) have shown great promise for high-resolution image generation but struggle with preserving fine-grained details that are key for accurate diagnosis. To address this issue, we introduce Pixel Perfect MegaMed, the first vision-language foundation model to synthesize images at resolutions of 1024x1024. Our method deploys a multi-scale transformer architecture designed specifically for ultra-high resolution medical image generation, enabling the preservation of both global anatomical context and local image-level details. By leveraging vision-language alignment techniques tailored to medical terminology and imaging modalities, Pixel Perfect MegaMed bridges the gap between textual descriptions and visual representations at unprecedented resolution levels. We apply our model to the CheXpert dataset and demonstrate its ability to generate clinically faithful chest X-rays from text prompts. Beyond visual quality, these high-resolution synthetic images prove valuable for downstream tasks such as classification, showing measurable performance gains when used for data augmentation, particularly in low-data regimes. Our code is accessible through the project website - https://tehraninasab.github.io/pixelperfect-megamed.

Traditional echocardiographic parameters such as ejection fraction (EF) and global longitudinal strain (GLS) have limitations in the early detection of cardiac dysfunction. EF often remains normal despite underlying pathology, and GLS is influenced by load conditions and vendor variability. There is a growing need for reproducible, interpretable, and operator-independent parameters that capture subtle and global cardiac functional alterations. We introduce the Acoustic Index, a novel AI-derived echocardiographic parameter designed to quantify cardiac dysfunction from standard ultrasound views. The model combines Extended Dynamic Mode Decomposition (EDMD) based on Koopman operator theory with a hybrid neural network that incorporates clinical metadata. Spatiotemporal dynamics are extracted from echocardiographic sequences to identify coherent motion patterns. These are weighted via attention mechanisms and fused with clinical data using manifold learning, resulting in a continuous score from 0 (low risk) to 1 (high risk). In a prospective cohort of 736 patients, encompassing various cardiac pathologies and normal controls, the Acoustic Index achieved an area under the curve (AUC) of 0.89 in an independent test set. Cross-validation across five folds confirmed the robustness of the model, showing that both sensitivity and specificity exceeded 0.8 when evaluated on independent data. Threshold-based analysis demonstrated stable trade-offs between sensitivity and specificity, with optimal discrimination near this threshold. The Acoustic Index represents a physics-informed, interpretable AI biomarker for cardiac function. It shows promise as a scalable, vendor-independent tool for early detection, triage, and longitudinal monitoring. Future directions include external validation, longitudinal studies, and adaptation to disease-specific classifiers.

Accurate diagnosis of pancreatic cystic lesions (PCLs) is essential to guide appropriate management and reduce unnecessary surgeries. Despite multiple guidelines in PCL management, a substantial proportion of patients still undergo major resections for benign cysts, and a majority of resected intraductal papillary mucinous neoplasms (IPMNs) show only low-grade dysplasia, leading to significant clinical, financial, and psychological burdens. This review highlights emerging endoscopic approaches that enhance diagnostic accuracy and support organ-sparing, minimally invasive management of PCLs. Recent studies suggest that endoscopic ultrasound (EUS) and its accessory techniques, such as contrast-enhanced EUS and needle-based confocal laser endomicroscopy, as well as next-generation sequencing analysis of cyst fluid, not only accurately characterize PCLs but are also well tolerated and cost-effective. Additionally, emerging therapeutics such as EUS-guided radiofrequency ablation (RFA) and EUS-chemoablation are promising as minimally invasive treatments for high-risk mucinous PCLs in patients who are not candidates for surgery. Accurate diagnosis of PCLs remains challenging, leading to many patients undergoing unnecessary surgery. Emerging endoscopic imaging biomarkers, artificial intelligence analysis, and molecular biomarkers enhance diagnostic precision. Additionally, novel endoscopic ablative therapies offer safe, minimally invasive, organ-sparing treatment options, thereby reducing the healthcare resource burdens associated with overtreatment.

Deep learning has revolutionized neuroimage analysis by delivering unprecedented speed and accuracy. However, the narrow scope of many training datasets constrains model robustness and generalizability. This challenge is particularly acute in magnetic resonance imaging (MRI), where image appearance varies widely across pulse sequences and scanner hardware. A recent domain-randomization strategy addresses the generalization problem by training deep neural networks on synthetic images with randomized intensities and anatomical content. By generating diverse data from anatomical segmentation maps, the approach enables models to accurately process image types unseen during training, without retraining or fine-tuning. It has demonstrated effectiveness across modalities including MRI, computed tomography, positron emission tomography, and optical coherence tomography, as well as beyond neuroimaging in ultrasound, electron and fluorescence microscopy, and X-ray microtomography. This tutorial paper reviews the principles, implementation, and potential of the synthesis-driven training paradigm. It highlights key benefits, such as improved generalization and resistance to overfitting, while discussing trade-offs such as increased computational demands. Finally, the article explores practical considerations for adopting the technique, aiming to accelerate the development of generalizable tools that make deep learning more accessible to domain experts without extensive computational resources or machine learning knowledge.

Interpretability can improve the safety, transparency and trust of AI models, which is especially important in healthcare applications where decisions often carry significant consequences. Mechanistic interpretability, particularly through the use of sparse autoencoders (SAEs), offers a promising approach for uncovering human-interpretable features within large transformer-based models. In this study, we apply Matryoshka-SAE to the radiology-specialised multimodal large language model, MAIRA-2, to interpret its internal representations. Using large-scale automated interpretability of the SAE features, we identify a range of clinically relevant concepts - including medical devices (e.g., line and tube placements, pacemaker presence), pathologies such as pleural effusion and cardiomegaly, longitudinal changes and textual features. We further examine the influence of these features on model behaviour through steering, demonstrating directional control over generations with mixed success. Our results reveal practical and methodological challenges, yet they offer initial insights into the internal concepts learned by MAIRA-2 - marking a step toward deeper mechanistic understanding and interpretability of a radiology-adapted multimodal large language model, and paving the way for improved model transparency. We release the trained SAEs and interpretations: https://huggingface.co/microsoft/maira-2-sae.

Pancreatic cystic lesions (PCLs) are often discovered incidentally on imaging and may progress to pancreatic ductal adenocarcinoma (PDAC). PCLs have a high incidence in the general population, and adherence to screening guidelines can be variable. With the advent of technologies that enable automated text classification, we sought to evaluate various natural language processing (NLP) tools including large language models (LLMs) for identifying and classifying PCLs from radiology reports. We correlated our classification of PCLs to clinical features to identify risk factors for a positive PDAC biopsy. We contrasted a previously described NLP classifier to LLMs for prospective identification of PCLs in radiology. We evaluated various LLMs for PCL classification into low-risk or high-risk categories based on published guidelines. We compared prompt-based PCL classification to specific entity-guided PCL classification. To this end, we developed tools to deidentify radiology and track patients longitudinally based on their radiology reports. Additionally, we used our newly developed tools to evaluate a retrospective database of patients who underwent pancreas biopsy to determine associated factors including those in their radiology reports and clinical features using multivariable logistic regression modelling. Of 14,574 prospective radiology reports, 665 (4.6%) described a pancreatic cyst, including 175 (1.2%) high-risk lesions. Our Entity-Extraction Large Language Model tool achieved recall 0.992 (95% confidence interval [CI], 0.985-0.998), precision 0.988 (0.979-0.996), and F1-score 0.990 (0.985-0.995) for detecting cysts; F1-scores were 0.993 (0.987-0.998) for low-risk and 0.977 (0.952-0.995) for high-risk classification. Among 4,285 biopsy patients, 330 had pancreatic cysts documented [&ge;]6 months before biopsy. In the final multivariable model (AUC = 0.877), independent predictors of adenocarcinoma were change in duct caliber with upstream atrophy (adjusted odds ratio [AOR], 4.94; 95% CI, 1.30-18.79), mural nodules (AOR, 11.02; 1.81-67.26), older age (AOR, 1.10; 1.05-1.16), lower body mass index (AOR, 0.86; 0.76-0.96), and total bilirubin (AOR, 1.81; 1.18-2.77). Automated NLP-based analysis of radiology reports using LLM-driven entity extraction can accurately identify and risk-stratify PCLs and, when retrospectively applied, reveal factors predicting malignant progression. Widespread implementation may improve surveillance and enable earlier intervention.

Accurate 3D aortic construction is crucial for clinical diagnosis, preoperative planning, and computational fluid dynamics (CFD) simulations, as it enables the estimation of critical hemodynamic parameters such as blood flow velocity, pressure distribution, and wall shear stress. Existing construction methods often rely on large annotated training datasets and extensive manual intervention. While the resulting meshes can serve for visualization purposes, they struggle to produce geometrically consistent, well-constructed surfaces suitable for downstream CFD analysis. To address these challenges, we introduce AortaDiff, a diffusion-based framework that generates smooth aortic surfaces directly from CT/MRI volumes. AortaDiff first employs a volume-guided conditional diffusion model (CDM) to iteratively generate aortic centerlines conditioned on volumetric medical images. Each centerline point is then automatically used as a prompt to extract the corresponding vessel contour, ensuring accurate boundary delineation. Finally, the extracted contours are fitted into a smooth 3D surface, yielding a continuous, CFD-compatible mesh representation. AortaDiff offers distinct advantages over existing methods, including an end-to-end workflow, minimal dependency on large labeled datasets, and the ability to generate CFD-compatible aorta meshes with high geometric fidelity. Experimental results demonstrate that AortaDiff performs effectively even with limited training data, successfully constructing both normal and pathologically altered aorta meshes, including cases with aneurysms or coarctation. This capability enables the generation of high-quality visualizations and positions AortaDiff as a practical solution for cardiovascular research.