BackgroundRetinal fundus images provide a noninvasive window into systemic health, offering opportunities for early detection of metabolic disorders such as metabolic syndrome (METS). ObjectiveThis study aimed to develop a deep learning model to predict METS from fundus images obtained during routine health checkups, leveraging a multi-task learning approach. MethodsWe retrospectively analyzed 5,000 fundus images from Japanese health checkup participants. Convolutional neural network (CNN) models were trained to classify METS status, incorporating fundus-specific data augmentation strategies and auxiliary regression tasks targeting clinical parameters such as abdominal circumference (AC). Model performance was evaluated using validation accuracy, test accuracy, and the area under the receiver operating characteristic curve (AUC). ResultsModels employing fundus-specific augmentation demonstrated more stable convergence and superior validation accuracy compared to general-purpose augmentation. Incorporating AC as an auxiliary task further enhanced performance across architectures. The final ensemble model with test-time augmentation achieved a test accuracy of 0.696 and an AUC of 0.73178. ConclusionCombining multi-task learning, fundus-specific data augmentation, and ensemble prediction substantially improves deep learning-based METS classification from fundus images. This approach may offer a practical, noninvasive screening tool for metabolic syndrome in general health checkup settings.

This study aimed to establish and validate a prediction model based on machine learning methods and SHAP algorithm to predict response to anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (AMD). In this retrospective study, we extracted data including demographic characteristics, laboratory test results, and imaging features from optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Eight machine learning methods, including Logistic Regression, Gradient Boosting Decision Tree, Random Forest, CatBoost, Support Vector Machine, XGboost, LightGBM, K Nearest Neighbors were employed to develop the predictive model. The machine learning method with optimal performance was selected for further interpretation. Finally, the SHAP algorithm was applied to explain the model's predictions. The study included 145 patients with neovascular AMD. Among the eight models developed, the Random Forest model demonstrated general optimal performance, achieving a high accuracy of 75.86% and the highest area under the receiver operating characteristic curve (AUC) value of 0.91. In this model, important features identified as significant contributors to the response to anti-VEGF therapy in neovascular AMD patients included fractal dimension, total number of end points, total number of junctions, total vessels length, vessels area, average lacunarity, choroidal neovascularization (CNV) type, age, duration and logMAR BCVA. SHAP analysis and visualization provided interpretation at both the factor level and individual level. The Random Forest model for predicting response to anti-VEGF therapy in neovascular AMD using SHAP algorithm proved to be feasible and effective. OCTA imaging features, such as fractal dimension, total number of end points et al, were the most effective predictive factors.

BackgroundAccurate left ventricular outflow tract obstruction (LVOTO) assessment is crucial for hypertrophic cardiomyopathy (HCM) management and prognosis. Traditional methods, requiring multiple views, Doppler, and provocation, is often infeasible, especially where resources are limited. This study aimed to develop and validate a deep learning (DL) model capable of predicting severe LVOTO in HCM patients using only the parasternal long-axis (PLAX) view from transthoracic echocardiography (TTE). MethodsA DL model was trained on PLAX videos extracted from TTE examinations (developmental dataset, n=1,007) to capture both morphological and dynamic motion features, generating a DL index for LVOTO (DLi-LVOTO, range 0-100). Performance was evaluated in an internal test dataset (ITDS, n=87) and externally validated in the distinct hospital dataset (DHDS, n=1,334) and the LVOTO reduction treatment dataset (n=156). ResultsThe model achieved high accuracy in detecting severe LVOTO (pressure gradient[&ge;] 50mmHg), with area under the receiver operating characteristics curve (AUROC) of 0.97 (95% confidence interval: 0.92-1.00) in ITDS and 0.93 (0.92-0.95) in DHDS. At a DLi-LVOTO threshold of 70, the model demonstrated a specificity of 97.3% and negative predictive value (NPV) of 96.1% in ITDS. In DHDS, a cutoff of 60 yielded a specificity of 94.6% and NPV of 95.5%. DLi-LVOTO also decreased significantly after surgical myectomy or Mavacamten treatment, correlating with reductions in peak pressure gradient (p<0.001 for all). ConclusionsOur DL-based approach predicts severe LVOTO using only the PLAX view from TTE, serving as a complementary tool, particularly in resource-limited settings or when Doppler is unavailable, and for monitoring treatment response.

Musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) are advanced imaging techniques that are increasingly important in the diagnosis and management of rheumatoid arthritis (RA) and have significantly enhanced the rheumatologist's ability to assess RA disease activity and progression. This review serves as a five-year update to our previous publication on the contemporary role of imaging in RA, emphasizing the continued importance of MSUS and MRI in clinical practice and their expanding utility. The review examines the role of MSUS in diagnosing RA, differentiating RA from mimickers, scoring systems and quality control measures, novel longitudinal approaches to disease monitoring, and patient populations that may benefit most from MSUS. It also examines the role of MRI in diagnosing pre-clinical and early RA, disease activity monitoring, research and clinical trials, and development of alternative scoring approaches utilizing artificial intelligence. Finally, the role of MRI in RA diagnosis and management is summarized, and selected practice points offer key tips for integrating MSUS and MRI into clinical practice.

Acute kidney injury (AKI) post-renal transplantation often has a poor prognosis. This study aimed to identify patients with elevated risks of AKI after kidney transplantation. A retrospective analysis was conducted on 422 patients who underwent kidney transplants from January 2020 to April 2023. Participants from 2020 to 2022 were randomized to training group (n=261) and validation group 1 (n=113), and those in 2023, as validation group 2 (n=48). Risk factors were determined by employing logistic regression analysis alongside the least absolute shrinkage and selection operator, making use of ultrasound hemodynamic, clinical, and laboratory information. Models for prediction were developed using logistic regression analysis and six machine-learning techniques. The evaluation of the logistic regression model encompassed its discrimination, calibration, and applicability in clinical settings, and a nomogram was created to illustrate the model. SHapley Additive exPlanations were used to explain and visualize the best of the six machine learning models. The least absolute shrinkage and selection operator combined with logistic regression identified and incorporated five risk factors into the predictive model. The logistic regression model (AUC=0.927 in the validation set 1; AUC=0.968 in the validation set 2) and the random forest model (AUC=0.946 in the validation set 1;AUC=0.996 in the validation set 2) showed good performance post-validation, with no significant difference in their predictive accuracy. These findings can assist clinicians in the early identification of patients at high risk for AKI, allowing for timely interventions and potentially enhancing the prognosis following kidney transplantation.

Deep learning models have shown promise in lung pathology detection from chest X-rays, but widespread clinical adoption remains limited due to opaque model decision-making. In prior work, we introduced ClinicXAI, a human-centric, expert-guided concept bottleneck model (CBM) designed for interpretable lung cancer diagnosis. We now extend that approach and present XpertXAI, a generalizable expert-driven model that preserves human-interpretable clinical concepts while scaling to detect multiple lung pathologies. Using a high-performing InceptionV3-based classifier and a public dataset of chest X-rays with radiology reports, we compare XpertXAI against leading post-hoc explainability methods and an unsupervised CBM, XCBs. We assess explanations through comparison with expert radiologist annotations and medical ground truth. Although XpertXAI is trained for multiple pathologies, our expert validation focuses on lung cancer. We find that existing techniques frequently fail to produce clinically meaningful explanations, omitting key diagnostic features and disagreeing with radiologist judgments. XpertXAI not only outperforms these baselines in predictive accuracy but also delivers concept-level explanations that better align with expert reasoning. While our focus remains on explainability in lung cancer detection, this work illustrates how human-centric model design can be effectively extended to broader diagnostic contexts - offering a scalable path toward clinically meaningful explainable AI in medical diagnostics.

Evaluating large artery atherosclerosis is critical for predicting and preventing ischemic strokes. Ultrasonographic assessment of the carotid arteries is the preferred first-line examination due to its ease of use, noninvasive, and absence of radiation exposure. This study proposed an automated classification model for the common carotid artery (CCA), carotid bulb, internal carotid artery (ICA), and external carotid artery (ECA) to enhance the quantification of carotid artery examinations.&#xD;Approach: A total of 2,943 B-mode ultrasound images (CCA: 1,563; bulb: 611; ICA: 476; ECA: 293) from 288 patients were collected. Three distinct sets of embedding features were extracted from artificial intelligence networks including pre-trained DenseNet201, vision Transformer (ViT), and echo contrastive language-image pre-training (EchoCLIP) models using deep learning architectures for pattern recognition. These features were then combined in a support vector machine (SVM) classifier to interpret the anatomical structures in B-mode images.&#xD;Main results: After ten-fold cross-validation, the model achieved an accuracy of 82.3%, which was significantly better than using individual feature sets, with a p-value of <0.001.&#xD;Significance: The proposed model could make carotid artery examinations more accurate and consistent with the achieved classification accuracy. The source code is available at https://github.com/buddykeywordw/Artery-Segments-Recognition&#xD.

Alzheimer's disease (AD) is a neurodegenerative disorder that affects memory and cognitive functions. Manual diagnosis is prone to human error, often leading to misdiagnosis or delayed detection. MRI techniques help visualize the fine tissues of the brain cells, indicating the stage of disease progression. Artificial intelligence techniques analyze MRI with high accuracy and extract subtle features that are difficult to diagnose manually. In this study, a modern methodology was designed that combines the power of CNN models (ResNet101 and GoogLeNet) to extract local deep features and the power of Vision Transformer (ViT) models to extract global features and find relationships between image spots. First, the MRI images of the Open Access Imaging Studies Series (OASIS) dataset were improved by two filters: the adaptive median filter (AMF) and Laplacian filter. The ResNet101 and GoogLeNet models were modified to suit the feature extraction task and reduce computational cost. The ViT architecture was modified to reduce the computational cost while increasing the number of attention vertices to further discover global features and relationships between image patches. The enhanced images were fed into the proposed ViT-CNN methodology. The enhanced images were fed to the modified ResNet101 and GoogLeNet models to extract the deep feature maps with high accuracy. Deep feature maps were fed into the modified ViT model. The deep feature maps were partitioned into 32 feature maps using ResNet101 and 16 feature maps using GoogLeNet, both with a size of 64 features. The feature maps were encoded to recognize the spatial arrangement of the patch and preserve the relationship between patches, helping the self-attention layers distinguish between patches based on their positions. They were fed to the transformer encoder, which consisted of six blocks and multiple vertices to focus on different patterns or regions simultaneously. Finally, the MLP classification layers classify each image into one of four dataset classes. The improved ResNet101-ViT hybrid methodology outperformed the GoogLeNet-ViT hybrid methodology. ResNet101-ViT achieved 98.7% accuracy, 95.05% AUC, 96.45% precision, 99.68% sensitivity, and 97.78% specificity.

To explore whether a CT-based AI framework, leveraging multi-scale features, can offer a non-invasive approach to accurately predict pathological grade and Ki67 index in clear cell renal cell carcinoma (ccRCC). In this multicenter retrospective study, a total of 1073 pathologically confirmed ccRCC patients from seven cohorts were split into internal cohorts (training and validation sets) and an external test set. The AI framework comprised an image processor, a 3D-kidney and tumor segmentation model by 3D-UNet, a multi-scale features extractor built upon unsupervised learning, and a multi-task classifier utilizing XGBoost. A quantitative model interpretation technique, known as SHapley Additive exPlanations (SHAP), was employed to explore the contribution of multi-scale features. The 3D-UNet model showed excellent performance in segmenting both the kidney and tumor regions, with Dice coefficients exceeding 0.92. The proposed multi-scale features model exhibited strong predictive capability for pathological grading and Ki67 index, with AUROC values of 0.84 and 0.87, respectively, in the internal validation set, and 0.82 and 0.82, respectively, in the external test set. The SHAP results demonstrated that features from radiomics, the 3D Auto-Encoder, and dimensionality reduction all made significant contributions to both prediction tasks. The proposed AI framework, leveraging multi-scale features, accurately predicts the pathological grade and Ki67 index of ccRCC. The CT-based AI framework leveraging multi-scale features offers a promising avenue for accurately predicting the pathological grade and Ki67 index of ccRCC preoperatively, indicating a direction for non-invasive assessment. Non-invasively determining pathological grade and Ki67 index in ccRCC could guide treatment decisions. The AI framework integrates segmentation, classification, and model interpretation, enabling fully automated analysis. The AI framework enables non-invasive preoperative detection of high-risk tumors, assisting clinical decision-making.

Deep learning, particularly convolutional neural networks (CNNs), has proven valuable for brain tumor classification, aiding diagnostic and therapeutic decisions in medical imaging. Despite their accuracy, these models are vulnerable to adversarial attacks, compromising their reliability in clinical settings. In this research, we utilized a VGG16-based CNN model to classify brain tumors, achieving 96% accuracy on clean magnetic resonance imaging (MRI) data. To assess robustness, we exposed the model to Fast Gradient Sign Method (FGSM) and Projected Gradient Descent (PGD) attacks, which reduced accuracy to 32% and 13%, respectively. We then applied a multi-layered defense strategy, including adversarial training with FGSM and PGD examples and feature squeezing techniques such as bit-depth reduction and Gaussian blurring. This approach improved model resilience, achieving 54% accuracy on FGSM and 47% on PGD adversarial examples. Our results highlight the importance of proactive defense strategies for maintaining the reliability of AI in medical imaging under adversarial conditions.