This study aimed to evaluate radiomic models' ability to predict hypoxia-related biomarker expression in clear cell renal cell carcinoma (ccRCC). Clinical and molecular data from 190 patients were extracted from The Cancer Genome Atlas-Kidney Renal Clear Cell Carcinoma dataset, and corresponding CT imaging data were manually segmented from The Cancer Imaging Archive. A panel of 2,824 radiomic features was analyzed, and robust, high-interscanner-reproducibility features were selected. Gene expression data for 13 hypoxia-related biomarkers were stratified by tumor grade (1/2 vs. 3/4) and stage (I/II vs. III/IV) and analyzed using Wilcoxon rank sum test. Machine learning modeling was conducted using the High-Performance Random Forest (RF) procedure in SAS Enterprise Miner 15.1, with significance at P < 0.05. Descriptive univariate analysis revealed significantly lower expression of several biomarkers in high-grade and late-stage tumors, with KLF6 showing the most notable decrease. The RF model effectively predicted the expression of KLF6, ETS1, and BCL2, as well as PLOD2 and PPARGC1A underexpression. Stratified performance assessment showed improved predictive ability for RORA, BCL2, and KLF6 in high-grade tumors and for ETS1 across grades, with no significant performance difference across grade or stage. The RF model demonstrated modest but significant associations between texture metrics derived from clinical CT scans, such as GLDM and GLCM, and key hypoxia-related biomarkers including KLF6, BCL2, ETS1, and PLOD2. These findings suggest that radiomic analysis could support ccRCC risk stratification and personalized treatment planning by providing non-invasive insights into tumor biology.

Accurate and non-invasive prediction of epidermal growth factor receptor (EGFR) mutation is crucial for the diagnosis and treatment of non-small cell lung cancer (NSCLC). While computed tomography (CT) imaging shows promise in identifying EGFR mutation, current prediction methods heavily rely on fully supervised learning, which overlooks the substantial heterogeneity of tumors and therefore leads to suboptimal results. To tackle tumor heterogeneity issue, this study introduces a novel weakly supervised method named TransMIEL, which leverages multiple instance learning techniques for accurate EGFR mutation prediction. Specifically, we first propose an innovative instance enhancement learning (IEL) strategy that strengthens the discriminative power of instance features for complex tumor CT images by exploring self-derived soft pseudo-labels. Next, to improve tumor representation capability, we design a spatial-aware transformer (SAT) that fully captures inter-instance relationships of different pathological subregions to mirror the diagnostic processes of radiologists. Finally, an instance adaptive gating (IAG) module is developed to effectively emphasize the contribution of informative instance features in heterogeneous tumors, facilitating dynamic instance feature aggregation and increasing model generalization performance. Experimental results demonstrate that TransMIEL significantly outperforms existing fully and weakly supervised methods on both public and in-house NSCLC datasets. Additionally, visualization results show that our approach can highlight intra-tumor and peri-tumor areas relevant to EGFR mutation status. Therefore, our method holds significant potential as an effective tool for EGFR prediction and offers a novel perspective for future research on tumor heterogeneity.

Deep learning (DL) requires large amounts of labeled data, which is extremely time-consuming and laborintensive to obtain for medical image segmentation tasks. Metalearning focuses on developing learning strategies that enable quick adaptation to new tasks with limited labeled data. However, rich-class medical image segmentation datasets for constructing meta-learning multi-tasks are currently unavailable. In addition, data collected from various healthcare sites and devices may present significant distribution differences, potentially degrading model's performance. In this paper, we propose a task augmentation-based meta-learning method for retinal image segmentation (TAMS) to meet labor-intensive annotation demand. A retinal Lesion Simulation Algorithm (LSA) is proposed to automatically generate multi-class retinal disease datasets with pixel-level segmentation labels, such that metalearning tasks can be augmented without collecting data from various sources. In addition, a novel simulation function library is designed to control generation process and ensure interpretability. Moreover, a generative simulation network (GSNet) with an improved adversarial training strategy is introduced to maintain high-quality representations of complex retinal diseases. TAMS is evaluated on three different OCT and CFP image datasets, and comprehensive experiments have demonstrated that TAMS achieves superior segmentation performance than state-of-the-art models.

Lattice radiation therapy (LRT) is a form of spatially fractionated radiation therapy that allows increased total dose delivery aiming for improved treatment response without an increase in toxicities, commonly utilized for palliation of bulky tumors. The LRT treatment planning process is complex, while eligible patients often have an urgent need for expedited treatment start. In this study, we aimed to develop a simulation-free workflow for volumetric modulated arc therapy (VMAT)-based LRT planning via deep learning-predicted synthetic CT (sCT) to expedite treatment initiation. Two deep learning models were initially trained using 3D U-Net architecture to generate sCT from diagnostic CTs (dCT) of the thoracic and abdomen regions using a training dataset of 50 patients. The models were then tested on an independent dataset of 15 patients using image similarity analysis assessing mean absolute error (MAE) and structural similarity index measure (SSIM) as metrics. VMAT-based LRT plans were generated based on sCT and recalculated on the planning CT (pCT) for dosimetric accuracy comparison. Differences in dose volume histogram (DVH) metrics between pCT and sCT plans were assessed using the Wilcoxon signed-rank test. The final sCT prediction model demonstrated high image similarity to pCT, with a MAE and SSIM of 38.93 ± 14.79 Hounsfield Units (HU) and 0.92 ± 0.05 for the thoracic region, and 73.60 ± 22.90 HU and 0.90 ± 0.03 for the abdominal region, respectively. There were no statistically significant differences between sCT and pCT plans in terms of organ-at-risk and target volume DVH parameters, including maximum dose (Dmax), mean dose (Dmean), dose delivered to 90% (D90%) and 50% (D50%) of target volume, except for minimum dose (Dmin) and (D10%). With demonstrated high image similarity and adequate dose agreement between sCT and pCT, our study is a proof-of-concept for using deep learning predicted sCT for a simulation-free treatment planning workflow for VMAT-based LRT.

This study aims to explore the feasibility to automate the application process of nomograms in clinical medicine, demonstrated through the task of preoperative pleural invasion prediction in non-small cell lung cancer patients using PET/CT imaging. The automatic pipeline involves multimodal segmentation, feature extraction, and model prediction. It is validated on a cohort of 1116 patients from two medical centers. The performance of the feature-based diagnostic model outperformed both the radiomics model and individual machine learning models. The segmentation models for CT and PET images achieved mean dice similarity coefficients of 0.85 and 0.89, respectively, and the segmented lung contours showed high consistency with the actual contours. The automatic diagnostic system achieved an accuracy of 0.87 in the internal test set and 0.82 in the external test set, demonstrating comparable overall diagnostic performance to the human-based diagnostic model. In comparative analysis, the automatic diagnostic system showed superior performance relative to other segmentation and diagnostic pipelines. The proposed automatic diagnostic system provides an interpretable, automated solution for predicting pleural invasion in non-small cell lung cancer.

Benign lymph node enlargement can mislead surgeons into overstaging colorectal cancer (CRC), causing unnecessarily extended lymphadenectomy. This study aimed to develop and validate a machine learning (ML) classifier utilizing multi-phase CT (MPCT) radiomics for accurate evaluation of the pre-treatment status of enlarged tumor-draining lymph nodes (TDLNs; defined as long-axis diameter ≥ 10 mm). This study included 430 pathologically confirmed CRC patients who underwent radical resection, stratified into a development cohort (n = 319; January 2015-December 2019, retrospectively enrolled) and test cohort (n = 111; January 2020-May 2023, prospectively enrolled). Radiomics features were extracted from multi-regional lesions (tumor and enlarged TDLNs) on MPCT. Following rigorous feature selection, optimal features were employed to train multiple ML classifiers. The top-performing classifier based on area under receiver operating characteristic curves (AUROCs) was validated. Ultimately, 15 classifiers based on features from multi-regional lesions were constructed (Tumor_{N, A}, _V; Ln_N, _A, _V; Ln, lymph node; _N, non-contrast phase; _A, arterial phase; _V, venous phase). Among all classifiers, the enlarged TDLNs fusion MPCT classifier (Ln_NAV) demonstrated the highest predictive efficacy, with AUROCs and AUPRCs of 0.820 and 0.883, respectively. When pre-treatment clinical variables were integrated (Clinical_Ln_NAV), the model's efficacy improved, with AUROCs of 0.839, AUPRCs of 0.903, accuracy of 76.6%, sensitivity of 67.7%, and specificity of 89.1%. The classifier Clinical_Ln_NAV demonstrated well performance in evaluating pre-treatment status of enlarged TDLNs. This tool may support clinicians in developing individualized treatment plans for CRC patients, helping to avoid inappropriate treatment. Question There are currently no effective non-invasive tools to assess the status of enlarged tumor-draining lymph nodes in colorectal cancer prior to treatment. Findings Pre-treatment multi-phase CT radiomics, combined with clinical variables, effectively assessed the status of enlarged tumor-draining lymph nodes, achieving a specificity of 89.1%. Clinical relevance statement The multi-phase CT-based classifier may assist clinicians in developing individualized treatment plans for colorectal cancer patients, potentially helping to avoid inappropriate preoperative adjuvant therapy and unnecessary extended lymphadenectomy.

Dental implant surgery has become a prevalent treatment option for patients with single tooth defects. However, the success of this surgery relies heavily on precise planning and execution. This study investigates the application of artificial intelligence (AI) in assisting the planning process of dental implant surgery for single tooth defects. Single tooth defects in the oral cavity pose a significant challenge in restorative dentistry. Dental implant restoration has emerged as an effective solution for rehabilitating such defects. However, the complexity of the procedure and the need for accurate treatment planning necessitate the integration of advanced technologies. In this study, we propose the utilisation of AI to enhance the precision and efficiency of implant surgery planning for single tooth defects. A total of twenty patients with single tooth loss were enrolled. Cone-beam computed tomography (CBCT) and intra-oral scans were obtained and imported into the AI-dentist software for 3D reconstruction. AI assisted in implant selection, tooth position identification, and crown fabrication. Evaluation included subjective verification and objective assessments. A paired samples t-test was used to compare planning times (dentist vs. AI), with a significance level of p < 0.05. Twenty patients (9 male, 11 female; mean age 59.5 ± 11.86 years) with single missing teeth participated in this study. Implant margins were carefully positioned: 3.05 ± 1.44 mm from adjacent roots, 2.52 ± 0.65 mm from bone plate edges, 3.05 ± 1.44 mm from sinus/canal, and 3.85 ± 1.23 mm from gingival height. Manual planning (21.50 ± 4.87 min) was statistically significantly slower than AI (11.84 ± 3.22 min, p < 0.01). Implant planning met 100% buccolingual/proximal/distal bone volume criteria and 90% sinus/canal distance criteria. Two patients required sinus lifting and bone grafting due to insufficient bone volume. This study highlights the promising role of AI in enhancing the precision and efficiency of dental implant surgery planning for single tooth defects. Further studies are necessary to validate the effectiveness and safety of AI-assisted planning in a larger patient population.

To develop a deep learning (DL) model for predicting disease-free survival (DFS) in clinical stage I lung cancer patients who underwent surgical resection using pre-treatment CT images, and further validate it in patients receiving stereotactic body radiation therapy (SBRT). A retrospective cohort of 2489 clinical stage I non-small cell lung cancer (NSCLC) patients treated with operation (2015-2017) was enrolled to develop a DL-based DFS prediction model. Tumor features were extracted from CT images using a three-dimensional convolutional neural network. External validation was performed on 248 clinical stage I patients receiving SBRT from two hospitals. A clinical model was constructed by multivariable Cox regression for comparison. Model performance was evaluated with Harrell's concordance index (C-index), which measures the model's ability to correctly rank survival times by comparing all possible pairs of subjects. In the surgical cohort, the DL model effectively predicted DFS with a C-index of 0.85 (95% CI: 0.80-0.89) in the internal testing set, significantly outperforming the clinical model (C-index: 0.76). Based on the DL model, 68 patients in the SBRT cohort identified as high-risk had significantly worse DFS compared to the low-risk group (p < 0.01, 5-year DFS rate: 34.7% vs 77.4%). The DL-score was demonstrated to be an independent predictor of DFS in both cohorts (p < 0.01). The CT-based DL model improved DFS prediction in clinical stage I lung cancer patients, identifying populations at high risk of recurrence and metastasis to guide clinical decision-making. Question The recurrence or metastasis rate of early-stage lung cancer remains high and varies among patients following radical treatments such as surgery or SBRT. Findings This CT-based DL model successfully predicted DFS and stratified varying disease risks in clinical stage I lung cancer patients undergoing surgery or SBRT. Clinical relevance The CT-based DL model is a reliable predictive tool for the prognosis of early-stage lung cancer. Its accurate risk stratification assists clinicians in identifying specific patients for personalized clinical decision making.

To investigate the feasibility of accelerated MRI with artificial intelligence-assisted compressed sensing (ACS) technique in the temporomandibular joint (TMJ) and compare its performance with parallel imaging (PI) protocol and standard (STD) protocol. Participants with TMJ-related symptoms were prospectively enrolled from April 2023 to May 2024, and underwent bilateral TMJ imaging examinations using ACS protocol (6:08 min), PI protocol (10:57 min), and STD protocol (13:28 min). Overall image quality and visibility of TMJ relevant structures were qualitatively evaluated by a 4-point Likert scale. Quantitative analysis of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of TMJ disc, condyle, and lateral pterygoid muscle (LPM) was performed. Diagnostic agreement of joint effusion and disc displacement among protocols and investigators was assessed by Fleiss' kappa analysis. A total of 51 participants (16 male and 35 female) with 102 TMJs were included. The overall image quality and most structures of the ACS protocol were significantly higher than the STD protocol (all p < 0.05), and similar to the PI protocol. For quantitative analysis, the ACS protocol demonstrated significantly higher SNR and CNR than the STD protocol in the TMJ disc, condyle, and LPM (all p < 0.05), and the ACS protocol showed comparable SNR to the PI protocol in most sequences. Good to excellent inter-protocol and inter-observer agreement was observed for diagnosing TMJ abnormalities (κ = 0.699-1.000). Accelerated MRI with ACS technique can significantly reduce the acquisition time of TMJ, while providing superior or equivalent image quality and great diagnostic agreement with PI and STD protocols. Question Patients with TMJ disorders often cannot endure long MRI examinations due to orofacial pain, necessitating accelerated MRI to improve patient comfort. Findings ACS technique can significantly reduce acquisition time in TMJ imaging while providing superior or equivalent image quality. Clinical relevance The time-saving ACS technique improves image quality and achieves excellent diagnostic agreement in the evaluation of joint effusion and disc displacement. It helps optimize clinical MRI workflow in patients with TMJ disorders.

Delayed neurological sequelae are among the most serious complications of carbon monoxide poisoning. However, no reliable tools are available for evaluating its potential risk. We aimed to assess whether machine learning models using imaging features that were automatically extracted from brain MRI can predict the potential delayed neurological sequelae risk in patients with acute carbon monoxide poisoning. This single-center, retrospective, observational study analyzed a prospectively collected registry of acute carbon monoxide poisoning patients who visited our emergency department from April 2011 to December 2015. Overall, 1618 radiomics and 4 lesion-segmentation features from DWI b1000 and ADC images, as well as 62 clinical variables were extracted from each patient. The entire dataset was divided into five subsets, with one serving as the hold-out test set and the remaining four used for training and tuning. Four machine learning models, linear regression, support vector machine, random forest, and extreme gradient boosting, as well as an ensemble model, were trained and evaluated using 20 different data configurations. The primary evaluation metric was the mean and 95% CI of the area under the receiver operating characteristic curve. Shapley additive explanations were calculated and visualized to enhance model interpretability. Of the 373 patients, delayed neurological sequelae occurred in 99 (26.5%) patients (mean age 43.0 ± 15.2; 62.0% male). The means [95% CIs] of the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity of the best performing machine learning model for predicting the development of delayed neurological sequelae were 0.88 [0.86-0.9], 0.82 [0.8-0.83], 0.81 [0.79-0.83], and 0.82 [0.8-0.84], respectively. Among imaging features, the presence, size, and number of acute brain lesions on DWI b1000 and ADC images more accurately predicted DNS risk than advanced radiomics features based on shape, texture and wavelet transformation. Machine learning models developed using automatically extracted brain MRI features with clinical features can distinguish patients at delayed neurological sequelae risk. The models enable effective prediction of delayed neurological sequelae in patients with acute carbon monoxide poisoning, facilitating timely treatment planning for prevention. ABL = Acute brain lesion; AUROC = area under the receiver operating characteristic curve; CO = carbon monoxide; DNS = delayed neurological sequelae; LR = logistic regression; ML = machine learning; RF = random forest; SVM = support vector machine; XGBoost = extreme gradient boosting.