Sincalide-stimulated cholescintigraphy (SSC) calculates the gallbladder ejection fraction (GBEF) to diagnose functional gallbladder disorder. Currently, artificial intelligence (AI)-driven workflows that integrate real-time image processing and organ function calculation remain unexplored in nuclear medicine practice. This pilot study explored an AI-based application for gallbladder radioactivity tracking. We retrospectively analyzed 20 SSC exams, categorized into 10 easy and 10 challenging cases. Two human operators (H1 and H2) independently annotated the gallbladder regions of interest manually over the course of the 60-minute SSC. A U-Net-based deep learning model was developed to automatically segment gallbladder masks, and a 10-fold cross-validation was performed for both easy and challenging cases. The AI-generated masks were compared with human-annotated ones, with Dice similarity coefficients (DICE) used to assess agreement. AI achieved an average DICE of 0.746 against H1 and 0.676 against H2, performing better in easy cases (0.781) than in challenging ones (0.641). Visual inspection showed AI was prone to errors with patient motion or low-count activity. This study highlights AI's potential in real-time gallbladder tracking and GBEF calculation during SSC. AI-enabled real-time evaluation of nuclear imaging data holds promise for advancing clinical workflows by providing instantaneous organ function assessments and feedback to technologists. This AI-enabled workflow could enhance diagnostic efficiency, reduce scan duration, and improve patient comfort by alleviating symptoms associated with SSC, such as abdominal discomfort due to sincalide administration.

The study aimed at developing and validating a deep learning (DL) model based on the ultrasound imaging for predicting the platinum resistance of patients with epithelial ovarian cancer (EOC). 392 patients were enrolled in this retrospective study who had been diagnosed with EOC between 2014 and 2020 and underwent pelvic ultrasound before initial treatment. A DL model was developed to predict patients' platinum resistance, and the model underwent evaluation through receiver-operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curve. The ROC curves showed that the area under the curve (AUC) of the DL model for predicting patients' platinum resistance in the internal and external test sets were 0.86 (95% CI 0.83-0.90) and 0.86 (95% CI 0.84-0.89), respectively. The model demonstrated high clinical value through clinical decision curve analysis and exhibited good calibration efficiency in the training cohort. Kaplan-Meier analyses showed that the model's optimal cutoff value successfully distinguished between patients at high and low risk of recurrence, with hazard ratios of 3.1 (95% CI 2.3-4.1, P < 0.0001) and 2.9 (95% CI 2.3-3.9; P < 0.0001) in the high-risk group of the internal and external test sets, serving as a prognostic indicator. The DL model based on ultrasound imaging can predict platinum resistance in patients with EOC and may support clinicians in making the most appropriate treatment decisions.

Diagnosis of peritoneal invasion, lymph node metastasis, and hepatic metastasis is crucial in the decision-making process of ovarian tumor treatment. This study aimed to test the feasibility of low-dose abdominopelvic CT with an artificial intelligence iterative reconstruction (AIIR) for diagnosing peritoneal invasion, lymph node metastasis, and hepatic metastasis in pre-operative imaging of ovarian tumor. This study prospectively enrolled 88 patients with pathology-confirmed ovarian tumors, where routine-dose CT at portal venous phase (120 kVp/ref. 200 mAs) with hybrid iterative reconstruction (HIR) was followed by a low-dose scan (120 kVp/ref. 40 mAs) with AIIR. The performance of diagnosing peritoneal invasion and lymph node metastasis was assessed using receiver operating characteristic (ROC) analysis with pathological results serving as the reference. The hepatic parenchymal metastases were diagnosed and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. The perihepatic structures were also scored on the clarity of porta hepatis, gallbladder fossa and intersegmental fissure. The effective dose of low-dose CT was 79.8% lower than that of routine-dose scan (2.64 ± 0.46 vs. 13.04 ± 2.25 mSv, p < 0.001). The low-dose AIIR showed similar area under the ROC curve (AUC) with routine-dose HIR for diagnosing both peritoneal invasion (0.961 vs. 0.960, p = 0.734) and lymph node metastasis (0.711 vs. 0.715, p = 0.355). The 10 hepatic parenchymal metastases were all accurately diagnosed on the two image sets. The low-dose AIIR exhibited higher SNR and CNR for hepatic parenchymal metastases and superior clarity for perihepatic structures. In low-dose pre-operative CT of ovarian tumor, AIIR delivers similar diagnostic accuracy for peritoneal invasion, lymph node metastasis, and hepatic metastasis, as compared to routine-dose abdominopelvic CT. It is feasible and diagnostically safe to apply up to 80% dose reduction in CT imaging of ovarian tumor by using AIIR.

Artificial intelligence applications in oncology imaging often struggle with diagnosing rare tumors. We identify significant gaps in detecting uncommon thyroid cancer types with ultrasound, where scarce data leads to frequent misdiagnosis. Traditional augmentation strategies do not capture the unique disease variations, hindering model training and performance. To overcome this, we propose a text-driven generative method that fuses clinical insights with image generation, producing synthetic samples that realistically reflect rare subtypes. In rigorous evaluations, our approach achieves substantial gains in diagnostic metrics, surpasses existing methods in authenticity and diversity measures, and generalizes effectively to other private and public datasets with various rare cancers. In this work, we demonstrate that text-guided image augmentation substantially enhances model accuracy and robustness for rare tumor detection, offering a promising avenue for more reliable and widespread clinical adoption.

Pancreatic cystic neoplasms (PCNs) are a complex group of lesions with a spectrum of malignancy. Accurate differentiation of PCN types is crucial for patient management, as misdiagnosis can result in unnecessary surgeries or treatment delays, affecting the quality of life. The significance of developing a non-invasive, accurate diagnostic model is underscored by the need to improve patient outcomes and reduce the impact of these conditions. We developed a machine learning model capable of accurately identifying different types of PCNs in a non-invasive manner, by using a dataset comprising 449 MRI and 568 CT scans from adult patients, spanning from 2009 to 2022. The study's results indicate that our multimodal machine learning algorithm, which integrates both clinical and imaging data, significantly outperforms single-source data algorithms. Specifically, it demonstrated state-of-the-art performance in classifying PCN types, achieving an average accuracy of 91.2%, precision of 91.7%, sensitivity of 88.9%, and specificity of 96.5%. Remarkably, for patients with mucinous cystic neoplasms (MCNs), regardless of undergoing MRI or CT imaging, the model achieved a 100% prediction accuracy rate. It indicates that our non-invasive multimodal machine learning model offers strong support for the early screening of MCNs, and represents a significant advancement in PCN diagnosis for improving clinical practice and patient outcomes. We also achieved the best results on an additional pancreatic cancer dataset, which further proves the generality of our model.

This study aims to evaluate the feasibility and effectiveness of deep learning-based super-resolution techniques to reduce scan time while preserving image quality in high-resolution prostate diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI). We retrospectively and prospectively analyzed prostate rs-EPI DWI data, employing deep learning super-resolution models, particularly the Multi-Scale Self-Similarity Network (MSSNet), to reconstruct low-resolution images into high-resolution images. Performance metrics such as structural similarity index (SSIM), Peak signal-to-noise ratio (PSNR), and normalized root mean squared error (NRMSE) were used to compare reconstructed images against the high-resolution ground truth (HR_GT). Additionally, we evaluated the apparent diffusion coefficient (ADC) values and signal-to-noise ratio (SNR) across different models. The MSSNet model demonstrated superior performance in image reconstruction, achieving maximum SSIM values of 0.9798, and significant improvements in PSNR and NRMSE compared to other models. The deep learning approach reduced the rs-EPI DWI scan time by 54.4 % while maintaining image quality comparable to HR_GT. Pearson correlation analysis revealed a strong correlation between ADC values from deep learning-reconstructed images and the ground truth, with differences remaining within 5 %. Furthermore, all models showed significant SNR enhancement, with MSSNet performing best across most cases. Deep learning-based super-resolution techniques, particularly MSSNet, effectively reduce scan time and enhance image quality in prostate rs-EPI DWI, making them promising tools for clinical applications.

The risk of postoperative pancreatic fistula (POPF), one of the most dreaded complications after pancreatic surgery, can be predicted from preoperative imaging and tabular clinical routine data. However, existing studies suffer from limited clinical applicability due to a need for manual data annotation and a lack of external validation. We propose AutoFRS (automated fistula risk score software), an externally validated end-to-end prediction tool for POPF risk stratification based on multimodal preoperative data. We trained AutoFRS on preoperative contrast-enhanced computed tomography imaging and clinical data from 108 patients undergoing pancreatic head resection and validated it on an external cohort of 61 patients. Prediction performance was assessed using the area under the receiver operating characteristic curve (AUC) and balanced accuracy. In addition, model performance was compared to the updated alternative fistula risk score (ua-FRS), the current clinical gold standard method for intraoperative POPF risk stratification. AutoFRS achieved an AUC of 0.81 and a balanced accuracy of 0.72 in internal validation and an AUC of 0.79 and a balanced accuracy of 0.70 in external validation. In a patient subset with documented intraoperative POPF risk factors, AutoFRS (AUC: 0.84 ± 0.05) performed on par with the uaFRS (AUC: 0.85 ± 0.06). The AutoFRS web application facilitates annotation-free prediction of POPF from preoperative imaging and clinical data based on the AutoFRS prediction model. POPF can be predicted from multimodal clinical routine data without human data annotation, automating the risk prediction process. We provide additional evidence of the clinical feasibility of preoperative POPF risk stratification and introduce a software pipeline for future prospective evaluation.

Deep learning networks map input data to output predictions by fitting network parameters using training data. However, applying a trained network to new, unseen inference data resembles an interpolation process, which may lead to inaccurate predictions if the training and inference data distributions differ significantly. This study aims to generally improve the prediction accuracy of deep learning networks on the inference case by bridging the gap between training and inference data. We propose an inference-specific learning strategy to enhance the network learning process without modifying the network structure. By aligning training data to closely match the specific inference data, we generate an inference-specific training dataset, enhancing the network optimization around the inference data point for more accurate predictions. Taking medical image auto-segmentation as an example, we develop an inference-specific auto-segmentation framework consisting of initial segmentation learning, inference-specific training data deformation, and inference-specific segmentation refinement. The framework is evaluated on public abdominal, head-neck, and pancreas CT datasets comprising 30, 42, and 210 cases, respectively, for medical image segmentation. Experimental results show that our method improves the organ-averaged mean Dice by 6.2% (p-value = 0.001), 1.5% (p-value = 0.003), and 3.7% (p-value < 0.001) on the three datasets, respectively, with a more notable increase for difficult-to-segment organs (such as a 21.7% increase for the gallbladder [p-value = 0.004]). By incorporating organ mask-based weak supervision into the training data alignment learning, the inference-specific auto-segmentation accuracy is generally improved compared with the image intensity-based alignment. Besides, a moving-averaged calculation of the inference organ mask during the learning process strengthens both the robustness and accuracy of the final inference segmentation. By leveraging inference data during training, the proposed inference-specific learning strategy consistently improves auto-segmentation accuracy and holds the potential to be broadly applied for enhanced deep learning decision-making.

The purpose of this study was to investigate the utility of deep learning image reconstruction at medium and high intensity levels (DLIR-M and DLIR-H, respectively) for better delineation of liver metastases in pre-contrast and post-contrast CT, compared to conventional hybrid iterative reconstruction (IR) methods. Forty-one patients with liver metastases who underwent abdominal CT were studied. The raw data were reconstructed with three different algorithms: hybrid IR (ASiR-V 50%), DLIR-M (TrueFildelity-M), and DLIR-H (TrueFildelity-H). Three experienced radiologists independently rated the lesion conspicuity of liver metastases on a qualitative 5-point scale (score 1 = very poor; score 5 = excellent). The observers also selected each image series for pre- and post-contrast CT per patient that was considered most preferable for liver metastases assessment. For pre-contrast CT, lesion conspicuity scores for DLIR-H and DLIR-M were significantly higher than those for hybrid IR for two of the three observers, while there was no significant difference for one observer. For post-contrast CT, the lesion conspicuity scores for DLIR-H images were significantly higher than those for DLIR-M images for two of the three observers on post-contrast CT (Observer 1: DLIR-H, 4.3 ± 0.8 vs. DLIR-M, 3.9 ± 0.9, p = 0.0006; Observer 3: DLIR-H, 4.6 ± 0.6 vs. DLIR-M, 4.3 ± 0.6, p = 0.0013). For post-contrast CT, all observers most often selected DLIR-H as the best reconstruction method for the diagnosis of liver metastases. However, in the pre-contrast CT, there was variation among the three observers in determining the most preferred image reconstruction method, and DLIR was not necessarily preferred over hybrid IR for the diagnosis of liver metastases.

Early allograft dysfunction (EAD) significantly affects liver transplantation prognosis. This study evaluated the effectiveness of artificial intelligence (AI)-assisted methods in accurately diagnosing EAD and identifying its causes. The primary metric for assessing the accuracy was the area under the receiver operating characteristic curve (AUC). Accuracy, sensitivity, and specificity were calculated and analyzed to compare the performance of the AI models with each other and with radiologists. EAD classification followed the criteria established by Olthoff et al. A total of 582 liver transplant patients who underwent transplantation between December 2012 and June 2021 were selected. Among these, 117 patients (mean age 33.5 ± 26.5 years, 80 men) were evaluated. The ultrasound parameters, images, and clinical information of patients were extracted from the database to train the AI model. The AUC for the ultrasound-spectrogram fusion network constructed from four ultrasound images and medical data was 0.968 (95%CI: 0.940, 0.991), outperforming radiologists by 30% for all metrics. AI assistance significantly improved diagnostic accuracy, sensitivity, and specificity (P < 0.050) for both experienced and less-experienced physicians. EAD lacks efficient diagnosis and causation analysis methods. The integration of AI and ultrasound enhances diagnostic accuracy and causation analysis. By modeling only images and data related to blood flow, the AI model effectively analyzed patients with EAD caused by abnormal blood supply. Our model can assist radiologists in reducing judgment discrepancies, potentially benefitting patients with EAD in underdeveloped regions. Furthermore, it enables targeted treatment for those with abnormal blood supply.