Pancreatic cancer carries a poor prognosis and relies on endoscopic ultrasound (EUS) for targeted biopsy and radiotherapy. However, the speckle noise, low contrast, and unintuitive appearance of EUS make segmentation of pancreatic tumors with fully supervised deep learning (DL) models both error-prone and dependent on large, expert-curated annotation datasets. To address these challenges, we present TextSAM-EUS, a novel, lightweight, text-driven adaptation of the Segment Anything Model (SAM) that requires no manual geometric prompts at inference. Our approach leverages text prompt learning (context optimization) through the BiomedCLIP text encoder in conjunction with a LoRA-based adaptation of SAM's architecture to enable automatic pancreatic tumor segmentation in EUS, tuning only 0.86% of the total parameters. On the public Endoscopic Ultrasound Database of the Pancreas, TextSAM-EUS with automatic prompts attains 82.69% Dice and 85.28% normalized surface distance (NSD), and with manual geometric prompts reaches 83.10% Dice and 85.70% NSD, outperforming both existing state-of-the-art (SOTA) supervised DL models and foundation models (e.g., SAM and its variants). As the first attempt to incorporate prompt learning in SAM-based medical image segmentation, TextSAM-EUS offers a practical option for efficient and robust automatic EUS segmentation.

The Diffusion Probabilistic Model (DPM) has demonstrated remarkable performance across a variety of generative tasks. The inherent randomness in diffusion models helps address issues such as blurring at the edges of medical images and labels, positioning Diffusion Probabilistic Models (DPMs) as a promising approach for lesion segmentation. However, we find that the current training and inference strategies of diffusion models result in an uneven distribution of attention across different timesteps, leading to longer training times and suboptimal solutions. To this end, we propose UniSegDiff, a novel diffusion model framework designed to address lesion segmentation in a unified manner across multiple modalities and organs. This framework introduces a staged training and inference approach, dynamically adjusting the prediction targets at different stages, forcing the model to maintain high attention across all timesteps, and achieves unified lesion segmentation through pre-training the feature extraction network for segmentation. We evaluate performance on six different organs across various imaging modalities. Comprehensive experimental results demonstrate that UniSegDiff significantly outperforms previous state-of-the-art (SOTA) approaches. The code is available at https://github.com/HUYILONG-Z/UniSegDiff.

Contrast-enhanced magnetic resonance imaging (CE-MRI) monitoring across multiple time points is critical for optimizing hepatocellular carcinoma (HCC) prognosis during transarterial chemoembolization (TACE) treatment. The aim of this retrospective study is to develop and validate an artificial intelligence (AI)-powered models utilizing multi-time-point arterial phase CE-MRI data for HCC prognosis stratification in TACE patients. A total of 543 individual arterial phase CE-MRI scans from 181 HCC patients were retrospectively collected in this study. All patients underwent TACE and longitudinal arterial phase CE-MRI assessments at three time points: prior to treatment, and following the first and second TACE sessions. Among them, 110 patients received TACE monotherapy, while the remaining 71 patients underwent TACE in combination with microwave ablation (MWA). All images were subjected to standardized preprocessing procedures. We developed an end-to-end deep learning model, ProgSwin-UNETR, based on the Swin Transformer architecture, to perform four-class prognosis stratification directly from input imaging data. The model was trained using multi-time-point arterial phase CE-MRI data and evaluated via fourfold cross-validation. Classification performance was assessed using the area under the receiver operating characteristic curve (AUC). For comparative analysis, we benchmarked performance against traditional radiomics-based classifiers and the mRECIST criteria. Prognostic utility was further assessed using Kaplan-Meier (KM) survival curves. Additionally, multivariate Cox proportional hazards regression was performed as a post hoc analysis to evaluate the independent and complementary prognostic value of the model outputs and clinical variables. GradCAM +  + was applied to visualize the imaging regions contributing most to model prediction. The ProgSwin-UNETR model achieved an accuracy of 0.86 and an AUC of 0.92 (95% CI: 0.90-0.95) for the four-class prognosis stratification task, outperforming radiomic models across all risk groups. Furthermore, KM survival analyses were performed using three different approaches-AI model, radiomics-based classifiers, and mRECIST criteria-to stratify patients by risk. Of the three approaches, only the AI-based ProgSwin-UNETR model achieved statistically significant risk stratification across the entire cohort and in both TACE-alone and TACE + MWA subgroups (p < 0.005). In contrast, the mRECIST and radiomics models did not yield significant survival differences across subgroups (p > 0.05). Multivariate Cox regression analysis further demonstrated that the model was a robust independent prognostic factor (p = 0.01), effectively stratifying patients into four distinct risk groups (Class 0 to Class 3) with Log(HR) values of 0.97, 0.51, -0.53, and -0.92, respectively. Additionally, GradCAM +  + visualizations highlighted critical regional features contributing to prognosis prediction, providing interpretability of the model. ProgSwin-UNETR can well predict the various risk groups of HCC patients undergoing TACE therapy and can further be applied for personalized prediction.

A chest X-ray radiology report describes abnormal findings not only from X-ray obtained at a given examination, but also findings on disease progression or change in device placement with reference to the X-ray from previous examination. Majority of the efforts on automatic generation of radiology report pertain to reporting the former, but not the latter, type of findings. To the best of the authors' knowledge, there is only one work dedicated to generating summary of the latter findings, i.e., follow-up radiology report summary. In this study, we propose a transformer-based framework to tackle this task. Motivated by our observations on the significance of medical lexicon on the fidelity of report summary generation, we introduce two mechanisms to bestow clinical insight to our model, namely disease probability soft guidance and masked entity modeling loss. The former mechanism employs a pretrained abnormality classifier to guide the presence level of specific abnormalities, while the latter directs the model's attention toward medical lexicon. Extensive experiments were conducted to demonstrate that the performance of our model exceeded the state-of-the-art.

To assess changes in peer-reviewed evidence on commercially available radiological artificial intelligence (AI) products from 2020 to 2023, as a follow-up to a 2020 review of 100 products. A literature review was conducted, covering January 2015 to March 2023, focusing on CE-certified radiological AI products listed on www.healthairegister.com . Papers were categorised using the hierarchical model of efficacy: technical/diagnostic accuracy (levels 1-2), clinical decision-making and patient outcomes (levels 3-5), or socio-economic impact (level 6). Study features such as design, vendor independence, and multicentre/multinational data usage were also examined. By 2023, 173 CE-certified AI products from 90 vendors were identified, compared to 100 products in 2020. Products with peer-reviewed evidence increased from 36% to 66%, supported by 639 papers (up from 237). Diagnostic accuracy studies (level 2) remained predominant, though their share decreased from 65% to 57%. Studies addressing higher-efficacy levels (3-6) remained constant at 22% and 24%, with the number of products supported by such evidence increasing from 18% to 31%. Multicentre studies rose from 30% to 41% (p < 0.01). However, vendor-independent studies decreased (49% to 45%), as did multinational studies (15% to 11%) and prospective designs (19% to 16%), all with p > 0.05. The increase in peer-reviewed evidence and higher levels of evidence per product indicate maturation in the radiological AI market. However, the continued focus on lower-efficacy studies and reductions in vendor independence, multinational data, and prospective designs highlight persistent challenges in establishing unbiased, real-world evidence. Question Evaluating advancements in peer-reviewed evidence for CE-certified radiological AI products is crucial to understand their clinical adoption and impact. Findings CE-certified AI products with peer-reviewed evidence increased from 36% in 2020 to 66% in 2023, but the proportion of higher-level evidence papers (~24%) remained unchanged. Clinical relevance The study highlights increased validation of radiological AI products but underscores a continued lack of evidence on their clinical and socio-economic impact, which may limit these tools' safe and effective implementation into clinical workflows.

To develop and assess the performance of an anatomically based multitask deep learning radiomics nomogram (AMDRN) system to predict implant failure risk before maxillary sinus floor elevation (MSFE) while incorporating automated segmentation of key anatomical structures. We retrospectively collected patients' preoperative cone beam computed tomography (CBCT) images and electronic medical records (EMRs). First, the nn-UNet v2 model was optimized to segment the maxillary sinus (MS), Schneiderian membrane (SM), and residual alveolar bone (RAB). Based on the segmentation mask, a deep learning model (3D-Attention-ResNet) and a radiomics model were developed to extract 3D features from CBCT scans, generating the DL Score, and Rad Score. Significant clinical features were also extracted from EMRs to build a clinical model. These components were then integrated using logistic regression (LR) to create the AMDRN model, which includes a visualization module to support clinical decision-making. Segmentation results for MS, RAB, and SM achieved high DICE coefficients on the test set, with values of 99.50% ± 0.84%, 92.53% ± 3.78%, and 91.58% ± 7.16%, respectively. On an independent test set, the Clinical model, Radiomics model, 3D-DL model, and AMDRN model achieved prediction accuracies of 60%, 76%, 82%, and 90%, respectively, with AMDRN achieving the highest AUC of 93%. The AMDRN system enables efficient preoperative prediction of implant failure risk in MSFE and accurate segmentation of critical anatomical structures, supporting personalized treatment planning and clinical risk management.

Unsupervised anomaly detection (UAD) plays a crucial role in neuroimaging for identifying deviations from healthy subject data and thus facilitating the diagnosis of neurological disorders. In this work, we focus on Bayesian flow networks (BFNs), a novel class of generative models, which have not yet been applied to medical imaging or anomaly detection. BFNs combine the strength of diffusion frameworks and Bayesian inference. We introduce AnoBFN, an extension of BFNs for UAD, designed to: i) perform conditional image generation under high levels of spatially correlated noise, and ii) preserve subject specificity by incorporating a recursive feedback from the input image throughout the generative process. We evaluate AnoBFN on the challenging task of Alzheimer's disease-related anomaly detection in FDG PET images. Our approach outperforms other state-of-the-art methods based on VAEs (beta-VAE), GANs (f-AnoGAN), and diffusion models (AnoDDPM), demonstrating its effectiveness at detecting anomalies while reducing false positive rates.

Automated X-ray inspection is crucial for efficient and unobtrusive security screening in various public settings. However, challenges such as object occlusion, variations in the physical properties of items, diversity in X-ray scanning devices, and limited training data hinder accurate and reliable detection of illicit items. Despite the large body of research in the field, reported experimental evaluations are often incomplete, with frequently conflicting outcomes. To shed light on the research landscape and facilitate further research, a systematic, detailed, and thorough comparative evaluation of recent Deep Learning (DL)-based methods for X-ray object detection is conducted. For this, a comprehensive evaluation framework is developed, composed of: a) Six recent, large-scale, and widely used public datasets for X-ray illicit item detection (OPIXray, CLCXray, SIXray, EDS, HiXray, and PIDray), b) Ten different state-of-the-art object detection schemes covering all main categories in the literature, including generic Convolutional Neural Network (CNN), custom CNN, generic transformer, and hybrid CNN-transformer architectures, and c) Various detection (mAP50 and mAP50:95) and time/computational-complexity (inference time (ms), parameter size (M), and computational load (GFLOPS)) metrics. A thorough analysis of the results leads to critical observations and insights, emphasizing key aspects such as: a) Overall behavior of the object detection schemes, b) Object-level detection performance, c) Dataset-specific observations, and d) Time efficiency and computational complexity analysis. To support reproducibility of the reported experimental results, the evaluation code and model weights are made publicly available at https://github.com/jgenc/xray-comparative-evaluation.

Breast cancer (BC) remains one of the leading causes of cancer-related mortality among women, despite recent advances in Computer-Aided Diagnosis (CAD) systems. Accurate and efficient interpretation of multi-view mammograms is essential for early detection, driving a surge of interest in Artificial Intelligence (AI)-powered CAD models. While state-of-the-art multi-view mammogram classification models are largely based on Transformer architectures, their computational complexity scales quadratically with the number of image patches, highlighting the need for more efficient alternatives. To address this challenge, we propose Mammo-Mamba, a novel framework that integrates Selective State-Space Models (SSMs), transformer-based attention, and expert-driven feature refinement into a unified architecture. Mammo-Mamba extends the MambaVision backbone by introducing the Sequential Mixture of Experts (SeqMoE) mechanism through its customized SecMamba block. The SecMamba is a modified MambaVision block that enhances representation learning in high-resolution mammographic images by enabling content-adaptive feature refinement. These blocks are integrated into the deeper stages of MambaVision, allowing the model to progressively adjust feature emphasis through dynamic expert gating, effectively mitigating the limitations of traditional Transformer models. Evaluated on the CBIS-DDSM benchmark dataset, Mammo-Mamba achieves superior classification performance across all key metrics while maintaining computational efficiency.

Early detection and precise preoperative staging of early gastric cancer (EGC) are critical. Therefore, this study aims to develop a deep learning model using portal venous phase CT images to accurately distinguish EGC without lymph node metastasis. This study included 3164 patients with gastric cancer (GC) who underwent radical surgery at two medical centers in China from 2006 to 2019. Moreover, 2.5D radiomic data and multi-instance learning (MIL) were novel approaches applied in this study. By basing the selection of features on 2.5D radiomic data and MIL, the ResNet101 model combined with the XGBoost model represented a satisfactory performance for diagnosing pT1N0 GC. Furthermore, the 2.5D MIL-based model demonstrated a markedly superior predictive performance compared to traditional radiomics models and clinical models. We first constructed a deep learning prediction model based on 2.5D radiomics and MIL for effectively diagnosing pT1N0 GC patients, which provides valuable information for the individualized treatment selection.