To train and test an AI-based algorithm for automated detection of focal bone marrow lesions (FL) from MRI. This retrospective feasibility study included 444 patients with monoclonal plasma cell disorders. For this feasibility study, only FLs in the left pelvis were included. Using the nnDetection framework, the algorithm was trained based on 334 patients with 494 FLs from center 1, and was tested on an internal test set (36 patients, 89 FLs, center 1) and a multicentric external test set (74 patients, 262 FLs, centers 2-11). Mean average precision (mAP), F1-score, sensitivity, positive predictive value (PPV), and Spearman correlation coefficient between automatically determined and actual number of FLs were calculated. On the internal/external test set, the algorithm achieved a mAP of 0.44/0.34, F1-Score of 0.54/0.44, sensitivity of 0.49/0.34, and a PPV of 0.61/0.61, respectively. In two subsets of the external multicentric test set with high imaging quality, the performance nearly matched that of the internal test set, with mAP of 0.45/0.41, F1-Score of 0.50/0.53, sensitivity of 0.44/0.43, and a PPV of 0.60/0.71, respectively. There was a significant correlation between the automatically determined and actual number of FLs on both the internal (r=0.51, p=0.001) and external multicentric test set (r=0.59, p<0.001). This study demonstrates that the automated detection of FLs from MRI, and thereby the automated assessment of the number of FLs, is feasible.

Artificial intelligence (AI) is increasingly used in radiology, but its development in pediatric imaging remains limited, particularly for emergent conditions. Ileocolic intussusception is an important cause of acute abdominal pain in infants and toddlers and requires timely diagnosis to prevent complications such as bowel ischemia or perforation. While ultrasonography is the diagnostic standard due to its high sensitivity and specificity, its accessibility may be limited, especially outside tertiary centers. Abdominal radiographs (AXRs), despite their limited sensitivity, are often the first-line imaging modality in clinical practice. In this context, AI could support early screening and triage by analyzing AXRs and identifying patients who require further ultrasonography evaluation. This study aimed to upgrade and externally validate an AI model for screening ileocolic intussusception using pediatric AXRs with multicenter data and to assess the diagnostic performance of the model in comparison with radiologists of varying experience levels with and without AI assistance. This retrospective study included pediatric patients (≤5 years) who underwent both AXRs and ultrasonography for suspected intussusception. Based on the preliminary study from hospital A, the AI model was retrained using data from hospital B and validated with external datasets from hospitals C and D. Diagnostic performance of the upgraded AI model was evaluated using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). A reader study was conducted with 3 radiologists, including 2 trainees and 1 pediatric radiologist, to evaluate diagnostic performance with and without AI assistance. Based on the previously developed AI model trained on 746 patients from hospital A, an additional 431 patients from hospital B (including 143 intussusception cases) were used for further training to develop an upgraded AI model. External validation was conducted using data from hospital C (n=68; 19 intussusception cases) and hospital D (n=90; 30 intussusception cases). The upgraded AI model achieved a sensitivity of 81.7% (95% CI 68.6%-90%) and a specificity of 81.7% (95% CI 73.3%-87.8%), with an AUC of 86.2% (95% CI 79.2%-92.1%) in the external validation set. Without AI assistance, radiologists showed lower performance (overall AUC 64%; sensitivity 49.7%; specificity 77.1%). With AI assistance, radiologists' specificity improved to 93% (difference +15.9%; P<.001), and AUC increased to 79.2% (difference +15.2%; P=.05). The least experienced reader showed the largest improvement in specificity (+37.6%; P<.001) and AUC (+14.7%; P=.08). The upgraded AI model improved diagnostic performance for screening ileocolic intussusception on pediatric AXRs. It effectively enhanced the specificity and overall accuracy of radiologists, particularly those with less experience in pediatric radiology. A user-friendly software platform was introduced to support broader clinical validation and underscores the potential of AI as a screening and triage tool in pediatric emergency settings.

A common site of metastases for a variety of cancers is the bone, which is challenging and time consuming to review and important for cancer staging. Here, we developed a deep learning approach for detection and classification of bone lesions on staging CTs. This study developed an nnUNet model using 402 patients' CTs, including prostate cancer patients with benign or malignant osteoblastic (blastic) bone lesions, and patients with benign or malignant osteolytic (lytic) bone lesions from various primary cancers. An expert radiologist contoured ground truth lesions, and the model was evaluated for detection on a lesion level. For classification performance, accuracy, sensitivity, specificity, and other metrics were calculated. The held-out test set consisted of 69 patients (32 with bone metastases). The AUC of AI-predicted burden of disease was calculated on a patient level. In the independent test set, 70% of ground truth lesions were detected (67% of malignant lesions and 72% of benign lesions). The model achieved accuracy of 85% in classifying lesions as malignant or benign (91% sensitivity and 81% specificity). Although AI identified false positives in several benign patients, the patient-level AUC was 0.82 using predicted disease burden proportion. Our lesion detection and classification AI model performs accurately and has the potential to correct physician errors. Further studies should investigate if the model can impact physician review in terms of detection rate, classification accuracy, and review time.

Colorectal cancer (CRC) is closely linked to the malignant transformation of colorectal polyps, making early detection essential. However, current models struggle with detecting small lesions, accurately localizing boundaries, and providing interpretable decisions. To address these issues, we propose HGNet, which integrates High-Order Spatial Awareness Hypergraph and Multi-Scale Context Attention. Key innovations include: (1) an Efficient Multi-Scale Context Attention (EMCA) module to enhance lesion feature representation and boundary modeling; (2) the deployment of a spatial hypergraph convolution module before the detection head to capture higher-order spatial relationships between nodes; (3) the application of transfer learning to address the scarcity of medical image data; and (4) Eigen Class Activation Map (Eigen-CAM) for decision visualization. Experimental results show that HGNet achieves 94% accuracy, 90.6% recall, and 90% [email protected], significantly improving small lesion differentiation and clinical interpretability. The source code will be made publicly available upon publication of this paper.

<b>Background</b>: Acute Aortic Syndrome (AAS), encompassing aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU), presents diagnostic challenges due to its varied manifestations and the critical need for rapid assessment. <b>Methods</b>: We developed a multi-stage deep learning model trained on chest computed tomography angiography (CTA) scans. The model utilizes a U-Net architecture for aortic segmentation, followed by a cascaded classification approach for detecting AD and IMH, and a multiscale CNN for identifying PAU. External validation was conducted on 260 anonymized CTA scans from 14 U.S. clinical sites, encompassing data from four different CT manufacturers. Performance metrics, including sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), were calculated with 95% confidence intervals (CIs) using Wilson's method. Model performance was compared against predefined benchmarks. <b>Results</b>: The model achieved a sensitivity of 0.94 (95% CI: 0.88-0.97), specificity of 0.93 (95% CI: 0.89-0.97), and an AUC of 0.96 (95% CI: 0.94-0.98) for overall AAS detection, with <i>p</i>-values < 0.001 when compared to the 0.80 benchmark. Subgroup analyses demonstrated consistent performance across different patient demographics, CT manufacturers, slice thicknesses, and anatomical locations. <b>Conclusions</b>: This deep learning model effectively detects the full spectrum of AAS across diverse populations and imaging platforms, suggesting its potential utility in clinical settings to enable faster triage and expedite patient management.

To assess the impact of a commercially available computed tomography (CT)-based artificial intelligence (AI) software for detecting acute intracranial hemorrhage (AIH) on radiologists' diagnostic performance and workflow in a real-world clinical setting. This retrospective study included a total of 956 non-contrast brain CT scans obtained over a 70-day period, interpreted independently by 2 board-certified general radiologists. Of these, 541 scans were interpreted during the initial 35 days before the implementation of AI software, and the remaining 415 scans were interpreted during the subsequent 35 days, with reference to AIH probability scores generated by the software. To assess the software's impact on radiologists' performance in detecting AIH, performance before and after implementation was compared. Additionally, to evaluate the software's effect on radiologists' workflow, Kendall's Tau was used to assess the correlation between the daily chronological order of CT scans and the radiologists' reading order before and after implementation. The early diagnosis rate for AIH (defined as the proportion of AIH cases read within the first quartile by radiologists) and the median reading order of AIH cases were also compared before and after implementation. A total of 956 initial CT scans from 956 patients [mean age: 63.14 ± 18.41 years; male patients: 447 (47%)] were included. There were no significant differences in accuracy [from 0.99 (95% confidence interval: 0.99-1.00) to 0.99 (0.98-1.00), <i>P</i> = 0.343], sensitivity [from 1.00 (0.99-1.00) to 1.00 (0.99-1.00), <i>P</i> = 0.859], or specificity [from 1.00 (0.99-1.00) to 0.99 (0.97-1.00), <i>P</i> = 0.252] following the implementation of the AI software. However, the daily correlation between the chronological order of CT scans and the radiologists' reading order significantly decreased [Kendall's Tau, from 0.61 (0.48-0.73) to 0.01 (0.00-0.26), <i>P</i> < 0.001]. Additionally, the early diagnosis rate significantly increased [from 0.49 (0.34-0.63) to 0.76 (0.60-0.93), <i>P</i> = 0.013], and the daily median reading order of AIH cases significantly decreased [from 7.25 (Q1-Q3: 3-10.75) to 1.5 (1-3), <i>P</i> < 0.001] after the implementation. After the implementation of CT-based AI software for detecting AIH, the radiologists' daily reading order was considerably reprioritized to allow more rapid interpretation of AIH cases without compromising diagnostic performance in a real-world clinical setting. With the increasing number of CT scans and the growing burden on radiologists, optimizing the workflow for diagnosing AIH through CT-based AI software integration may enhance the prompt and efficient treatment of patients with AIH.

Artificial intelligence (AI) algorithms for lung nodule detection assist radiologists. As their performance using ultra-high-resolution CT (U-HRCT) images has not been evaluated, we investigated the usefulness of 0.25-mm slices at U-HRCT using the commercially available deep-learning-based lung nodule detection (DL-LND) system. We enrolled 63 patients who underwent U-HRCT for lung cancer and suspected lung cancer. Two board-certified radiologists identified nodules more than 4 mm in diameter on 1-mm HRCT slices and set the reference standard consensually. They recorded all lesions detected on 5-, 1-, and 0.25-mm slices by the DL-LND system. Unidentified nodules were included in the reference standard. To examine the performance of the DL-LND system, the sensitivity, and positive predictive value (PPV) and the number of false positive (FP) nodules were recorded. The mean number of lesions detected on 5-, 1-, and 0.25-mm slices was 5.1, 7.8 and 7.2 per CT scan. On 5-mm slices the sensitivity and PPV were 79.8% and 46.4%; on 1-mm slices they were 91.5% and 34.8%, and on 0.25-mm slices they were 86.7% and 36.1%. The sensitivity was significantly higher on 1- than 5-mm slices (p < 0.01) while the PPV was significantly lower on 1- than 5-mm slices (p < 0.01). A slice thickness of 0.25 mm failed to improve its performance. The mean number of FP nodules on 5-, 1-, and 0.25-mm slices was 2.8, 5.2, and 4.7 per CT scan. We found that 1 mm was the best slice thickness for U-HRCT images using the commercially available DL-LND system.

The integration of artificial intelligence (AI) with point-of-care ultrasound (POCUS) is transforming cardiovascular diagnostics by enhancing image acquisition, interpretation, and workflow efficiency. These advancements hold promise in expanding access to cardiovascular imaging in resource-limited settings and enabling early disease detection through screening applications. This review explores the opportunities and challenges of AI-enabled POCUS as it reshapes the landscape of cardiovascular imaging. AI-enabled systems can reduce operator dependency, improve image quality, and support clinicians-both novice and experienced-in capturing diagnostically valuable images, ultimately promoting consistency across diverse clinical environments. However, widespread adoption faces significant challenges, including concerns around algorithm generalizability, bias, explainability, clinician trust, and data privacy. Addressing these issues through standardized development, ethical oversight, and clinician-AI collaboration will be critical to safe and effective implementation. Looking ahead, emerging innovations-such as autonomous scanning, real-time predictive analytics, tele-ultrasound, and patient-performed imaging-underscore the transformative potential of AI-enabled POCUS in reshaping cardiovascular care and advancing equitable healthcare delivery worldwide.

Incidental pulmonary embolism (PE) is detected in 1% of cardiac CT angiography (CCTA) scans, despite the targeted aortic opacification and limited field of view. While artificial intelligence (AI) algorithms have proven effective in detecting PE in CT pulmonary angiography (CTPA), their use in CCTA remains unexplored. This study aimed to evaluate the feasibility of an AI algorithm for detecting incidental PE in CCTA scans. A dedicated AI algorithm was retrospectively applied to CCTA scans to detect PE. Radiology reports were reviewed using a natural language processing (NLP) tool to detect mentions of PE. Discrepancies between the AI and radiology reports triggered a blinded review by a cardiothoracic radiologist. All scans identified as positive for PE were thoroughly assessed for radiographic features, including the location of emboli and right ventricular (RV) strain. The performance of the AI algorithm for PE detection was compared to the original radiology report. Between 2021 and 2023, 1534 CCTA scans were analyzed. The AI algorithm identified 27 positive PE scans, with a subsequent review confirming PE in 22/27 cases. Of these, 10 (45.5%) were missed in the initial radiology report, all involving segmental or subsegmental arteries (P < 0.05) with no evidence of RV strain. This study demonstrates the feasibility of using an AI algorithm to detect incidental PE in CCTA scans. A notable radiology report miss rate (45.5%) of segmental and subsegmental emboli was documented. While these findings emphasize the potential value of AI for PE detection in the daily radiology workflow, further research is needed to fully determine its clinical impact.

Accurate detection of anatomic landmarks is essential for assessing alveolar bone and root conditions, thereby optimizing clinical outcomes in orthodontics, periodontics, and implant dentistry. Manual annotation of landmarks on cone-beam computed tomography (CBCT) by dentists is time-consuming, labor-intensive, and subject to inter-observer variability. Deep learning-based automated methods present a promising approach to streamline this process efficiently. However, the scarcity of training data and the high cost of expert annotations hinder the adoption of conventional deep learning techniques. To overcome these challenges, we introduce GeoSapiens, a novel few-shot learning framework designed for robust dental landmark detection using limited annotated CBCT of anterior teeth. Our GeoSapiens framework comprises two key components: (1) a robust baseline adapted from Sapiens, a foundational model that has achieved state-of-the-art performance in human-centric vision tasks, and (2) a novel geometric loss function that improves the model's capacity to capture critical geometric relationships among anatomical structures. Experiments conducted on our collected dataset of anterior teeth landmarks revealed that GeoSapiens surpassed existing landmark detection methods, outperforming the leading approach by an 8.18% higher success detection rate at a strict 0.5 mm threshold-a standard widely recognized in dental diagnostics. Code is available at: https://github.com/xmed-lab/GeoSapiens.