Bone metastases, affecting more than 4.8% of patients with cancer annually, and particularly spinal metastases require urgent intervention to prevent neurological complications. However, the current process of manually reviewing radiological reports leads to potential delays in specialist referrals. We hypothesized that natural language processing (NLP) review of routine radiology reports could automate the referral process for timely multidisciplinary care of spinal metastases. We assessed 3 NLP models-a rule-based regular expression (RegEx) model, GPT-4, and a specialized Bidirectional Encoder Representations from Transformers (BERT) model (NYUTron)-for automated detection and referral of bone metastases. Study inclusion criteria targeted patients with active cancer diagnoses who underwent advanced imaging (computed tomography, MRI, or positron emission tomography) without previous specialist referral. We defined 2 separate tasks: task of identifying clinically significant bone metastatic terms (lexical detection), and identifying cases needing a specialist follow-up (clinical referral). Models were developed using 3754 hand-labeled advanced imaging studies in 2 phases: phase 1 focused on spine metastases, and phase 2 generalized to bone metastases. Standard McRae's line performance metrics were evaluated and compared across all stages and tasks. In the lexical detection, a simple RegEx achieved the highest performance (sensitivity 98.4%, specificity 97.6%, F1 = 0.965), followed by NYUTron (sensitivity 96.8%, specificity 89.9%, and F1 = 0.787). For the clinical referral task, RegEx also demonstrated superior performance (sensitivity 92.3%, specificity 87.5%, and F1 = 0.936), followed by a fine-tuned NYUTron model (sensitivity 90.0%, specificity 66.7%, and F1 = 0.750). An NLP-based automated referral system can accurately identify patients with bone metastases requiring specialist evaluation. A simple RegEx model excels in syntax-based identification and expert-informed rule generation for efficient referral patient recommendation in comparison with advanced NLP models. This system could significantly reduce missed follow-ups and enhance timely intervention for patients with bone metastases.

Existing deep learning models for functional MRI-based classification have limitations in network architecture determination (relying on experience) and feature space fusion (mostly simple concatenation, lacking mutual learning). Inspired by the human brain's mechanism of updating neural connections through learning and decision-making, we proposed a novel BRain-Inspired feature Fusion (BRIEF) framework, which is able to optimize network architecture automatically by incorporating an improved neural network connection search (NCS) strategy and a Transformer-based multi-feature fusion module. Specifically, we first extracted 4 types of fMRI temporal representations, i.e., time series (TCs), static/dynamic functional connection (FNC/dFNC), and multi-scale dispersion entropy (MsDE), to construct four encoders. Within each encoder, we employed a modified Q-learning to dynamically optimize the NCS to extract high-level feature vectors, where the NCS is formulated as a Markov Decision Process. Then, all feature vectors were fused via a Transformer, leveraging both stable/time-varying connections and multi-scale dependencies across different brain regions to achieve the final classification. Additionally, an attention module was embedded to improve interpretability. The classification performance of our proposed BRIEF was compared with 21 state-of-the-art models by discriminating two mental disorders from healthy controls: schizophrenia (SZ, n=1100) and autism spectrum disorder (ASD, n=1550). BRIEF demonstrated significant improvements of 2.2% to 12.1% compared to 21 algorithms, reaching an AUC of 91.5% - 0.6% for SZ and 78.4% - 0.5% for ASD, respectively. This is the first attempt to incorporate a brain-inspired, reinforcement learning strategy to optimize fMRI-based mental disorder classification, showing significant potential for identifying precise neuroimaging biomarkers.

Dentocraniofacial hard tissue defects profoundly affect patients' physiological functions, facial aesthetics, and psychological well-being, posing significant challenges for precise reconstruction. Current deep learning models are limited to single-tissue scenarios and modality-specific imaging inputs, resulting in poor generalizability and trade-offs between anatomical fidelity, computational efficiency, and cross-tissue adaptability. Here we introduce UniDCF, a unified framework capable of reconstructing multiple dentocraniofacial hard tissues through multimodal fusion encoding of point clouds and multi-view images. By leveraging the complementary strengths of each modality and incorporating a score-based denoising module to refine surface smoothness, UniDCF overcomes the limitations of prior single-modality approaches. We curated the largest multimodal dataset, comprising intraoral scans, CBCT, and CT from 6,609 patients, resulting in 54,555 annotated instances. Evaluations demonstrate that UniDCF outperforms existing state-of-the-art methods in terms of geometric precision, structural completeness, and spatial accuracy. Clinical simulations indicate UniDCF reduces reconstruction design time by 99% and achieves clinician-rated acceptability exceeding 94%. Overall, UniDCF enables rapid, automated, and high-fidelity reconstruction, supporting personalized and precise restorative treatments, streamlining clinical workflows, and enhancing patient outcomes.

Foundation models (FMs) have shown great promise in medical image analysis by improving generalization across diverse downstream tasks. In ophthalmology, several FMs have recently emerged, but there is still no clear answer to fundamental questions: Which FM performs the best? Are they equally good across different tasks? What if we combine all FMs together? To our knowledge, this is the first study to systematically evaluate both single and fused ophthalmic FMs. To address these questions, we propose FusionFM, a comprehensive evaluation suite, along with two fusion approaches to integrate different ophthalmic FMs. Our framework covers both ophthalmic disease detection (glaucoma, diabetic retinopathy, and age-related macular degeneration) and systemic disease prediction (diabetes and hypertension) based on retinal imaging. We benchmarked four state-of-the-art FMs (RETFound, VisionFM, RetiZero, and DINORET) using standardized datasets from multiple countries and evaluated their performance using AUC and F1 metrics. Our results show that DINORET and RetiZero achieve superior performance in both ophthalmic and systemic disease tasks, with RetiZero exhibiting stronger generalization on external datasets. Regarding fusion strategies, the Gating-based approach provides modest improvements in predicting glaucoma, AMD, and hypertension. Despite these advances, predicting systemic diseases, especially hypertension in external cohort remains challenging. These findings provide an evidence-based evaluation of ophthalmic FMs, highlight the benefits of model fusion, and point to strategies for enhancing their clinical applicability.

Lung cancer is the leading cause of cancer-related death worldwide. Deep learning-based computer-aided diagnosis (CAD) systems in screening programs enhance malignancy prediction, assist radiologists in decision-making, and reduce inter-reader variability. However, limited research has explored the analysis of repeated annual exams of indeterminate lung nodules to improve accuracy. We introduced a novel spatio-temporal deep learning framework, the global attention convolutional recurrent neural network (globAttCRNN), to predict indeterminate lung nodule malignancy using serial screening computed tomography (CT) images from the National Lung Screening Trial (NLST) dataset. The model comprises a lightweight 2D convolutional neural network for spatial feature extraction and a recurrent neural network with a global attention module to capture the temporal evolution of lung nodules. Additionally, we proposed new strategies to handle missing data in the temporal dimension to mitigate potential biases arising from missing time steps, including temporal augmentation and temporal dropout. Our model achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.954 in an independent test set of 175 lung nodules, each detected in multiple CT scans over patient follow-up, outperforming baseline single-time and multiple-time architectures. The temporal global attention module prioritizes informative time points, enabling the model to capture key spatial and temporal features while ignoring irrelevant or redundant information. Our evaluation emphasizes its potential as a valuable tool for the diagnosis and stratification of patients at risk of lung cancer.

This study introduces the Structural MRI-based Alzheimer's Disease Score (SMAS), a novel index intended to quantify Alzheimer's Disease (AD)-related morphometric patterns using a deep learning Bayesian-supervised Variational Autoencoder (Bayesian-SVAE). The SMAS index was constructed using baseline structural MRI data from the DELCODE study and evaluated longitudinally in two independent cohorts: DELCODE (n=415) and ADNI (n=190). Our findings indicate that SMAS has strong associations with cognitive performance (DELCODE: r=-0.83; ADNI: r=-0.62), age (DELCODE: r=0.50; ADNI: r=0.28), hippocampal volume (DELCODE: r=-0.44; ADNI: r=-0.66), and total gray matter volume (DELCODE: r=-0.42; ADNI: r=-0.47), suggesting its potential as a biomarker for AD-related brain atrophy. Moreover, our longitudinal studies indicated that SMAS may be useful for the early identification and tracking of AD. The model demonstrated significant predictive accuracy in distinguishing cognitively healthy individuals from those with AD (DELCODE: AUC=0.971 at baseline, 0.833 at 36 months; ADNI: AUC=0.817 at baseline, improving to 0.903 at 24 months). Notably, over 36 months, the SMAS index outperformed existing measures such as SPARE-AD and hippocampal volume. The relevance map analysis revealed significant morphological changes in key AD-related brain regions, including the hippocampus, posterior cingulate cortex, precuneus, and lateral parietal cortex, highlighting that SMAS is a sensitive and interpretable biomarker of brain atrophy, suitable for early AD detection and longitudinal monitoring of disease progression.

Spontaneous intracranial hemorrhages have a high disease burden. Due to increasing medical imaging, new technological solutions for assisting in image interpretation are warranted. We developed a deep learning (DL) solution for spontaneous intracranial hemorrhage detection from head CT scans. The DL solution included four base convolutional neural networks (CNNs), which were trained using 300 head CT scans. A metamodel was trained on top of the four base CNNs, and simple post processing steps were applied to improve the solution's accuracy. The solution performance was evaluated using a retrospective dataset of consecutive emergency head CTs imaged in ten different emergency rooms. 7797 head CT scans were included in the validation dataset and 118 CT scans presented with spontaneous intracranial hemorrhage. The trained metamodel together with a simple rule-based post-processing step showed 89.8% sensitivity and 89.5% specificity for hemorrhage detection at the case-level. The solution detected all 78 spontaneous hemorrhage cases imaged presumably or confirmedly within 12 h from the symptom onset and identified five hemorrhages missed in the initial on-call reports. Although the success of DL algorithms depends on multiple factors, including training data versatility and quality of annotations, using the proposed ensemble-learning approach and rule-based post-processing may help clinicians to develop highly accurate DL solutions for clinical imaging diagnostics.

Focal cortical dysplasia (FCD) is the leading cause of drug-resistant epilepsy (DRE) in pediatric patients. Accurate detection of FCDs is crucial for successful surgical outcomes, yet remains challenging due to frequently subtle MRI findings, especially in children, whose brain morphology undergoes significant developmental changes. Automated detection algorithms have the potential to improve diagnostic precision, particularly in cases, where standard visual assessment fails. This study aimed to evaluate the performance of automated algorithms in detecting FCD type II in pediatric patients and to examine the impact of adult versus pediatric templates on detection accuracy. MRI data from 23 surgical pediatric patients with histologically confirmed FCD type II were retrospectively analyzed. Three imaging-based detection algorithms were applied to T1-weighted images, each targeting key structural features: cortical thickness, gray matter intensity (extension), and gray-white matter junction blurring. Their performance was assessed using adult and pediatric healthy controls templates, with validation against both predictive radiological ROIs (PRR) and post-resection cavities (PRC). The junction algorithm achieved the highest median dice score (0.028, IQR 0.038, p < 0.01 when compared with other algorithms) and detected relevant clusters even in MRI-negative cases. The adult template (median dice score 0.013, IQR 0.027) significantly outperformed the pediatric template (0.0032, IQR 0.023) (p < 0.001), highlighting the importance of template consistency. Despite superior performance of the adult template, its use in pediatric populations may introduce bias, as it does not account for age-specific morphological features such as cortical maturation and incomplete myelination. Automated algorithms, especially those targeting junction blurring, enhance FCD detection in pediatric populations. These algorithms may serve as valuable decision-support tools, particularly in settings where neuroradiological expertise is limited.

Radiomics has emerged as a promising non-invasive imaging approach in pediatric neuro-oncology, offering the ability to extract high-dimensional quantitative features from routine MRI to support diagnosis, risk stratification, molecular characterization, and outcome prediction. Pediatric brain tumors, which differ significantly from adult tumors in biology and imaging appearance, present unique diagnostic and prognostic challenges. By integrating radiomics with machine learning algorithms, studies have demonstrated strong performance in classifying tumor types such as medulloblastoma, ependymoma, and gliomas, and predicting molecular subgroups and mutations such as H3K27M and BRAF. Recent studies combining radiomics with machine learning algorithms - including support vector machines, random forests, and deep learning CNNs - have demonstrated promising performance, with AUCs ranging from 0.75 to 0.98 for tumor classification and 0.77 to 0.88 for molecular subgroup prediction, across cohorts from 50 to over 450 patients, with internal cross-validation and external validation in some cases. In resource-limited settings or regions with limited radiologist manpower, radiomics-based tools could help augment diagnostic accuracy and consistency, serving as decision support to prioritize patients for further evaluation or biopsy. Emerging applications such as radio-immunomics and radio-pathomics may further enhance understanding of tumor biology but remain investigational. Despite its potential, clinical translation faces notable barriers, including limited pediatric-specific datasets, variable imaging protocols, and the lack of standardized, reproducible workflows. Multi-institutional collaboration, harmonized pipelines, and prospective validation are essential next steps. Radiomics should be viewed as a supplementary tool that complements existing clinical and pathological frameworks, supporting more informed and equitable care in pediatric brain tumor management.

This study developed an end-to-end deep learning (DL) model using non-enhanced MRI to diagnose benign and malignant pelvic and sacral tumors (PSTs). Retrospective data from 835 patients across four hospitals were employed to train, validate, and test the models. Six diagnostic models with varied input sources were compared. Performance (AUC, accuracy/ACC) and reading times of three radiologists were compared. The proposed Model SEG-CL-NC achieved AUC/ACC of 0.823/0.776 (Internal Test Set 1) and 0.836/0.781 (Internal Test Set 2). In External Dataset Centers 2, 3, and 4, its ACC was 0.714, 0.740, and 0.756, comparable to contrast-enhanced models and radiologists (P > 0.05), while its diagnosis time was significantly shorter than radiologists (P < 0.01). Our results suggested that the proposed Model SEG-CL-NC could achieve comparable performance to contrast-enhanced models and radiologists in diagnosing benign and malignant PSTs, offering an accurate, efficient, and cost-effective tool for clinical practice.