To construct a pathomics-based machine learning model to enhance the diagnostic efficacy of LungPro navigational bronchoscopy for peripheral pulmonary lesions and to optimize the management strategy for LungPro-diagnosed negative lesions. Clinical data and hematoxylin and eosin (H&E)-stained whole slide images (WSIs) were collected from 144 consecutive patients undergoing LungPro virtual bronchoscopy at a single institution between January 2022 and December 2023. Patients were stratified into diagnosis-positive and diagnosis-negative cohorts based on histopathological or etiological confirmation. An artificial intelligence (AI) model was developed and validated using 94 diagnosis-positive cases. Logistic regression (LR) identified associations between clinical/imaging characteristics and malignant pulmonary lesion risk factors. We implemented a convolutional neural network (CNN) with weakly supervised learning to extract image-level features, followed by multiple instance learning (MIL) for patient-level feature aggregation. Multiple machine learning (ML) algorithms were applied to model the extracted features. A multimodal diagnostic framework integrating clinical, imaging, and pathomics data were subsequently developed and evaluated on 50 LungPro-negative patients to assess the framework's diagnostic performance and predictive validity. Univariable and multivariable logistic regression analyses identified that age, lesion boundary and mean computed tomography (CT) attenuation were independent risk factors for malignant peripheral pulmonary lesions (P < 0.05). A histopathological model using a MIL fusion strategy showed strong diagnostic performance for lung cancer, with area under the curve (AUC) values of 0.792 (95% CI 0.680-0.903) in the training cohort and 0.777 (95% CI 0.531-1.000) in the test cohort. Combining predictive clinical features with pathological characteristics enhanced diagnostic yield for peripheral pulmonary lesions to 0.848 (95% CI 0.6945-1.0000). In patients with initially negative LungPro biopsy results, the model identified 20 of 28 malignant lesions (sensitivity: 71.43%) and 15 of 22 benign lesions (specificity: 68.18%). Class activation mapping (CAM) validated the model by highlighting key malignant features, including conspicuous nucleoli and nuclear atypia. The fusion diagnostic model that incorporates clinical and pathomic features markedly enhances the diagnostic accuracy of LungPro in this retrospective cohort. This model aids in the detection of subtle malignant characteristics, thereby offering evidence to support precise and targeted therapeutic interventions for lesions that LungPro classifies as negative in clinical settings.

Deep learning necessitates a substantial amount of data, yet obtaining sufficient medical images is difficult due to concerns about patient privacy and high collection costs. To address this issue, we propose a conditional latent diffusion model-based medical image enhancement network, referred to as the Medical Image Enhancement Network (MedIENet). To meet the rigorous standards required for image generation in the medical imaging field, a multi-attention module is incorporated in the encoder of the denoising U-Net backbone. Additionally Rotary Position Embedding (RoPE) is integrated into the self-attention module to effectively capture positional information, while cross-attention is utilised to embed integrate class information into the diffusion process. MedIENet is evaluated on three datasets: Chest CT-Scan images, Chest X-Ray Images (Pneumonia), and Tongue dataset. Compared to existing methods, MedIENet demonstrates superior performance in both fidelity and diversity of the generated images. Experimental results indicate that for downstream classification tasks using ResNet50, the Area Under the Receiver Operating Characteristic curve (AUROC) achieved with real data alone is 0.76 for the Chest CT-Scan images dataset, 0.87 for the Chest X-Ray Images (Pneumonia) dataset, and 0.78 for the Tongue Dataset. When using mixed data consisting of real data and generated data, the AUROC improves to 0.82, 0.94, and 0.82, respectively, reflecting increases of approximately 6%, 7%, and 4%. These findings indicate that the images generated by MedIENet can enhance the performance of downstream classification tasks, providing an effective solution to the scarcity of medical image training data.

Pneumonia is a prevalent and serious respiratory disease, responsible for a significant number of cases globally. With advancements in deep learning, the automatic diagnosis of pneumonia has attracted significant research attention in medical image classification. However, current methods still face several challenges. First, since lesions are often visible in only a few slices, slice-based classification algorithms may overlook critical spatial contextual information in CT sequences, and slice-level annotations are labor-intensive. Moreover, chest CT sequence-based pneumonia classification algorithms that rely solely on sequence-level coarse-grained labels remain limited, especially in integrating multi-modal information. To address these challenges, we propose a Multi-modal Text-Guided Network (MTGNet) for pneumonia classification using chest CT sequences. In this model, we design a sequential graph pooling network to encode the CT sequences by gradually selecting important slice features to obtain a sequence-level representation. Additionally, a CT description encoder is developed to learn representations from textual reports. To simulate the clinical diagnostic process, we employ multi-modal training and single-modal testing. A modal transfer module is proposed to generate simulated textual features from CT sequences. Cross-modal attention is then employed to fuse the sequence-level and simulated textual representations, thereby enhancing feature learning within the CT sequences by incorporating semantic information from textual descriptions. Furthermore, contrastive learning is applied to learn discriminative features by maximizing the similarity of positive sample pairs and minimizing the similarity of negative sample pairs. Extensive experiments on a self-constructed pneumonia CT sequences dataset demonstrate that the proposed model significantly improves classification performance.

Cystic bronchiectasis and pneumonia are respiratory conditions that significantly impact morbidity and mortality worldwide. Diagnosing these diseases accurately is crucial, as early detection can greatly improve patient outcomes. These diseases are respiratory conditions that present with overlapping features on chest X-rays (CXR), making accurate diagnosis challenging. Recent advancements in deep learning (DL) have improved diagnostic accuracy in medical imaging. This study proposes the EffConvNeXt model, a hybrid approach combining EfficientNetB1 and ConvNeXtTiny, designed to enhance classification accuracy for cystic bronchiectasis, pneumonia, and normal cases in CXRs. The model effectively balances EfficientNetB1's efficiency with ConvNeXtTiny's advanced feature extraction, allowing for better identification of complex patterns in CXR images. Additionally, the EffConvNeXt model combines EfficientNetB1 and ConvNeXtTiny, addressing limitations of each model individually: EfficientNetB1's SE blocks improve focus on critical image areas while keeping the model lightweight and fast, and ConvNeXtTiny enhances detection of subtle abnormalities, making the combined model highly effective for rapid and accurate CXR image analysis in clinical settings. For the performance analysis of the EffConvNeXt model, experimental studies were conducted using 5899 CXR images collected from Dicle University Medical Faculty. When used individually, ConvNeXtTiny achieved an accuracy rate of 97.12%, while EfficientNetB1 reached 97.79%. By combining both models, the EffConvNeXt raised the accuracy to 98.25%, showing a 0.46% improvement. With this result, the other tested DL models fell behind. These findings indicate that EffConvNeXt provides a reliable, automated solution for distinguishing cystic bronchiectasis and pneumonia, supporting clinical decision-making with enhanced diagnostic accuracy.

To evaluate the value of quantitative CT (QCT) parameters, radiomics features, and deep learning (DL) features based on inspiratory and expiratory CT for the identification and severity staging of chronic obstructive pulmonary disease (COPD). This retrospective analysis included 223 COPD patients and 59 healthy controls from the Guangzhou cohort. We stratified the participants into a training cohort and a testing cohort (7:3) and extracted DL features based on VGG-16 method, radiomics features based on pyradiomics package, and QCT parameters based on NeuLungCARE software. The Logistic regression method was employed to construct models for the identification and severity staging of COPD. The Shenzhen cohort was used as the external validation cohort to assess the generalizability of the models. In the COPD identification models, Model 5-B1 (the QCT combined with DL model in biphasic CT) showed the best predictive performance with AUC of 0.920, and 0.897 in testing cohort and external validation cohort, respectively. In the COPD severity staging models, the predictive performance of Model 4-B2 (the model combining QCT with radiomics features in biphasic CT) and Model 5-B2 (the model combining QCT with DL features in biphasic CT was superior to that of the other models. This biphasic CT-based multi-modal approach integrating QCT, radiomics, or DL features offers a clinically valuable tool for COPD identification and severity staging.

Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD. We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation. The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team. The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words).

Explore the clinical characteristics of Tuberculosis Destroyed Lung (TDL) with pulmonary hypertension. Use Artificial Intelligence (AI) CT Imaging for the Diagnosis of TDL Patients with PH. 51 cases of TDL patients. Based on the results of the right heart catheterization examination, the patients were divided into two groups: TDL with group (n=31) and TDL Non-PH (n=20). The original chest CT data of the patients were reconstructed, segmented, and rendered using AI, and lung volume-related data were calculated. The differences in clinical data, hemodynamic data, and lung volume-related data between the two groups of patients were compared. The proportion of TDL patients with PH is significantly higher than those without TDL (61.82% vs. 22.64%, P<0.01). There were significant differences between the two groups of patients in terms of pulmonary function, PCWP/PVR, PASP/TRV and total volume of destroyed lung tissue (V_TDLT) (P<0.05), and V_TDLT is positively correlated with mean pulmonary arterial pressure (mPAP). Combined Diagnosis (V_TDLT + PSAP): The area under the AUC was 0.917 (95%CI: 0.802-1), with a predicted probability of 0.51 and a Youden index of 0.789. The sensitivity was 90% and specificity was 88.9%. Patients with TDL accompanied by pulmonary hypertension are related to restrictive disorders. The V_TDLT is positively correlated with mPAP. By calculating the V_TDLT and combining it with the estimated PASP from echocardiography, it assists in the diagnosis of PH in these patients.

While the primary goal of lung cancer screening CT is to detect early-stage lung cancer in high-risk populations, it often reveals asymptomatic cardiovascular abnormalities that can be clinically significant. These findings include coronary artery calcifications (CACs), myocardial pathologies, cardiac chamber enlargement, valvular lesions, and vascular disease. CAC, a marker of subclinical atherosclerosis, is particularly emphasized due to its strong predictive value for cardiovascular events and mortality. Guidelines recommend qualitative or quantitative CAC scoring on all noncontrast chest CTs. Other actionable findings include aortic aneurysms, pericardial disease, and myocardial pathology, some of which may indicate past or impending cardiac events. This article explores the wide range of incidental cardiovascular findings detectable during low-dose CT (LDCT) scans for lung cancer screening, as well as noncontrast chest CT scans. Distinguishing which findings warrant further evaluation is essential to avoid overdiagnosis, unnecessary anxiety, and resource misuse. The article advocates for a structured approach to follow-up based on the clinical significance of each finding and the patient's overall risk profile. It also notes the rising role of artificial intelligence in automatically detecting and quantifying these abnormalities, potentiating early behavioral modification or medical and surgical interventions. Ultimately, this piece highlights the opportunity to reframe LDCT as a comprehensive cardiothoracic screening tool.

Photon-counting detector computed tomography (PCD-CT) is an emerging imaging technology that promises to overcome the limitations of conventional energy-integrating detector (EID)-CT, particularly in thoracic oncology. This narrative review summarizes technical advances and clinical applications of PCD-CT in the thorax with emphasis on spatial resolution, dose-image-quality balance, and intrinsic spectral imaging, and it outlines practical implications relevant to thoracic oncology. A literature review of PubMed through May 31, 2025, was conducted using combinations of "photon counting," "computed tomography," "thoracic oncology," and "artificial intelligence." We screened the retrieved records and included studies with direct relevance to lung and mediastinal tumors, image quality, radiation dose, spectral/iodine imaging, or artificial intelligence-based reconstruction; case reports, editorials, and animal-only or purely methodological reports were excluded. PCD-CT demonstrated superior spatial resolution compared with EID-CT, enabling clearer visualization of fine pulmonary structures, such as bronchioles and subsolid nodules; slice thicknesses of approximately 0.4 mm and <i>ex vivo</i> resolvable structures approaching 0.11 mm have been reported. Across intraindividual clinical comparisons, radiation-dose reductions of 16%-43% have been achieved while maintaining or improving diagnostic image quality. Intrinsic spectral imaging enables accurate iodine mapping and low-keV virtual monoenergetic images and has shown quantitative advantages versus dual-energy CT in phantoms and early clinical work. Artificial intelligence-based deep-learning reconstruction and super-resolution can complement detector capabilities to reduce noise and stabilize fine-structure depiction without increasing dose. Potential reductions in contrast volume are biologically plausible given improved low-keV contrast-to-noise ratio, although clinical dose-finding data remain limited, and routine K-edge imaging has not yet translated to clinical thoracic practice. In conclusion, PCD-CT provides higher spatial and spectral fidelity at lower or comparable doses, supporting earlier and more precise tumor detection and characterization; future work should prioritize outcome-oriented trials, protocol harmonization, and implementation studies aligned with "Green Radiology".

Public healthcare datasets of Chest X-Rays (CXRs) have long been a popular benchmark for developing computer vision models in healthcare. However, strong average-case performance of machine learning (ML) models on these datasets is insufficient to certify their clinical utility. In this paper, we use clinical context, as captured by prior discharge summaries, to provide a more holistic evaluation of current ``state-of-the-art'' models for the task of CXR diagnosis. Using discharge summaries recorded prior to each CXR, we derive a ``prior'' or ``pre-test'' probability of each CXR label, as a proxy for existing contextual knowledge available to clinicians when interpreting CXRs. Using this measure, we demonstrate two key findings: First, for several diagnostic labels, CXR models tend to perform best on cases where the pre-test probability is very low, and substantially worse on cases where the pre-test probability is higher. Second, we use pre-test probability to assess whether strong average-case performance reflects true diagnostic signal, rather than an ability to infer the pre-test probability as a shortcut. We find that performance drops sharply on a balanced test set where this shortcut does not exist, which may indicate that much of the apparent diagnostic power derives from inferring this clinical context. We argue that this style of analysis, using context derived from clinical notes, is a promising direction for more rigorous and fine-grained evaluation of clinical vision models.