F3-Net is a foundation model designed to overcome persistent challenges in clinical medical image segmentation, including reliance on complete multimodal inputs, limited generalizability, and narrow task specificity. Through flexible synthetic modality training, F3-Net maintains robust performance even in the presence of missing MRI sequences, leveraging a zero-image strategy to substitute absent modalities without relying on explicit synthesis networks, thereby enhancing real-world applicability. Its unified architecture supports multi-pathology segmentation across glioma, metastasis, stroke, and white matter lesions without retraining, outperforming CNN-based and transformer-based models that typically require disease-specific fine-tuning. Evaluated on diverse datasets such as BraTS 2021, BraTS 2024, and ISLES 2022, F3-Net demonstrates strong resilience to domain shifts and clinical heterogeneity. On the whole pathology dataset, F3-Net achieves average Dice Similarity Coefficients (DSCs) of 0.94 for BraTS-GLI 2024, 0.82 for BraTS-MET 2024, 0.94 for BraTS 2021, and 0.79 for ISLES 2022. This positions it as a versatile, scalable solution bridging the gap between deep learning research and practical clinical deployment.

Craniofacial reconstruction in forensic science is crucial for the identification of the victims of crimes and disasters. The objective is to map a given skull to its corresponding face in a corpus of faces with known identities using recent advancements in computer vision, such as deep learning. In this paper, we presented a framework for the identification of a person given the X-ray image of a skull using convolutional Siamese networks for cross-domain identity representation. Siamese networks are twin networks that share the same architecture and can be trained to discover a feature space where nearby observations that are similar are grouped and dissimilar observations are moved apart. To do this, the network is exposed to two sets of comparable and different data. The Euclidean distance is then minimized between similar pairs and maximized between dissimilar ones. Since getting pairs of skull and face images are difficult, we prepared our own dataset of 40 volunteers whose front and side skull X-ray images and optical face images were collected. Experiments were conducted on the collected cross-domain dataset to train and validate the Siamese networks. The experimental results provide satisfactory results on the identification of a person from the given skull.

In-context learning (ICL) is emerging as a promising technique for achieving universal medical image segmentation, where a variety of objects of interest across imaging modalities can be segmented using a single model. Nevertheless, its performance is highly sensitive to the alignment between the query image and in-context image-mask pairs. In a clinical scenario, the scarcity of annotated medical images makes it challenging to select optimal in-context pairs, and fine-tuning foundation ICL models on contextual data is infeasible due to computational costs and the risk of catastrophic forgetting. To address this challenge, we propose Cycle Context Verification (CCV), a novel framework that enhances ICL-based medical image segmentation by enabling self-verification of predictions and accordingly enhancing contextual alignment. Specifically, CCV employs a cyclic pipeline in which the model initially generates a segmentation mask for the query image. Subsequently, the roles of the query and an in-context pair are swapped, allowing the model to validate its prediction by predicting the mask of the original in-context image. The accuracy of this secondary prediction serves as an implicit measure of the initial query segmentation. A query-specific prompt is introduced to alter the query image and updated to improve the measure, thereby enhancing the alignment between the query and in-context pairs. We evaluated CCV on seven medical image segmentation datasets using two ICL foundation models, demonstrating its superiority over existing methods. Our results highlight CCV's ability to enhance ICL-based segmentation, making it a robust solution for universal medical image segmentation. The code will be available at https://github.com/ShishuaiHu/CCV.

Neurological Disorders (ND) affect a large portion of the global population, impacting the brain, spinal cord, and nerves. These disorders fall into categories such as NeuroDevelopmental (NDD), NeuroBiological (NBD), and NeuroDegenerative (ND_e) disorders, which range from common to rare conditions. While Artificial Intelligence (AI) has advanced healthcare diagnostics, training Machine Learning (ML) and Deep Learning (DL) models for early detection of rare neurological disorders remains a challenge due to limited patient data. This data scarcity poses a significant public health issue. Meta_Trans Learning (M_TAL), which integrates Meta-Learning (M_tL) and Transfer Learning (TL), offers a promising solution by leveraging small datasets to extract expert patterns, generalize findings, and reduce AI bias in healthcare. This research systematically reviews studies from 2018 to 2024 to explore how ML and M_TAL techniques are applied in diagnosing NDD, NBD, and ND_e disorders. It also provides statistical and parametric analysis of ML and DL methods for neurological disorder diagnosis. Lastly, the study introduces a MRI-based ND_e-M_TAL framework to aid healthcare professionals in early detection of rare neuro disorders, aiming to enhance diagnostic accuracy and advance healthcare practices.

Robust and accurate segmentation of subcortical structures in brain MR images lays the foundation for observation, analysis and treatment planning of various brain diseases. Deep learning techniques based on Deep Neural Networks (DNNs) have achieved remarkable results in medical image segmentation by using abundant labeled data. However, due to the time-consuming and expensive of acquiring high quality annotations of brain subcortical structures, semi-supervised algorithms become practical in application. In this paper, we propose a novel framework for semi-supervised subcortical brain structure segmentation, based on pseudo-labels Cross Supervising and Confidence Enhancement (CSCE). Our framework comprises dual student-teacher models, specifically a U-Net and a TransUNet. For unlabeled data training, the TransUNet teacher generates pseudo-labels to supervise the U-Net student, while the U-Net teacher generates pseudo-labels to supervise the TransUNet student. This mutual supervision between the two models promotes and enhances their performance synergistically. We have designed two mechanisms to enhance the confidence of pseudo-labels to improve the reliability of cross-supervision: a) Using information entropy to describe uncertainty quantitatively; b) Design an auxiliary detection task to perform uncertainty detection on the pseudo-labels output by the teacher model, and then screened out reliable pseudo-labels for cross-supervision. Finally, we construct an end-to-end deep brain structure segmentation network only using one teacher network (U-Net or TransUNet) for inference, the segmentation results are significantly improved without increasing the parameters amount and segmentation time compared with supervised U-Net or TransUNet based segmentation algorithms. Comprehensive experiments are performed on two public benchmark brain MRI datasets. The proposed method achieves the best Dice scores and MHD values on both datasets compared to several recent state-of-the-art semi-supervised segmentation methods.

Neurodegeneration and cognitive impairment are commonly reported in Alzheimers disease (AD); however, their multivariate links are not well understood. To map the multivariate relationships between whole brain neurodegenerative (WBN) markers, global cognition, and clinical severity in the AD continuum, we developed the explainable artificial intelligence (AI) methods, validated on semi-simulated data, and applied the outperforming method systematically to large-scale experimental data (N=1,756). The outperforming explainable AI method showed robust performance in predicting cognition from regional WBN markers and identified the ground-truth simulated dominant brain regions contributing to cognition. This method also showed excellent performance on experimental data and identified several prominent WBN regions hierarchically and simultaneously associated with cognitive declines across the AD continuum. These multivariate regional features also correlated with clinical severity, suggesting their clinical relevance. Overall, this study innovatively mapped the multivariate regional WBN-cognitive-clinical severity relationships in the AD continuum, thereby significantly advancing AD-relevant neurobiological pathways.

Echocardiography traditionally requires experienced operators to select and interpret clips from specific viewing angles. Clinical decision-making is therefore limited for handheld cardiac ultrasound (HCU), which is often collected by novice users. In this study, we developed a view-agnostic deep learning framework to estimate left ventricular ejection fraction (LVEF), patient age, and patient sex from any of several views containing the left ventricle. Model performance was: (1) consistently strong across retrospective transthoracic echocardiography (TTE) datasets; (2) comparable between prospective HCU versus TTE (625 patients; LVEF r2 0.80 vs. 0.86, LVEF [> or [≤]40%] AUC 0.981 vs. 0.993, age r2 0.85 vs. 0.87, sex classification AUC 0.985 vs. 0.996); (3) comparable between prospective HCU data collected by experts versus novice users (100 patients; LVEF r2 0.78 vs. 0.66, LVEF AUC 0.982 vs. 0.966). This approach may broaden the clinical utility of echocardiography by lessening the need for user expertise in image acquisition.

The REgistry of Flow and Perfusion Imaging for Artificial INtelligEnce with PET (REFINE PET) was established to aggregate PET and associated computed tomography (CT) images with clinical data from hospitals around the world into one comprehensive research resource. REFINE PET is a multicenter, international registry that contains both clinical and imaging data. The PET scans were processed using QPET software (Cedars-Sinai Medical Center, Los Angeles, CA), while the CT scans were processed using deep learning (DL) to detect coronary artery calcium (CAC). Patients were followed up for the occurrence of major adverse cardiovascular events (MACE), which include death, myocardial infarction, unstable angina, and late revascularization (>90 days from PET). The REFINE PET registry currently contains data for 35,588 patients from 14 sites, with additional patient data and sites anticipated. Comprehensive clinical data (including demographics, medical history, and stress test results) were integrated with more than 2200 imaging variables across 42 categories. The registry is poised to address a broad range of clinical questions, supported by correlating invasive angiography (within 6 months of MPI) in 5972 patients and a total of 9252 major adverse cardiovascular events during a median follow-up of 4.2 years. The REFINE PET registry leverages the integration of clinical, multimodality imaging, and novel quantitative and AI tools to advance the role of PET/CT MPI in diagnosis and risk stratification.

Introduction: Chest CT scans are increasingly used in dyspneic patients where acute heart failure (AHF) is a key differential diagnosis. Interpretation remains challenging and radiology reports are frequently delayed due to a radiologist shortage, although flagging such information for emergency physicians would have therapeutic implication. Artificial intelligence (AI) can be a complementary tool to enhance the diagnostic precision. We aim to develop an explainable AI model to detect radiological signs of AHF in chest CT with an accuracy comparable to thoracic radiologists. Methods: A single-center, retrospective study during 2016-2021 at Copenhagen University Hospital - Bispebjerg and Frederiksberg, Denmark. A Boosted Trees model was trained to predict AHF based on measurements of segmented cardiac and pulmonary structures from acute thoracic CT scans. Diagnostic labels for training and testing were extracted from radiology reports. Structures were segmented with TotalSegmentator. Shapley Additive explanations values were used to explain the impact of each measurement on the final prediction. Results: Of the 4,672 subjects, 49% were female. The final model incorporated twelve key features of AHF and achieved an area under the ROC of 0.87 on the independent test set. Expert radiologist review of model misclassifications found that 24 out of 64 (38%) false positives and 24 out of 61 (39%) false negatives were actually correct model predictions, with the errors originating from inaccuracies in the initial radiology reports. Conclusion: We developed an explainable AI model with strong discriminatory performance, comparable to thoracic radiologists. The AI model's stepwise, transparent predictions may support decision-making.

BackgroundPositron Emission Tomography (PET) myocardial perfusion imaging (MPI) is a powerful tool for predicting coronary artery disease (CAD). Coronary artery calcium (CAC) provides incremental risk stratification to PET-MPI and enhances diagnostic accuracy. We assessed additive value of CAC score, derived from PET/CT attenuation maps to stress TPD results using the novel 18F-flurpiridaz tracer in detecting significant CAD. Methods and ResultsPatients from 18F-flurpiridaz phase III clinical trial who underwent PET/CT MPI with 18F-flurpiridaz tracer, had available CT attenuation correction (CTAC) scans for CAC scoring, and underwent invasive coronary angiography (ICA) within a 6-month period between 2011 and 2013, were included. Total perfusion deficit (TPD) was quantified automatically, and CAC scores from CTAC scans were assessed using artificial intelligence (AI)-derived segmentation and manual scoring. Obstructive CAD was defined as [≥]50% stenosis in Left Main (LM) artery, or 70% or more stenosis in any of the other major epicardial vessels. Prediction performance for CAD was assessed by comparing the area under receiver operating characteristic curve (AUC) for stress TPD alone and in combination with CAC score. Among 498 patients (72% males, median age 63 years) 30.1% had CAD. Incorporating CAC score resulted in a greater AUC: manual scoring (AUC=0.87, 95% Confidence Interval [CI] 0.34-0.90; p=0.015) and AI-based scoring (AUC=0.88, 95%CI 0.85-0.90; p=0.002) compared to stress TPD alone (AUC 0.84, 95% CI 0.80-0.92). ConclusionsCombining automatically derived TPD and CAC score enhances 18F-flurpiridaz PET MPI accuracy in detecting significant CAD, offering a method that can be routinely used with PET/CT scanners without additional scanning or technologist time. CONDENSED ABSTRACTO_ST_ABSBackgroundC_ST_ABSWe assessed the added value of CAC score from hybrid PET/CT CTAC scans combined with stress TPD for detecting significant CAD using novel 18F-flurpiridaz tracer Methods and resultsPatients from the 18F-flurpiridaz phase III clinical trial (n=498, 72% male, median age 63) who underwent PET/CT MPI and ICA within 6-months were included. TPD was quantified automatically, and CAC scores were assessed by AI and manual methods. Adding CAC score to TPD improved AUC for manual (0.87) and AI-based (0.88) scoring versus TPD alone (0.84). ConclusionsCombining TPD and CAC score enhances 18F-flurpiridaz PET MPI accuracy for CAD detection O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=110 SRC="FIGDIR/small/25330013v1_ufig1.gif" ALT="Figure 1"> View larger version (37K): [email protected]@ba93d1org.highwire.dtl.DTLVardef@13eabd9org.highwire.dtl.DTLVardef@1845505_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOGraphical Abstract.C_FLOATNO Overview of the study design. C_FIG