To develop and validate a deep learning model for automated 3D segmentation of rotator cuff muscles on longitudinal CT scans to quantify muscle volume and fat fraction in patients undergoing total shoulder arthroplasty (TSA). The proposed segmentation models adopted DeepLabV3 + with ResNet50 as the backbone. The models were trained, validated, and tested on preoperative or minimum 2-year follow-up CT scans from 53 TSA subjects. 3D Dice similarity scores, average symmetric surface distance (ASSD), 95th percentile Hausdorff distance (HD95), and relative absolute volume difference (RAVD) were used to evaluate the model performance on hold-out test sets. The trained models were applied to a cohort of 172 patients to quantify rotator cuff muscle volumes and fat fractions across preoperative and minimum 2- and 5-year follow-ups. Compared to the ground truth, the models achieved mean Dice of 0.928 and 0.916, mean ASSD of 0.844 mm and 1.028 mm, mean HD95 of 3.071 mm and 4.173 mm, and mean RAVD of 0.025 and 0.068 on the hold-out test sets for the pre-operative and the minimum 2-year follow-up CT scans, respectively. This study developed accurate and reliable deep learning models for automated 3D segmentation of rotator cuff muscles on clinical CT scans in TSA patients. These models substantially reduce the time required for muscle volume and fat fraction analysis and provide a practical tool for investigating how rotator cuff muscle health relates to surgical outcomes. This has the potential to inform patient selection, rehabilitation planning, and surgical decision-making in TSA and RCR.

Lung cancer (LC) is one of the leading causes of cancer related deaths worldwide and early recognition is critical for enhancing patient outcomes. However, existing LC detection techniques face challenges such as high computational demands, complex data integration, scalability limitations, and difficulties in achieving rigorous clinical validation. This research proposes an Enhanced Hyper Tuning Deep Learning (EHTDL) model utilizing bioinspired algorithms to overcome these limitations and improve accuracy and efficiency of LC detection and classification. The methodology begins with the Smooth Edge Enhancement (SEE) technique for preprocessing CT images, followed by feature extraction using GLCM-based Texture Analysis. To refine the features and reduce dimensionality, a Hybrid Feature Selection approach combining Grey Wolf optimization (GWO) and Differential Evolution (DE) is employed. Precise lung segmentation is performed using Mask R-CNN to ensure accurate delineation of lung regions. A Deep Fractal Edge Classifier (DFEC) is introduced, consisting of five fractal blocks with convolutional layers and pooling to progressively learn LC characteristics. The proposed EHTDL model achieves remarkable performance metrics, including 99% accuracy, 100% precision, 98% recall, and 99% <i>F</i>1-score, demonstrating its robustness and effectiveness. The model's scalability and efficiency make it suitable for real-time clinical application offering a promising solution for early LC detection and significantly enhancing patient care.

Complete tumour removal is vital in curative breast cancer (BCa) surgery to prevent recurrence. Recently, [¹⁸F]FDG micro-PET-CT of lumpectomy specimens has shown promise for intraoperative margin assessment (IMA). To aid interpretation, we trained a 2D Residual U-Net to delineate invasive carcinoma of no special type in micro-PET-CT lumpectomy images. We collected 53 BCa lamella images from 19 patients with true histopathology-defined tumour segmentations. Group five-fold cross-validation yielded a dice similarity coefficient of 0.71 ± 0.20 for segmentation. Afterwards, an ensemble model was generated to segment tumours and predict margin status. Comparing predicted and true histopathological margin status in a separate set of 31 micro-PET-CT lumpectomy images of 31 patients achieved an F1 score of 84%, closely matching the mean performance of seven physicians who manually interpreted the same images. This model represents an important step towards a decision-support system that enhances micro-PET-CT-based IMA in BCa, facilitating its clinical adoption.

Optic disc and cup segmentation is a crucial subfield of computer vision, playing a pivotal role in automated pathological image analysis. It enables precise, efficient, and automated diagnosis of ocular conditions, significantly aiding clinicians in real-world medical applications. However, due to the scarcity of medical segmentation data and the insufficient integration of global contextual information, the segmentation accuracy remains suboptimal. This issue becomes particularly pronounced in optic disc and cup cases with complex anatomical structures and ambiguous boundaries.In order to address these limitations, this paper introduces a self-supervised training strategy integrated with a newly designed network architecture to improve segmentation accuracy.Specifically,we initially propose a non-local dual deformable convolutional block,which aims to capture the irregular image patterns(i.e. boundary).Secondly,we modify the traditional vision transformer and design an adaptive K-Nearest Neighbors(KNN) transformation block to extract the global semantic context from images. Finally,an initialization strategy based on self-supervised training is proposed to reduce the burden on the network on labeled data.Comprehensive experimental evaluations demonstrate the effectiveness of our proposed method, which outperforms previous networks and achieves state-of-the-art performance,with IOU scores of 0.9577 for the optic disc and 0.8399 for the optic cup on the REFUGE dataset.

Decreased kidney volume is a sign of renal aging and/or decreased vascularization. The aim of this study was to determine whether renal volume changes 24 months after exclusion of an abdominal aortic aneurysm (AAA), and to compare fenestrated (FEVAR) and subrenal (EVAR) stents. Retrospective single-center study from a prospective registry, including patients between 60 and 80 years with normal preoperative renal function (eGFR≥60 ml/min/1.73 m^-2) who underwent fenestrated (FEVAR) or infrarenal (EVAR) stent grafts between 2015 and 2021. Patients had to have had an CT scan at 24 months of the study to be included. Exclusion criteria were renal branches, the presence of preoperative renal insufficiency, a single kidney, embolization or coverage of an accessory renal artery, occlusion of a renal artery during follow-up and mention of AAA rupture. Renal volume was measured using sizing software (EndoSize, therenva) based on fully automatic deep-learning segmentation of several anatomical structures (arterial lumen, bone structure, thrombus, heart, etc.), including the kidneys. In the presence of renal cysts, these were manually excluded from the segmentation. Forty-eight patients were included (24 EVAR vs. 24 FEVAR), 96 kidneys were segmented. There was no difference between groups in age (78.9±6.7 years vs. 69.4±6.8, p=0.89), eGFR 85.8 ± 12.4 [62-107] ml/min/1.73 m^-2 vs. 81 ± 16.2 [42-107] (p=0.36), and renal volume 170.9 ± 29.7 [123-276] mL vs. 165.3 ± 37.4 [115-298] (p=0.12). At 24 months in the EVAR group, there was a non-significant reduction in eGFR 84.1 ± 17.2 [61-128] ml/min/1.73 m^-2 vs. 81 ± 16.2 [42-107] (p=0.36) or renal volume 170.9 ± 29.7 [123-276] mL vs. 165.3 ± 37.4 [115-298] (p=0.12). In the FEVAR group, at 24 months there was a non-significant fall in eGFR 84.1 ± 17.2 [61-128] ml/min/1.73 m^-2 vs. 73.8 ± 21.4 [40-110] (p=0.09), while renal volume decreased significantly 182 ± 37.8 [123-293] mL vs. 158.9 ± 40.2 [45-258] (p=0.007). In this study, there appears to be a significant decrease in renal volume without a drop in eGFR 24 months after fenestrated stenting. This decrease may reflect changes in renal perfusion and could potentially be predictive of long-term renal impairment, although this cannot be confirmed within the limits of this small sample. Further studies with long-term follow-up are needed.

To treat Trochlear Dysplasia (TD), current approaches rely mainly on low-resolution clinical Magnetic Resonance (MR) scans and surgical intuition. The surgeries are planned based on surgeons experience, have limited adoption of minimally invasive techniques, and lead to inconsistent outcomes. We propose a pipeline that generates super-resolved, patient-specific 3D pseudo-healthy target morphologies from conventional clinical MR scans. First, we compute an isotropic super-resolved MR volume using an Implicit Neural Representation (INR). Next, we segment femur, tibia, patella, and fibula with a multi-label custom-trained network. Finally, we train a Wavelet Diffusion Model (WDM) to generate pseudo-healthy target morphologies of the trochlear region. In contrast to prior work producing pseudo-healthy low-resolution 3D MR images, our approach enables the generation of sub-millimeter resolved 3D shapes compatible for pre- and intraoperative use. These can serve as preoperative blueprints for reshaping the femoral groove while preserving the native patella articulation. Furthermore, and in contrast to other work, we do not require a CT for our pipeline - reducing the amount of radiation. We evaluated our approach on 25 TD patients and could show that our target morphologies significantly improve the sulcus angle (SA) and trochlear groove depth (TGD). The code and interactive visualization are available at https://wehrlimi.github.io/sr-3d-planning/.

Intravascular ultrasound (IVUS)-based tissue characterization has been used to detect vulnerable plaque or lipid-rich plaque (LRP). Recently, advancements in artificial intelligence (AI) technology have enabled automated coronary arterial plaque segmentation and tissue characterization. The purpose of this study was to evaluate the feasibility and diagnostic accuracy of a deep learning model for plaque segmentation, tissue characterization and identification of LRP. A total of 1,098 IVUS images from 67 patients who underwent IVUS-guided percutaneous coronary intervention were selected for the training group, while 1,100 IVUS images from 100 vessels (88 patients) were used for the validation group. A 7-layer U-Net ++ was applied for automated coronary artery segmentation and tissue characterization. Segmentation and quantification of the external elastic membrane (EEM), lumen and guidewire artifact were performed and compared with manual measurements. Plaque tissue characterization was conducted using integrated backscatter (IB)-IVUS as the gold standard. LRP was defined as %lipid area of ≥65 %. The deep learning model accurately segmented EEM and lumen. AI-predicted %lipid area (R = 0.90, P < 0.001), % fibrosis area (R = 0.89, P < 0.001), %dense fibrosis area (R = 0.81, P < 0.001) and % calcification area (R = 0.89, P < 0.001), showed strong correlation with IB-IVUS measurements. The model predicted LRP with a sensitivity of 62 %, specificity of 94 %, positive predictive value of 69 %, negative predictive value of 92 % and an area under the receiver operating characteristic curve of 0.919 (95 % CI:0.902-0.934), respectively. The deep-learning model demonstrated accurate automatic segmentation and tissue characterization of human coronary arteries, showing promise for identifying LRP.

Clinical magnetic resonance imaging (MRI) is a high-resolution tool widely used for detailed anatomical imaging. However, prolonged scan times often lead to motion artefacts and patient discomfort. Fast acquisition techniques can reduce scan times but often produce noisy, low-contrast images, compromising segmentation accuracy essential for diagnosis and treatment planning. To address these limitations, we developed an end-to-end framework that incorporates BIDS-based data organiser and anonymizer, a GAN-based MR image enhancement model (GAN-MRI), AssemblyNet for brain region segmentation, and an attention-residual U-Net with Guided loss for abdominal and thigh segmentation. Thirty brain scans (5,400 slices) and 32 abdominal (1,920 slices) and 55 thigh scans (2,200 slices) acquired from multiple MRI scanners (GE, Siemens, Toshiba) underwent evaluation. Image quality improved significantly, with SNR and CNR for brain scans increasing from 28.44 to 42.92 (p < 0.001) and 11.88 to 18.03 (p < 0.001), respectively. Abdominal scans exhibited SNR increases from 35.30 to 50.24 (p < 0.001) and CNR from 10,290.93 to 93,767.22 (p < 0.001). Double-blind evaluations highlighted improved visualisations of anatomical structures and bias field correction. Segmentation performance improved substantially in the thigh (muscle: + 21%, IMAT: + 9%) and abdominal regions (SSAT: + 1%, DSAT: + 2%, VAT: + 12%), while brain segmentation metrics remained largely stable, reflecting the robustness of the baseline model. Proposed framework is designed to handle data from multiple anatomies with variations from different MRI scanners and centres by enhancing MRI scan and improving segmentation accuracy, diagnostic precision and treatment planning while reducing scan times and maintaining patient comfort.

Accurate thyroid volume assessment is critical in thyroid disease diagnostics, yet conventional high-resolution 2D ultrasound has limitations. Freehand 3D ultrasound with AI-assisted segmentation presents a potential advancement, but its clinical accuracy requires validation. This prospective clinical trial included 14 patients scheduled for total thyroidectomy. Preoperative thyroid volume was measured using both 2D ultrasound (ellipsoid method) and freehand 3D ultrasound with AI segmentation. Postoperative thyroid volume, determined via the water displacement method, served as the reference standard. The median postoperative thyroid volume was 14.8 mL (IQR 8.8-20.2). The median volume difference was 1.7 mL (IQR 1.2-3.3) for 3D ultrasound and 3.6 mL (IQR 2.3-6.6) for 2D ultrasound (p = 0.02). The inter-operator reliability coefficient for 3D ultrasound was 0.986 (p < 0.001). These findings suggest that freehand 3D ultrasound with AI-assisted segmentation provides superior accuracy and reproducibility compared to 2D ultrasound and may enhance clinical thyroid volume assessment. ClinicalTrials.gov identifier: NCT05510609.

To assess the feasibility and accuracy of a deep learning (DL) model to identify acute middle cerebral artery (MCA) occlusion using high resolution non-contrast CT (NCCT) imaging data. In this study, a total of 4,648 consecutive exams (July 2021 to December 2023) were retrospectively used for model training and validation, while an additional 1,011 consecutive exams (January 2024 to August 2024) were used for independent testing. Using high-resolution NCCT acquired at 1.0 mm slice thickness or less, MCA thrombus was labeled using same day CTA as ground-truth. A 3D DL model was trained for per-voxel thrombus segmentation, with the sum of positive voxels used to estimate likelihood of acute MCA occlusion. For detection of MCA M1 segment acute occlusion, the model yielded an AUROC of 0.952 [0.904 -1.00], accuracy of 93.6%[88.1 -98.2], sensitivity of 90.9% [83.1 -100], and specificity of 93.6% [88.0 -98.3]. Inclusion of M2 segment occlusions reduced performance only slightly, yielding an AUROC of 0.884 [0.825 -0.942], accuracy of 93.2% [85.1 -97.2], sensitivity of 77.4% [69.3 92.2], and specificity of 93.6% [85.1 -97.8]. A DL model can detect acute MCA occlusion from high resolution NCCT with accuracy approaching that of CTA. Using this tool, a majority of candidate thrombectomy patients may be identified with NCCT alone, which could aid stroke triage in settings that lack CTA or are otherwise resource constrained. DL＝ deep learning.