Automated 3D CT diagnosis empowers clinicians to make timely, evidence-based decisions by enhancing diagnostic accuracy and workflow efficiency. While multimodal large language models (MLLMs) exhibit promising performance in visual-language understanding, existing methods mainly focus on 2D medical images, which fundamentally limits their ability to capture complex 3D anatomical structures. This limitation often leads to misinterpretation of subtle pathologies and causes diagnostic hallucinations. In this paper, we present Hybrid Spatial Encoding Network (HSENet), a framework that exploits enriched 3D medical visual cues by effective visual perception and projection for accurate and robust vision-language understanding. Specifically, HSENet employs dual-3D vision encoders to perceive both global volumetric contexts and fine-grained anatomical details, which are pre-trained by dual-stage alignment with diagnostic reports. Furthermore, we propose Spatial Packer, an efficient multimodal projector that condenses high-resolution 3D spatial regions into a compact set of informative visual tokens via centroid-based compression. By assigning spatial packers with dual-3D vision encoders, HSENet can seamlessly perceive and transfer hybrid visual representations to LLM's semantic space, facilitating accurate diagnostic text generation. Experimental results demonstrate that our method achieves state-of-the-art performance in 3D language-visual retrieval (39.85% of R@100, +5.96% gain), 3D medical report generation (24.01% of BLEU-4, +8.01% gain), and 3D visual question answering (73.60% of Major Class Accuracy, +1.99% gain), confirming its effectiveness. Our code is available at https://github.com/YanzhaoShi/HSENet.

Supervised machine learning has enabled accurate pathology detection in brain MRI, but requires training data from diseased subjects that may not be readily available in some scenarios, for example, in the case of rare diseases. Reconstruction-based unsupervised anomaly detection, in particular using diffusion models, has gained popularity in the medical field as it allows for training on healthy images alone, eliminating the need for large disease-specific cohorts. These methods assume that a model trained on normal data cannot accurately represent or reconstruct anomalies. However, this assumption often fails with models failing to reconstruct healthy tissue or accurately reconstruct abnormal regions i.e., failing to remove anomalies. In this work, we introduce a novel conditional diffusion model framework for anomaly detection and healthy image reconstruction in brain MRI. Our weakly supervised approach integrates synthetically generated pseudo-pathology images into the modeling process to better guide the reconstruction of healthy images. To generate these pseudo-pathologies, we apply fluid-driven anomaly randomization to augment real pathology segmentation maps from an auxiliary dataset, ensuring that the synthetic anomalies are both realistic and anatomically coherent. We evaluate our model's ability to detect pathology, using both synthetic anomaly datasets and real pathology from the ATLAS dataset. In our extensive experiments, our model: (i) consistently outperforms variational autoencoders, and conditional and unconditional latent diffusion; and (ii) surpasses on most datasets, the performance of supervised inpainting methods with access to paired diseased/healthy images.

Latent diffusion models (LDM) could alleviate data scarcity challenges affecting machine learning development for medical imaging. However, medical LDM training typically relies on performance- or scientific accessibility-limiting strategies including a reliance on short-prompt text encoders, the reuse of non-medical LDMs, or a requirement for fine-tuning with large data volumes. We propose a Class-Conditioned Efficient Large Language model Adapter (CCELLA) to address these limitations. CCELLA is a novel dual-head conditioning approach that simultaneously conditions the LDM U-Net with non-medical large language model-encoded text features through cross-attention and with pathology classification through the timestep embedding. We also propose a joint loss function and a data-efficient LDM training framework. In combination, these strategies enable pathology-conditioned LDM training for high-quality medical image synthesis given limited data volume and human data annotation, improving LDM performance and scientific accessibility. Our method achieves a 3D FID score of 0.025 on a size-limited prostate MRI dataset, significantly outperforming a recent foundation model with FID 0.071. When training a classifier for prostate cancer prediction, adding synthetic images generated by our method to the training dataset improves classifier accuracy from 69% to 74%. Training a classifier solely on our method's synthetic images achieved comparable performance to training on real images alone.

Using radio signals from a magnetic field, magnetic resonance imaging (MRI) represents a medical procedure that produces images to provide more information than typical scans. Diagnosing brain tumors from MRI is difficult because of the wide range of tumor shapes, areas, and visual features, thus universal and automated system to handle this task is required. Among the best deep learning methods, the U-Net architecture is the most widely used in diagnostic medical images. Therefore, U-Net-based attention is the most effective automated model in medical image segmentation dealing with various modalities. The self-attention structures that are used in the U-Net design allow for fast global preparation and better feature visualization. This research aims to study the progress of U-Net design and show how it improves the performance of brain tumor segmentation. We have investigated three U-Net designs (standard U-Net, Attention U-Net, and self-attention U-Net) for five epochs to find the last segmentation. An MRI image dataset that includes 3064 images from the Kaggle website is used to give a more comprehensive overview. Also, we offer a comparison with several studies that are based on U-Net structures to illustrate the evolution of this network from an accuracy standpoint. U-Net-based self-attention has demonstrated superior performance compared to other studies because self-attention can enhance segmentation quality, particularly for unclear structures, by concentrating on the most significant parts. Four main metrics are applied with a loss function of 5.03 %, a validation loss function of 4.82 %, a validation accuracy of 98.49 %, and an accuracy of 98.45 %.

Prostate cancer (PCa) is one of the most common cancers among men, and artificial intelligence (AI) is emerging as a promising tool to enhance its diagnosis. This work proposes a classification approach for PCa cases using deep learning techniques. We conducted a comparison between unimodal models based either on biparametric magnetic resonance imaging (bpMRI) or clinical data (such as prostate-specific antigen levels, prostate volume, and age). We also introduced a bimodal model that simultaneously integrates imaging and clinical data to address the limitations of unimodal approaches. Furthermore, we propose a framework that not only detects the presence of PCa but also evaluates the uncertainty associated with the predictions. This approach makes it possible to identify highly confident predictions and distinguish them from those characterized by uncertainty, thereby enhancing the reliability and applicability of automated medical decisions in clinical practice. The results show that the bimodal model significantly improves performance, with an area under the curve (AUC) reaching 0.82±0.03, a sensitivity of 0.73±0.04, while maintaining high specificity. Uncertainty analysis revealed that the bimodal model produces more confident predictions, with an uncertainty accuracy of 0.85, surpassing the imaging-only model (which is 0.71). This increase in reliability is crucial in a clinical context, where precise and dependable diagnostic decisions are essential for patient care. The integration of clinical data with imaging data in a bimodal model not only improves diagnostic performance but also strengthens the reliability of predictions, making this approach particularly suitable for clinical use.

Small cell lung cancer (SCLC) is aggressive with poor survival outcomes, and most patients develop resistance to chemotherapy. No predictive biomarkers currently guide therapy. This study evaluates radiomic features to predict PFS and OS in limited-stage SCLC (LS-SCLC) and assesses PFS, OS, and the added benefit of chemoimmunotherapy (CHIO) in extensive-stage SCLC (ES-SCLC). A total of 660 SCLC patients (470 ES-SCLC, 190 LS-SCLC) from three sites were analyzed. LS-SCLC patients received chemotherapy and radiation, while ES-SCLC patients received either chemotherapy alone or chemoimmunotherapy. Radiomic and quantitative vasculature tortuosity features were extracted from CT scans. A LASSO-Cox regression model was used to construct the ES- Risk-Score (ESRS) and LS- Risk-Score (LSRS). ESRS was associated with PFS in training (HR = 1.54, adj. P = .0013) and validation sets (HR = 1.32, adj. P = .0001; HR = 2.4, adj. P = .0073) and with OS in training (HR = 1.37, adj. P = .0054) and validation sets (HR = 1.35, adj. P < .0006; HR = 1.6, adj. P < .0085) in ES-SCLC patients treated with chemotherapy. High-risk patients had improved PFS (HR = 0.68, adj. P < .001) and OS (HR = 0.78, adj. P = .026) with chemoimmunotherapy. LSRS was associated with PFS in training and validation sets (HR = 1.9, adj. P = .007; HR = 1.4, adj. P = .0098; HR = 2.1, adj. P = .028) in LS-SCLC patients receiving chemoradiation. Radiomics is prognostic for PFS and OS and predicts chemoimmunotherapy benefit in high-risk ES-SCLC patients.

Magnetic resonance angiography (MRA) is an important tool for aortic assessment in several cardiovascular diseases. Assessment of MRA images relies on manual segmentation; a time-intensive process that is subject to operator variability. We aimed to optimize and validate two deep-learning models for automatic segmentation of the aortic lumen and vessel wall in high-resolution ECG-triggered free-breathing respiratory motion-corrected 3D bright- and black-blood MRA images. Manual segmentation, serving as the ground truth, was performed on 25 bright-blood and 15 black-blood 3D MRA image sets acquired with the iT2PrepIR-BOOST sequence (1.5T) in thoracic aortopathy patients. The training was performed with nnU-Net for bright-blood (lumen) and black-blood image sets (lumen and vessel wall). Training consisted of a 70:20:10% training: validation: testing split. Inference was run on datasets (single vendor) from different centres (UK, Spain, and Australia), sequences (iT2PrepIR-BOOST, T2 prepared CMRA, and TWIST MRA), acquired resolutions (from 0.9 mm³ to 3 mm³), and field strengths (0.55T, 1.5T, and 3T). Predictive measurements comprised Dice Similarity Coefficient (DSC), and Intersection over Union (IoU). Postprocessing (3D slicer) included centreline extraction, diameter measurement, and curved planar reformatting (CPR). The optimal configuration was the 3D U-Net. Bright blood segmentation at 1.5T on iT2PrepIR-BOOST datasets (1.3 and 1.8 mm³) and 3D CMRA datasets (0.9 mm³) resulted in DSC ≥ 0.96 and IoU ≥ 0.92. For bright-blood segmentation on 3D CMRA at 0.55T, the nnUNet achieved DSC and IoU scores of 0.93 and 0.88 at 1.5 mm³, and 0.68 and 0.52 at 3.0 mm³, respectively. DSC and IoU scores of 0.89 and 0.82 were obtained for CMRA image sets (1 mm³) at 1.5T (Barcelona dataset). DSC and IoU score of the BRnnUNet model were 0.90 and 0.82 respectively for the contrast-enhanced dataset (TWIST MRA). Lumen segmentation on black blood 1.5T iT2PrepIR-BOOST image sets achieved DSC ≥ 0.95 and IoU ≥ 0.90, and vessel wall segmentation resulted in DSC ≥ 0.80 and IoU ≥ 0.67. Automated centreline tracking, diameter measurement and CPR were successfully implemented in all subjects. Automated aortic lumen and wall segmentation on 3D bright- and black-blood image sets demonstrated excellent agreement with ground truth. This technique demonstrates a fast and comprehensive assessment of aortic morphology with great potential for future clinical application in various cardiovascular diseases.

Neoadjuvant therapy (NAT) is the standard treatment strategy for MRI-defined cT4 rectal cancer. Predicting tumor regression can guide the resection plane to some extent. Here, we covered pre-treatment MRI imaging of 363 cT4 rectal cancer patients receiving NAT and radical surgery from three hospitals: Center 1 (n = 205), Center 2 (n = 109) and Center 3 (n = 52). We propose a machine learning model named RCMIX, which incorporates a multilayer perceptron algorithm based on 19 pre-treatment MRI radiomic features and 2 clinical features in cT4 rectal cancer patients receiving NAT. The model was trained on 205 cases of cT4 rectal cancer patients, achieving an AUC of 0.903 (95% confidence interval, 0.861-0.944) in predicting T-downstage. It also achieved AUC of 0.787 (0.699-0.874) and 0.773 (0.646-0.901) in two independent test cohorts, respectively. cT4 rectal cancer patients who were predicted as Well T-downstage by the RCMIX model had significantly better disease-free survival than those predicted as Poor T-downstage. Our study suggests that the RCMIX model demonstrates satisfactory performance in predicting T-downstage by NAT for cT4 rectal cancer patients, which may provide critical insights to improve surgical strategies.

Fully automated, artificial intelligence (AI) -based software has recently become available for scalable body composition analysis. Prior to broad application in the clinical arena, validation studies are needed. Our goal was to compare the results of a fully automated, AI-based software with a semi-automatic software in a sample of hospitalized patients. A diverse group of patients with Coronovirus-2 (COVID-19) and evaluable computed tomography (CT) images were included in this retrospective cohort. Our goal was to compare multiple aspects of body composition procuring results from fully automated and semi-automated body composition software. Bland-Altman analyses and correlation coefficients were used to calculate average bias and trend of bias for skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and total adipose tissue (TAT-the sum of SAT, VAT, and IMAT). A total of 141 patients (average (standard deviation (SD)) age of 58.2 (18.9), 61% male, and 31% White Non-Hispanic, 31% Black Non-Hispanic, and 33% Hispanic) contributed to the analysis. Average bias (mean ± SD) was small (in comparison to the SD) and negative for SM (-3.79 cm² ± 7.56 cm²) and SAT (-7.06 cm² ± 19.77 cm²), and small and positive for VAT (2.29 cm² ± 15.54 cm²). A large negative bias was observed for IMAT (-7.77 cm² ± 5.09 cm²), where fully automated software underestimated intramuscular tissue quantity relative to the semi-automated software. The discrepancy in IMAT calculation was not uniform across its range given a correlation coefficient of -0.625; as average IMAT increased, the bias (underestimation by fully automated software) was greater. When compared to a semi-automated software, a fully automated, AI-based software provides consistent findings for key CT body composition measures (SM, SAT, VAT, TAT). While our findings support good overall agreement as evidenced by small biases and limited outliers, additional studies are needed in other clinical populations to further support validity and advanced precision, especially in the context of body composition and malnutrition assessment.

Artificial intelligence (AI) enhances diagnostic accuracy, efficiency, and patient outcomes in radiology. Patient acceptance is essential for successful integration. This study examines patient perspectives on AI in radiology within the UAE, focusing on their knowledge, attitudes, and perceived barriers. Understanding these factors can address concerns, improve trust, and guide patient-centered AI implementation. The findings aim to support effective AI adoption in healthcare. A cross-sectional study involving 205 participants undergoing radiological imaging in the UAE. Data was collected through an online questionnaire, developed based on a literature review, and pre-tested for reliability and validity. Non-probability sampling methods, including convenience and snowball sampling, were employed. The questionnaire assessed participants' knowledge, attitudes, and perceived barriers regarding AI in radiology. Data was analyzed, and categorical variables were expressed as frequencies and percentages. Most participants (89.8 %) believed AI could improve diagnostic accuracy, and 87.8 % acknowledged its role in prioritizing urgent cases. However, only 22 % had direct experience with AI in radiology. While 81 % expressed comfort with AI-based technology, concerns about data security (80.5 %), lack of empathy in AI systems (82.9 %), and insufficient information about AI (85.8 %) were significant barriers. Additionally, (87.3 %) of participants were concerned about the cost of AI implementation. Despite these concerns, 86.3 % believed AI could improve the quality of radiological services, and 83.9 % were satisfied with its potential applications. UAE patients generally support AI in radiology, recognizing its potential for improved diagnostic accuracy. However, concerns about data security, empathy, and understanding of AI technologies necessitate improved patient education, transparent communication, and regulatory frameworks to foster trust and acceptance.