Transperineal ultrasound (TPUS) is a widely used tool for evaluating female pelvic organ prolapse (POP), but its accurate interpretation relies on experience, causing diagnostic variability. This study aims to develop and validate a multi-task deep learning model to automate POP assessment using TPUS images. TPUS images from 1340 female patients (January-June 2023) were evaluated by two experienced physicians. The presence and severity of cystocele, uterine prolapse, rectocele, and excessive mobility of perineal body (EMoPB) were documented. After preprocessing, 1072 images were used for training and 268 for validation. The model used ResNet34 as the feature extractor and four parallel fully connected layers to predict the conditions. Model performance was assessed using confusion matrix and area under the curve (AUC). Gradient-weighted class activation mapping (Grad-CAM) visualized the model's focus areas. The model demonstrated strong diagnostic performance, with accuracies and AUC values as follows: cystocele, 0.869 (95% CI, 0.824-0.905) and 0.947 (95% CI, 0.930-0.962); uterine prolapse, 0.799 (95% CI, 0.746-0.842) and 0.931 (95% CI, 0.911-0.948); rectocele, 0.978 (95% CI, 0.952-0.990) and 0.892 (95% CI, 0.849-0.927); and EMoPB, 0.869 (95% CI, 0.824-0.905) and 0.942 (95% CI, 0.907-0.967). Grad-CAM heatmaps revealed that the model's focus areas were consistent with those observed by human experts. This study presents a multi-task deep learning model for automated POP assessment using TPUS images, showing promising efficacy and potential to benefit a broader population of women.

This study aimed to develop a machine learning model using breast ultrasound images to improve the non-invasive differential diagnosis between Sclerosing Adenosis (SA) and Invasive Ductal Carcinoma (IDC). 2046 ultrasound images from 772 SA and IDC patients were collected, Regions of Interest (ROI) were delineated, and features were extracted. The dataset was split into training and test cohorts, and feature selection was performed by correlation coefficients and Recursive Feature Elimination. 10 classifiers with Grid Search and 5-fold cross-validation were applied during model training. Receiver Operating Characteristic (ROC) curve and Youden index were used to model evaluation. SHapley Additive exPlanations (SHAP) was employed for model interpretation. Another 224 ROIs of 84 patients from other hospitals were used for external validation. For the ROI-level model, XGBoost with 18 features achieved an area under the curve (AUC) of 0.9758 (0.9654-0.9847) in the test cohort and 0.9906 (0.9805-0.9973) in the validation cohort. For the patient-level model, logistic regression with 9 features achieved an AUC of 0.9653 (0.9402-0.9859) in the test cohort and 0.9846 (0.9615-0.9978) in the validation cohort. The feature "Original shape Major Axis Length" was identified as the most important, with its value positively correlated with a higher likelihood of the sample being IDC. Feature contributions for specific ROIs were visualized as well. We developed explainable, ultrasound-based machine learning models with high performance for differentiating SA and IDC, offering a potential non-invasive tool for improved differential diagnosis. Question Accurately distinguishing between sclerosing adenosis (SA) and invasive ductal carcinoma (IDC) in a non-invasive manner has been a diagnostic challenge. Findings Explainable, ultrasound-based machine learning models with high performance were developed for differentiating SA and IDC, and validated well in external validation cohort. Critical relevance These models provide non-invasive tools to reduce misdiagnoses of SA and improve early detection for IDC.

Intraoperative ultrasound scanning is a demanding visuotactile task. It requires operators to simultaneously localise the ultrasound perspective and manually perform slight adjustments to the pose of the probe, making sure not to apply excessive force or breaking contact with the tissue, while also characterising the visible tissue. To analyse the probe-tissue contact, an iterative filtering and topological method is proposed to identify the underlying visible tissue, which can be used to detect acoustic shadow and construct confidence maps of perceptual salience. For evaluation, datasets containing both in vivo and medical phantom data are created. A suite of evaluations is performed, including an evaluation of acoustic shadow classification. Compared to an ablation, deep learning, and statistical method, the proposed approach achieves superior classification on in vivo data, achieving an <math xmlns="http://www.w3.org/1998/Math/MathML"><msub><mi>F</mi> <mi>β</mi></msub> </math> score of 0.864, in comparison with 0.838, 0.808, and 0.808. A novel framework for evaluating the confidence estimation of probe-tissue contact is created. The phantom data are captured specifically for this, and comparison is made against two established methods. The proposed method produced the superior response, achieving an average normalised root-mean-square error of 0.168, in comparison with 1.836 and 4.542. Evaluation is also extended to determine the algorithm's robustness to parameter perturbation, speckle noise, data distribution shift, and capability for guiding a robotic scan. The results of this comprehensive set of experiments justify the potential clinical value of the proposed algorithm, which can be used to support clinical training and robotic ultrasound automation.

This retrospective study aims to develop a deep learning-based approach to whole-body CT segmentation out of standard PSMA-PET-CT to assess body composition in metastatic castration resistant prostate cancer (mCRPC) patients prior to [¹⁷⁷Lu]Lu-PSMA radioligand therapy (RLT). Our goal is to go beyond standard PSMA-PET-based pretherapeutic assessment and identify additional body composition metrics out of the CT-component, with potential prognostic value. We used a deep learning segmentation model to perform fully automated segmentation of different tissue compartments, including visceral- (VAT), subcutaneous- (SAT), intra/intermuscular- adipose tissue (IMAT) from [⁶⁸ Ga]Ga-PSMA-PET-CT scans of n = 86 prostate cancer patients before RLT. The proportions of different adipose tissue compartments to total adipose tissue (TAT) assessed on a 3D CT-volume of the abdomen or on a 2D single slice basis (centered at third lumbal vertebra (L3)) were compared for their prognostic value. First, univariate and multivariate Cox proportional hazards regression analyses were performed. Subsequently, the subjects were dichotomized at the median tissue composition, and these subgroups were evaluated by Kaplan-Meier analysis with the log-rank test. The automated segmentation model was useful for delineating different adipose tissue compartments and skeletal muscle across different patient anatomies. Analyses revealed significant correlations between lower SAT and higher IMAT ratios and poorer therapeutic outcomes in Cox regression analysis (SAT/TAT: p = 0.038; IMAT/TAT: p < 0.001) in the 3D model. In the single slice approach only IMAT/SAT was significantly associated with survival in Cox regression analysis (p < 0.001; SAT/TAT: p > 0.05). IMAT ratio remained an independent predictor of survival in multivariate analysis when including PSMA-PET and blood-based prognostic factors. In this proof-of-principle study the implementation of a deep learning-based whole-body analysis provides a robust and detailed CT-based assessment of body composition in mCRPC patients undergoing RLT. Potential prognostic parameters have to be corroborated in larger prospective datasets.

BackgroundInadequate pharmacologic stress may limit the diagnostic and prognostic accuracy of myocardial perfusion imaging (MPI). The splenic ratio (SR), a measure of stress adequacy, has emerged as a potential imaging biomarker. ObjectivesTo evaluate the prognostic value of artificial intelligence (AI)-derived SR in a large multicenter 82Rb-PET cohort undergoing regadenoson stress testing. MethodsWe retrospectively analyzed 10,913 patients from three sites in the REFINE PET registry with clinically indicated MPI and linked clinical outcomes. SR was calculated using fully automated algorithms as the ratio of splenic uptake at stress versus rest. Patients were stratified by SR into high ([&ge;]90th percentile) and low (<90th percentile) groups. The primary outcome was major adverse cardiovascular events (MACE). Survival analysis was conducted using Kaplan-Meier and Cox proportional hazards models adjusted for clinical and imaging covariates, including myocardial flow reserve (MFR [&ge;]2 vs. <2). ResultsThe cohort had a median age of 68 years, with 57% male patients. Common risk factors included hypertension (84%), dyslipidemia (76%), diabetes (33%), and prior coronary artery disease (31%). Median follow-up was 4.6 years. Patients with high SR (n=1,091) had an increased risk of MACE (HR 1.18, 95% CI 1.06-1.31, p=0.002). Among patients with preserved MFR ([&ge;]2; n=7,310), high SR remained independently associated with MACE (HR 1.44, 95% CI 1.24-1.67, p<0.0001). ConclusionsElevated AI-derived SR was independently associated with adverse cardiovascular outcomes, including among patients with preserved MFR. These findings support SR as a novel, automated imaging biomarker for risk stratification in 82Rb PET MPI. Condensed AbstractAI-derived splenic ratio (SR), a marker of pharmacologic stress adequacy, was independently associated with increased cardiovascular risk in a large 82Rb PET cohort, even among patients with preserved myocardial flow reserve (MFR). High SR identified individuals with elevated MACE risk despite normal perfusion and flow findings, suggesting unrecognized physiologic vulnerability. Incorporating automated SR into PET MPI interpretation may enhance risk stratification and identify patients who could benefit from intensified preventive care, particularly when traditional imaging markers appear reassuring. These findings support SR as a clinically meaningful, easily integrated biomarker in stress PET imaging.

BackgroundPrecise delineation of non-contrast-enhancing tumor (nCET) in glioblastoma (GB) is critical for maximal safe resection, yet routine imaging cannot reliably separate infiltrative tumor from vasogenic edema. The aim of this study was to develop and validate an automated method to identify nCET and assess its prognostic value. MethodsPre-operative T2-weighted and FLAIR MRI from 940 patients with newly diagnosed GB in four multicenter cohorts were analyzed. A deep-learning model segmented enhancing tumor, edema and necrosis; a non-local spatially varying finite mixture model then isolated edema subregions containing nCET. The ratio of nCET to total edema volume--the Diffuse Infiltration Index (DII)--was calculated. Associations between DII and overall survival (OS) were examined with Kaplan-Meier curves and multivariable Cox regression. ResultsThe algorithm distinguished nCET from vasogenic edema in 97.5 % of patients, showing a mean signal-intensity gap > 5 %. Higher DII is able to stratify patients with shorter OS. In the NCT03439332 cohort, DII above the optimal threshold doubled the hazard of death (hazard ratio 2.09, 95 % confidence interval 1.34-3.25; p = 0.0012) and reduced median survival by 122 days. Significant, though smaller, effects were confirmed in GLIOCAT & BraTS (hazard ratio 1.31; p = 0.022), OUS (hazard ratio 1.28; p = 0.007) and in pooled analysis (hazard ratio 1.28; p = 0.0003). DII remained an independent predictor after adjustment for age, extent of resection and MGMT methylation. ConclusionsWe present a reproducible, server-hosted tool for automated nCET delineation and DII biomarker extraction that enables robust, independent prognostic stratification. It promises to guide supramaximal surgical planning and personalized neuro-oncology research and care. Key Points- KP1: Robust automated MRI tool segments non-contrast-enhancing (nCET) glioblastoma. - KP2: Introduced and validated the Diffuse Infiltration Index with prognostic value. - KP3: nCET mapping enables RANO supramaximal resection for personalized surgery. Importance of the StudyThis study underscores the clinical importance of accurately delineating non-contrast-enhancing tumor (nCET) regions in glioblastoma (GB) using standard MRI. Despite their lack of contrast enhancement, nCET areas often harbor infiltrative tumor cells critical for disease progression and recurrence. By integrating deep learning segmentation with a non-local finite mixture model, we developed a reproducible, automated methodology for nCET delineation and introduced the Diffuse Infiltration Index (DII), a novel imaging biomarker. Higher DII values were independently associated with reduced overall survival across large, heterogeneous cohorts. These findings highlight the prognostic relevance of imaging-defined infiltration patterns and support the use of nCET segmentation in clinical decision-making. Importantly, this methodology aligns with and operationalizes recent RANO criteria on supramaximal resection, offering a practical, image-based tool to improve surgical planning. In doing so, our work advances efforts toward more personalized neuro-oncological care, potentially improving outcomes while minimizing functional compromise.

In domain continual medical image segmentation, distillation-based methods mitigate catastrophic forgetting by continuously reviewing old knowledge. However, these approaches often exhibit biases towards both new and old knowledge simultaneously due to confounding factors, which can undermine segmentation performance. To address these biases, we propose the Causality-Adjusted Data Augmentation (CauAug) framework, introducing a novel causal intervention strategy called the Texture-Domain Adjustment Hybrid-Scheme (TDAHS) alongside two causality-targeted data augmentation approaches: the Cross Kernel Network (CKNet) and the Fourier Transformer Generator (FTGen). (1) TDAHS establishes a domain-continual causal model that accounts for two types of knowledge biases by identifying irrelevant local textures (L) and domain-specific features (D) as confounders. It introduces a hybrid causal intervention that combines traditional confounder elimination with a proposed replacement approach to better adapt to domain shifts, thereby promoting causal segmentation. (2) CKNet eliminates confounder L to reduce biases in new knowledge absorption. It decreases reliance on local textures in input images, forcing the model to focus on relevant anatomical structures and thus improving generalization. (3) FTGen causally intervenes on confounder D by selectively replacing it to alleviate biases that impact old knowledge retention. It restores domain-specific features in images, aiding in the comprehensive distillation of old knowledge. Our experiments show that CauAug significantly mitigates catastrophic forgetting and surpasses existing methods in various medical image segmentation tasks. The implementation code is publicly available at: https://github.com/PerceptionComputingLab/CauAug_DCMIS.

ObjectiveTo develop and validate machine learning (ML) models for objective and comprehensive quantification of sagittal craniosynostosis (SCS) severity, enhancing clinical assessment, management, and research.DesignA cross-sectional study that combined the analysis of computed tomography (CT) scans and expert ratings.SettingThe study was conducted at a children's hospital and a major computer imaging institution. Our survey collected expert ratings from participating surgeons.ParticipantsThe study included 195 patients with nonsyndromic SCS, 221 patients with nonsyndromic metopic craniosynostosis (CS), and 178 age-matched controls. Fifty-four craniofacial surgeons participated in rating 20 patients head CT scans.InterventionsComputed tomography scans for cranial morphology assessment and a radiographic diagnosis of nonsyndromic SCS.Main OutcomesAccuracy of the proposed Sagittal Severity Score (SSS) in predicting expert ratings compared to cephalic index (CI). Secondary outcomes compared Likert ratings with SCS status, the predictive power of skull-based versus skin-based landmarks, and assessments of an unsupervised ML model, the Cranial Morphology Deviation (CMD), as an alternative without ratings.ResultsThe SSS achieved significantly higher accuracy in predicting expert responses than CI (<i>P</i> < .05). Likert ratings outperformed SCS status in supervising ML models to quantify within-group variations. Skin-based landmarks demonstrated equivalent predictive power as skull landmarks (<i>P</i> < .05, threshold 0.02). The CMD demonstrated a strong correlation with the SSS (Pearson coefficient: 0.92, Spearman coefficient: 0.90, <i>P</i> < .01).ConclusionsThe SSS and CMD can provide accurate, consistent, and comprehensive quantification of SCS severity. Implementing these data-driven ML models can significantly advance CS care through standardized assessments, enhanced precision, and informed surgical planning.

Patients with recurrent complaints after total knee arthroplasty may suffer from aseptic implant loosening. Current imaging modalities do not quantify looseness of knee arthroplasty components. A recently developed and validated workflow quantifies the tibial component displacement relative to the bone from CT scans acquired under valgus and varus load. The 3D analysis approach includes segmentation and registration of the tibial component and bone. In the current approach, the semi-automatic segmentation requires user interaction, adding complexity to the analysis. The research question is whether the segmentation step can be fully automated while keeping outcomes indifferent. In this study, different deep-learning (DL) models for fully automatic segmentation are proposed and evaluated. For this, we employ three different datasets for model development (20 cadaveric CT pairs and 10 cadaveric CT scans) and evaluation (72 patient CT pairs). Based on the performance on the development dataset, the final model was selected, and its predictions replaced the semi-automatic segmentation in the current approach. Implant displacement was quantified by the rotation about the screw-axis, maximum total point motion, and mean target registration error. The displacement parameters of the proposed approach showed a statistically significant difference between fixed and loose samples in a cadaver dataset, as well as between asymptomatic and loose samples in a patient dataset, similar to the outcomes of the current approach. The methodological error calculated on a reproducibility dataset showed values that were not statistically significant different between the two approaches. The results of the proposed and current approaches showed excellent reliability for one and three operators on two datasets. The conclusion is that a full automation in knee implant displacement assessment is feasible by utilizing a DL-based segmentation model while maintaining the capability of distinguishing between fixed and loose implants.

Automated detection and segmentation of surgical devices, such as catheters or wires, in X-ray fluoroscopic images have the potential to enhance image guidance in minimally invasive heart surgeries. In this paper, we present a convolutional neural network model that integrates a resnet architecture with multiple prediction heads to achieve real-time, accurate localization of electrodes on catheters and catheter segmentation in an end-to-end deep learning framework. We also propose a multi-task learning strategy in which our model is trained to perform both accurate electrode detection and catheter segmentation simultaneously. A key challenge with this approach is achieving optimal performance for both tasks. To address this, we introduce a novel multi-level dynamic resource prioritization method. This method dynamically adjusts sample and task weights during training to effectively prioritize more challenging tasks, where task difficulty is inversely proportional to performance and evolves throughout the training process. The proposed method has been validated on both public and private datasets for single-task catheter segmentation and multi-task catheter segmentation and detection. The performance of our method is also compared with existing state-of-the-art methods, demonstrating significant improvements, with a mean <math xmlns="http://www.w3.org/1998/Math/MathML"><mi>J</mi></math> of 64.37/63.97 and with average precision over all IoU thresholds of 84.15/83.13, respectively, for detection and segmentation multi-task on the validation and test sets of the catheter detection and segmentation dataset. Our approach achieves a good balance between accuracy and efficiency, making it well-suited for real-time surgical guidance applications.