Medicine is one of the most sensitive fields in which artificial intelligence (AI) is extensively used, spanning from medical image analysis to clinical support. Specifically, in medicine, where every decision may severely affect human lives, the issue of ensuring that AI systems operate ethically and produce results that align with ethical considerations is of great importance. In this work, we investigate the combination of several key parameters on the performance of artificial neural networks (ANNs) used for medical image analysis in the presence of data corruption or errors. For this purpose, we examined five different ANN architectures (AlexNet, LeNet 5, VGG16, ResNet-50, and Vision Transformers - ViT), and for each architecture, we checked its performance under varying combinations of training dataset sizes and percentages of images that are corrupted through mislabeling. The image mislabeling simulates deliberate or nondeliberate changes to the dataset, which may cause the AI system to produce unreliable results. We found that the five ANN architectures produce different results for the same task, both for cases with and without dataset modification, which implies that the selection of which ANN architecture to implement may have ethical aspects that need to be considered. We also found that label corruption resulted in a mixture of performance metrics tendencies, indicating that it is difficult to conclude whether label corruption has occurred. Our findings demonstrate the relation between ethics in AI and ANN architecture implementation and AI computational parameters used therefor, and raise awareness of the need to find appropriate ways to determine whether label corruption has occurred.

Gliomas exhibit a high recurrence rate, particularly in the peritumoural brain zone after surgery. This study aims to develop and validate a radiomics-based model using preoperative fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced (T1-CE) magnetic resonance imaging (MRI) sequences to predict glioma recurrence within specific quadrants of the surgical margin. In this retrospective study, 149 patients with confirmed glioma recurrence were included. 23 cases of data from Guizhou Medical University were used as a test set, and the remaining data were randomly used as a training set (70%) and a validation set (30%). Two radiologists from the research group established a Cartesian coordinate system centred on the tumour, based on FLAIR and T1-CE MRI sequences, dividing the tumour into four quadrants. Recurrence in each quadrant after surgery was assessed, categorising preoperative tumour quadrants as recurrent and non-recurrent. Following the division of tumours into quadrants and the removal of outliers, These quadrants were assigned to a training set (105 non-recurrence quadrants and 226 recurrence quadrants), a verification set (45 non-recurrence quadrants and 97 recurrence quadrants) and a test set (16 non-recurrence quadrants and 68 recurrence quadrants). Imaging features were extracted from preoperative sequences, and feature selection was performed using least absolute shrinkage and selection operator. Machine learning models included support vector machine, random forest, extra trees, and XGBoost. Clinical efficacy was evaluated through model calibration and decision curve analysis. The fusion model, which combines features from FLAIR and T1-CE sequences, exhibited higher predictive accuracy than single-modality models. Among the models, the LightGBM model demonstrated the highest predictive accuracy, with an area under the curve of 0.906 in the training set, 0.832 in the validation set and 0.805 in the test set. The study highlights the potential of a multimodal radiomics approach for predicting glioma recurrence, with the fusion model serving as a robust tool for clinical decision-making.

Enhancing the accuracy of tumor response predictions enables the development of tailored therapeutic strategies for patients with breast cancer. In this study, we developed deep radiomic models to enhance the prediction of chemotherapy response after the first treatment cycle. 18F-Fludeoxyglucose PET/CT imaging data and clinical record from 60 breast cancer patients were retrospectively obtained from the Cancer Imaging Archive. PET/CT scans were conducted at three distinct stages of treatment; prior to the initiation of chemotherapy (T1), following the first cycle of chemotherapy (T2), and after the full chemotherapy regimen (T3). The patient's primary gross tumor volume (GTV) was delineated on PET images using a 40% threshold of the maximum standardized uptake value (SUVmax). Radiomic features were extracted from the GTV based on the PET/CT images. In addition, a squeeze-and-excitation network (SENet) deep learning model was employed to generate additional features from the PET/CT images for combined analysis. A XGBoost machine learning model was developed and compared with the conventional machine learning algorithm [random forest (RF), logistic regression (LR) and support vector machine (SVM)]. The performance of each model was assessed using receiver operating characteristics area under the curve (ROC AUC) analysis, and prediction accuracy in a validation cohort. Model performance was evaluated through fivefold cross-validation on the entire cohort, with data splits stratified by treatment response categories to ensure balanced representation. The AUC values for the machine learning models using only radiomic features were 0.85(XGBoost), 0.76 (RF), 0.80 (LR), and 0.59 (SVM), with XGBoost showing the best performance. After incorporating additional deep learning-derived features from SENet, the AUC values increased to 0.92, 0.88, 0.90, and 0.61, respectively, demonstrating significant improvements in predictive accuracy. Predictions were based on pre-treatment (T1) and post-first-cycle (T2) imaging data, enabling early assessment of chemotherapy response after the initial treatment cycle. Integrating deep learning-derived features significantly enhanced the performance of predictive models for chemotherapy response in breast cancer patients. This study demonstrated the superior predictive capability of the XGBoost model, emphasizing its potential to optimize personalized therapeutic strategies by accurately identifying patients unlikely to respond to chemotherapy after the first treatment cycle.

Retrospective cross-sectional study. To develop a multi-view fusion framework that effectively identifies suspect keratoconus cases and facilitates the possibility of early clinical intervention. A total of 573 corneal topography maps representing eyes classified as normal, suspect, or keratoconus. We designed the Corneal Multi-View Fusion Transformer (CMVFT), which integrates features from seven standard corneal topography maps. A pretrained ResNet-50 extracts single-view representations that are further refined by a custom-designed Multi-Scale Attention Module (MSAM). This integrated design specifically compensates for the representation gap commonly encountered when applying Transformers to small-sample corneal topography datasets by dynamically bridging local convolution-based feature extraction with global self-attention mechanisms. A subsequent fusion Transformer then models long-range dependencies across views for comprehensive multi-view feature integration. The primary measure was the framework's ability to differentiate suspect cases from normal and keratoconus cases, thereby creating a pathway for early clinical intervention. Experimental evaluation demonstrated that CMVFT effectively distinguishes suspect cases within a feature space characterized by overlapping attributes. Ablation studies confirmed that both the MSAM and the fusion Transformer are essential for robust multi-view feature integration, successfully compensating for potential representation shortcomings in small datasets. This study is the first to apply a Transformer-driven multi-view fusion approach in corneal topography analysis. By compensating for the representation gap inherent in small-sample settings, CMVFT shows promise in enabling the identification of suspect keratoconus cases and supporting early intervention strategies, with prospective implications for early clinical intervention.

BackgroundBreast microcalcification diagnostics are challenging due to their subtle presentation, overlapping with benign findings, and high inter-reader variability, often leading to unnecessary biopsies. While deep learning (DL) models - particularly deep convolutional neural networks (DCNNs) - have shown potential to improve diagnostic accuracy, their clinical application remains limited by the need for large annotated datasets and the "black box" nature of their decision-making. PurposeTo develop and validate a deep learning model (DCNN) using a double transfer learning (d-TL) strategy for classifying suspected mammographic microcalcifications, with explainable AI (XAI) techniques to support model interpretability. Material and methodsA retrospective dataset of 396 annotated regions of interest (ROIs) from full-field digital mammography (FFDM) images of 194 patients who underwent stereotactic vacuum-assisted biopsy at the Womens Hospital radiological department, Helsinki University Hospital, was collected. The dataset was randomly split into training and test sets (24% test set, balanced for benign and malignant cases). A ResNeXt-based DCNN was developed using a d-TL approach: first pretrained on ImageNet, then adapted using an intermediate mammography dataset before fine-tuning on the target microcalcification data. Saliency maps were generated using Gradient-weighted Class Activation Mapping (Grad-CAM) to evaluate the visual relevance of model predictions. Diagnostic performance was compared to a radiologists BI-RADS-based assessment, using final histopathology as the reference standard. ResultsThe ensemble DCNN achieved an area under the ROC curve (AUC) of 0.76, with 65% sensitivity, 83% specificity, 79% positive predictive value (PPV), and 70% accuracy. The radiologist achieved an AUC of 0.65 with 100% sensitivity but lower specificity (30%) and PPV (59%). Grad-CAM visualizations showed consistent activation of the correct ROIs, even in misclassified cases where confidence scores fell below the threshold. ConclusionThe DCNN model utilizing d-TL achieved performance comparable to radiologists, with higher specificity and PPV than BI-RADS. The approach addresses data limitation issues and may help reduce additional imaging and unnecessary biopsies.

Epilepsy affects over 50 million people worldwide, with anti-seizure medications (ASMs) as the primary treatment for seizure control. However, ASM selection remains a "trial and error" process due to the lack of reliable predictors of effectiveness and tolerability. While machine learning approaches have been explored, existing models are limited to predicting outcomes only for ASMs encountered during training and have not leveraged recent biomedical foundation models for this task. This work investigates ASM outcome prediction using only patient MRI scans and reports. Specifically, we leverage biomedical vision-language foundation models and introduce a novel contextualized instruction-tuning framework that integrates expert-built knowledge trees of MRI entities to enhance their performance. Additionally, by training only on the four most commonly prescribed ASMs, our framework enables generalization to predicting outcomes and effectiveness for unseen ASMs not present during training. We evaluate our instruction-tuning framework on two retrospective epilepsy patient datasets, achieving an average AUC of 71.39 and 63.03 in predicting outcomes for four primary ASMs and three completely unseen ASMs, respectively. Our approach improves the AUC by 5.53 and 3.51 compared to standard report-based instruction tuning for seen and unseen ASMs, respectively. Our code, MRI knowledge tree, prompting templates, and TREE-TUNE generated instruction-answer tuning dataset are available at the link.

Prostate cancer remains one of the most prevalent malignancies and a leading cause of cancer-related deaths among men worldwide. Despite advances in traditional diagnostic methods such as Prostate-specific antigen testing, digital rectal examination, and multiparametric Magnetic resonance imaging, these approaches remain constrained by modality-specific limitations, suboptimal sensitivity and specificity, and reliance on expert interpretation, which may introduce diagnostic inconsistency. Multimodal deep learning and machine learning fusion, which integrates diverse data sources including imaging, clinical, and molecular information, has emerged as a promising strategy to enhance the accuracy of prostate cancer classification. This review aims to outline the current state-of-the-art deep learning and machine learning based fusion techniques for prostate cancer classification, focusing on their implementation, performance, challenges, and clinical applicability. Following the PRISMA guidelines, a total of 131 studies were identified, of which 27 met the inclusion criteria for studies published between 2021 and 2025. Extracted data included input techniques, deep learning architectures, performance metrics, and validation approaches. The majority of the studies used an early fusion approach with convolutional neural networks to integrate the data. Clinical and imaging data were the most commonly used modalities in the reviewed studies for prostate cancer research. Overall, multimodal deep learning and machine learning-based fusion significantly advances prostate cancer classification and outperform unimodal approaches.

Cervical cancer is a leading cause of death from malignant tumors in women, and accurate evaluation of occult lymph node metastasis (OLNM) is crucial for optimal treatment. This study aimed to develop several predictive models-including Clinical model, Radiomics models (RD), Deep Learning models (DL), Radiomics-Deep Learning fusion models (RD-DL), and a Clinical-RD-DL combined model-for assessing the risk of OLNM in cervical cancer patients.The study included 130 patients from Center 1 (training set) and 55 from Center 2 (test set). Clinical data and imaging sequences (T1, T2, and DWI) were used to extract features for model construction. Model performance was assessed using the DeLong test, and SHAP analysis was used to examine feature contributions. Results showed that both the RD-combined (AUC = 0.803) and DL-combined (AUC = 0.818) models outperformed single-sequence models as well as the standalone Clinical model (AUC = 0.702). The RD-DL model yielded the highest performance, achieving an AUC of 0.981 in the training set and 0.903 in the test set. Notably, integrating clinical variables did not further improve predictive performance; the Clinical-RD-DL model performed comparably to the RD-DL model. SHAP analysis showed that deep learning features had the greatest impact on model predictions. Both RD and DL models effectively predict OLNM, with the RD-DL model offering superior performance. These findings provide a rapid, non-invasive clinical prediction method.

Alzheimer's disease is a progressive neurodegenerative disorder marked by cognitive decline, memory loss, and behavioral changes. Early diagnosis, particularly identifying Early Mild Cognitive Impairment (EMCI), is vital for managing the disease and improving patient outcomes. Detecting EMCI is challenging due to the subtle structural changes in the brain, making precise slice selection from MRI scans essential for accurate diagnosis. In this context, the careful selection of specific MRI slices that provide distinct anatomical details significantly enhances the ability to identify these early changes. The chief novelty of the study is that instead of selecting all slices, an approach for identifying the important slices is developed. The ADNI-3 dataset was used as the dataset when running the models for early detection of Alzheimer's disease. Satisfactory results have been obtained by classifying with deep learning models, vision transformers (ViT) and by adding new structures to them, together with the model proposal. In the results obtained, while an accuracy of 99.45% was achieved with EfficientNetB2 + FPN in AD vs. LMCI classification from the slices selected with SSIM, an accuracy of 99.19% was achieved in AD vs. EMCI classification, in fact, the study significantly advances early detection by demonstrating improved diagnostic accuracy of the disease at the EMCI stage. The results obtained with these methods emphasize the importance of developing deep learning models with slice selection integrated with the Vision Transformers architecture. Focusing on accurate slice selection enables early detection of Alzheimer's at the EMCI stage, allowing for timely interventions and preventive measures before the disease progresses to more advanced stages. This approach not only facilitates early and accurate diagnosis, but also lays the groundwork for timely intervention and treatment, offering hope for better patient outcomes in Alzheimer's disease. The study is finally evaluated by a statistical significance test.

Pulmonary disease can severely impair respiratory function and be life-threatening. Accurately recognizing pulmonary diseases in chest X-ray images is challenging due to overlapping body structures and the complex anatomy of the chest. We propose an adaptive multiscale feature fusion model for recognizing Chest X-ray images of pneumonia, tuberculosis, and COVID-19, which are common pulmonary diseases. We introduce an Adaptive Multiscale Fusion Network (AMFNet) for pulmonary disease classification in chest X-ray images. AMFNet consists of a lightweight Multiscale Fusion Network (MFNet) and ResNet50 as the secondary feature extraction network. MFNet employs Fusion Blocks with self-calibrated convolution (SCConv) and Attention Feature Fusion (AFF) to capture multiscale semantic features, and integrates a custom activation function, MFReLU, which is employed to reduce the model's memory access time. A fusion module adaptively combines features from both networks. Experimental results show that AMFNet achieves 97.48% accuracy and an F1 score of 0.9781 on public datasets, outperforming models like ResNet50, DenseNet121, ConvNeXt-Tiny, and Vision Transformer while using fewer parameters.