It is a challenging task to use ultrasound for bone imaging, as the bone tissue has a complex structure with high acoustic impedance and speed-of-sound (SOS). Recently, full waveform inversion (FWI) has shown promising imaging for musculoskeletal tissues. However, the FWI showed a limited ability and tended to produce artifacts in bone imaging because the inversion process would be more easily trapped in local minimum for bone tissue with a large discrepancy in SOS distribution between bony and soft tissues. In addition, the application of FWI required a high computational burden and relatively long iterations. The objective of this study was to achieve high-resolution ultrasonic imaging of bone using a deep learning-based FWI approach. In this paper, we proposed a novel network named CEDD-Unet. The CEDD-Unet adopts a Dual-Decoder architecture, with the first decoder tasked with reconstructing the SOS model, and the second decoder tasked with finding the main boundaries between bony and soft tissues. To effectively capture multi-scale spatial-temporal features from ultrasound radio frequency (RF) signals, we integrated a Convolutional LSTM (ConvLSTM) module. Additionally, an Efficient Multi-scale Attention (EMA) module was incorporated into the encoder to enhance feature representation and improve reconstruction accuracy. Using the ultrasonic imaging modality with a ring array transducer, the performance of CEDD-Unet was tested on the SOS model datasets from human bones (noted as Dataset1) and mouse bones (noted as Dataset2), and compared with three classic reconstruction architectures (Unet, Unet++, and Att-Unet), four state-of-the-art architecture (InversionNet, DD-Net, UPFWI, and DEFE-Unet). Experiments showed that CEDD-Unet outperforms all competing methods, achieving the lowest MAE of 23.30 on Dataset1 and 25.29 on Dataset2, the highest SSIM of 0.9702 on Dataset1 and 0.9550 on Dataset2, and the highest PSNR of 30.60 dB on Dataset1 and 32.87 dB on Dataset2. Our method demonstrated superior reconstruction quality, with clearer bone boundaries, reduced artifacts, and improved consistency with ground truth. Moreover, CEDD-Unet surpasses traditional FWI by producing sharper skeletal SOS reconstructions, reducing computational cost, and eliminating the reliance for an initial model. Ablation studies further confirm the effectiveness of each network component. The results suggest that CEDD-Unet is a promising deep learning-based FWI method for high-resolution bone imaging, with the potential to reconstruct accurate and sharp-edged skeletal SOS models.

Embolic protection devices (EPDs) used during carotid artery stenting (CAS) are crucial in reducing ischemic complications. Although minimizing the filter-type EPD movement is considered important, limited research has demonstrated this practice. We used an artificial intelligence (AI)-based device recognition technology to investigate the correlation between filter movements and ischemic complications. We retrospectively studied 28 consecutive patients who underwent CAS using FilterWire EZ (Boston Scientific, Marlborough, MA, USA) from April 2022 to September 2023. Clinical data, procedural videos, and postoperative magnetic resonance imaging were collected. An AI-based device detection function in the Neuro-Vascular Assist (iMed Technologies, Tokyo, Japan) was used to quantify the filter movement. Multivariate proportional odds model analysis was performed to explore the correlations between postoperative diffusion-weighted imaging (DWI) hyperintense lesions and potential ischemic risk factors, including filter movement. In total, 23 patients had sufficient information and were eligible for quantitative analysis. Fourteen patients (60.9 %) showed postoperative DWI hyperintense lesions. Multivariate analysis revealed significant associations between filter movement distance (odds ratio, 1.01; 95 % confidence interval, 1.00-1.02; p = 0.003) and high-intensity signals in time-of-flight magnetic resonance angiography with DWI hyperintense lesions. Age, symptomatic status, and operative time were not significantly correlated. Increased filter movement during CAS was correlated with a higher incidence of postoperative DWI hyperintense lesions. AI-based quantitative evaluation of endovascular techniques may enable demonstration of previously unproven recommendations. To the best of our knowledge, this is the first study to use an AI system for quantitative evaluation to address real-world clinical issues.

To develop a positron emission tomography/computed tomography (PET/CT)-based radiomics model for predicting programmed cell death ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) patients and estimating progression-free survival (PFS) and overall survival (OS) in PD-L1-positive patients undergoing first-line immunotherapy. We retrospectively analysed 143 NSCLC patients who underwent pretreatment ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT scans, of whom 86 were PD-L1-positive. Clinical data collected included gender, age, smoking history, Tumor-Node-Metastases (TNM) staging system, pathologic types, laboratory parameters, and PET metabolic parameters. Four machine learning algorithms-Bayes, logistic, random forest, and Supportsupport vector machine (SVM)-were used to build models. The predictive performance was validated using receiver operating characteristic (ROC) curves. Univariate and multivariate Cox analyses identified independent predictors of OS and PFS in PD-L1-positive expression patients undergoing immunotherapy, and a nomogram was created to predict OS. A total of 20 models were built for predicting PD-L1 expression. The clinical combined PET/CT radiomics model based on the SVM algorithm performed best (area under curve for training and test sets: 0.914 and 0.877, respectively). The Cox analyses showed that smoking history independently predicted PFS. SUVmean, monocyte percentage and white blood cell count were independent predictors of OS, and the nomogram was created to predict 1-year, 2-year, and 3-year OS based on these three factors. We developed PET/CT-based machine learning models to help predict PD-L1 expression in NSCLC patients and identified independent predictors of PFS and OS in PD-L1-positive patients receiving immunotherapy, thereby aiding precision treatment.

Deformable registration is essential in medical image analysis, especially for handling various multi- and mono-modal registration tasks in neuroimaging. Existing studies lack exploration of brain MR-CT registration, and face challenges in both accuracy and efficiency improvements of learning-based methods. To enlarge the practice of multi-modal registration in brain, we present SR-Reg, a new benchmark dataset comprising 180 volumetric paired MR-CT images and annotated anatomical regions. Building on this foundation, we introduce MambaMorph, a novel deformable registration network based on an efficient state space model Mamba for global feature learning, with a fine-grained feature extractor for low-level embedding. Experimental results demonstrate that MambaMorph surpasses advanced ConvNet-based and Transformer-based networks across several multi- and mono-modal tasks, showcasing impressive enhancements of efficacy and efficiency. Code and dataset are available at https://github.com/mileswyn/MambaMorph.

Accurate adult age estimation (AAE) is critical for forensic and anthropological applications, yet traditional methods relying on bone mineral density (BMD) face significant challenges due to biological variability and methodological limitations. This study aims to develop an end-to-end Deep Learning (DL) based pipeline for automated AAE using BMD from proximal femoral CT scans. The main objectives are to construct a large-scale dataset of 5151 CT scans from real-world clinical and cadaver cohorts, fine-tune the Segment Anything Model (SAM) for accurate femoral bone segmentation, and evaluate multiple convolutional neural networks (CNNs) for precise age estimation based on segmented BMD data. Model performance was assessed through cross-validation, internal clinical testing, and external post-mortem validation. SAM achieved excellent segmentation performance with a Dice coefficient of 0.928 and an average intersection over union (mIoU) of 0.869. The CNN models achieved an average mean absolute error (MAE) of 5.20 years in cross-validation (male: 5.72; female: 4.51), which improved to 4.98 years in the independent clinical test set (male: 5.32; female: 4.56). External validation on the post-mortem dataset revealed an MAE of 6.91 years, with 6.97 for males and 6.69 for females. Ensemble learning further improved accuracy, reducing MAE to 4.78 years (male: 5.12; female: 4.35) in the internal test set, and 6.58 years (male: 6.64; female: 6.37) in the external validation set. These findings highlight the feasibility of dl-driven AAE and its potential for forensic applications, offering a fully automated framework for robust age estimation.

Despite their exposure to potentially traumatic stressors, the majority of World Trade Center (WTC) responders-those who worked on rescue, recovery, and cleanup efforts on or following September 11, 2001-have shown psychological resilience, never developing long-term psychopathology. Psychological resilience may be protective against the earlier age-related cognitive changes associated with posttraumatic stress disorder (PTSD) in this cohort. In the current study, we calculated the difference between estimated brain age from structural magnetic resonance imaging (MRI) data and chronological age in WTC responders who participated in a parent functional MRI study of resilience (<i>N</i> = 97). We hypothesized that highly resilient responders would show the least brain aging and explored associations between brain aging and psychological and cognitive measures. WTC responders screened for the absence of cognitive impairment were classified into 3 groups: a WTC-related PTSD group (<i>n</i> = 32), a Highly Resilient group without lifetime psychopathology despite high WTC-related exposure (<i>n</i> = 34), and a Lower WTC-Exposed control group also without lifetime psychopathology (<i>n</i> = 31). We used <i>BrainStructureAges</i>, a deep learning algorithm that estimates voxelwise age from T1-weighted MRI data to calculate decelerated (or accelerated) brain aging relative to chronological age. Globally, brain aging was decelerated in the Highly Resilient group and accelerated in the PTSD group, with a significant group difference (<i>p</i> = .021, Cohen's <i>d</i> = 0.58); the Lower WTC-Exposed control group exhibited no significant brain age gap or group difference. Lesser brain aging was associated with resilience-linked factors including lower emotional suppression, greater optimism, and better verbal learning. Cognitively healthy WTC responders show differences in brain aging related to resilience and PTSD.

In recent years, machine learning and deep learning have shown potential for improving Parkinson's disease (PD) diagnosis, one of the most common neurodegenerative diseases. This comprehensive analysis examines machine learning and deep learning-based Parkinson's disease diagnosis using MRI, speech, and handwriting datasets. To thoroughly analyze PD, this study collected data from scientific literature, experimental investigations, publicly accessible datasets, and global health reports. This study examines the worldwide historical setting of Parkinson's disease, focusing on its increasing prevalence and inequities in treatment access across various regions. A comprehensive summary consolidates essential findings from clinical investigations and pertinent datasets related to Parkinson's disease management. The worldwide context, prospective treatments, therapies, and drugs for Parkinson's disease have been thoroughly examined. This analysis identifies significant research deficiencies and suggests future methods, emphasizing the necessity for more extensive and diverse datasets and improved model accessibility. The current study proposes the Meta-Park model for diagnosing Parkinson's disease, achieving training, testing, and validation accuracy of 97.67 %, 95 %, and 94.04 %. This method provides a dependable and scalable way to improve clinical decision-making in managing Parkinson's disease. This research seeks to provide innovative, data-driven decisions for early diagnosis and effective treatment by merging the proposed method with a thorough examination of existing interventions, providing renewed hope to patients and the medical community.

The intertumoral and intratumoral heterogeneity of colorectal adenocarcinoma (CRC) at the morphologic level is poorly understood. Previously, we identified morphological patterns associated with CRC molecular subtypes and their distinct molecular motifs. Here we aimed to evaluate the heterogeneity of these patterns across CRC. Three pathologists evaluated dominant, secondary, and tertiary morphology on four sections from four different FFPE blocks per tumor in a pilot set of 22 CRCs. An AI-based image analysis tool was trained on these tumors to evaluate the morphologic heterogeneity on an extended set of 161 stage I-IV primary CRCs (n = 644 H&E sections). We found that most tumors had two or three different dominant morphotypes and the complex tubular (CT) morphotype was the most common. The CT morphotype showed no combinatorial preferences. Desmoplastic (DE) morphotype was rarely dominant and rarely combined with other dominant morphotypes. Mucinous (MU) morphotype was mostly combined with solid/trabecular (TB) and papillary (PP) morphotypes. Most tumors showed medium or high heterogeneity, but no associations were found between heterogeneity and clinical parameters. A higher proportion of DE morphotype was associated with higher T-stage, N-stage, distant metastases, AJCC stage, and shorter overall survival (OS) and relapse-free survival (RFS). A higher proportion of MU morphotype was associated with higher grade, right side, and microsatellite instability (MSI). PP morphotype was associated with earlier T- and N-stage, absence of metastases, and improved OS and RFS. CT was linked to left side, lower grade, and better survival in stage I-III patients. MSI tumors showed higher proportions of MU and TB, and lower CT and PP morphotypes. These findings suggest that morphological shifts accompany tumor progression and highlight the need for extensive sampling and AI-based analysis. In conclusion, we observed unexpectedly high intratumoral morphological heterogeneity of CRC and found that it is not heterogeneity per se, but the proportions of morphologies that are associated with clinical outcomes.

Chronic back pain (CBP) affects over 80 million people in Europe, contributing to substantial healthcare costs and disability. Understanding modifiable risk factors, such as muscle composition, may aid in prevention and treatment. This study investigates the association between lean muscle mass (LMM) and intermuscular adipose tissue (InterMAT) with CBP using noninvasive whole-body magnetic resonance imaging (MRI). This cross-sectional analysis used whole-body MRI data from 30,868 participants in the German National Cohort (NAKO), collected between 1 May 2014 and 1 September 2019. CBP was defined as back pain persisting >3 months. LMM and InterMAT were quantified via MRI-based muscle segmentations using a validated deep learning model. Associations were analyzed using mixed logistic regression, adjusting for age, sex, diabetes, dyslipidemia, osteoporosis, osteoarthritis, physical activity, and study site. Among 27,518 participants (n = 12,193/44.3% female, n = 14,605/55.7% male; median age 49 years IQR 41; 57), 21.8% (n = 6003; n = 2999/50.0% female, n = 3004/50% male; median age 53 years IQR 46; 60) reported CBP, compared to 78.2% (n = 21,515; n = 9194/42.7% female, n = 12,321/57.3% male; median age 48 years IQR 39; 56) who did not. CBP prevalence was highest in those with low (<500 MET min/week) or high (>5000 MET min/week) self-reported physical activity levels (24.6% (n = 10,892) and 22.0% (n = 3800), respectively) compared to moderate (500-5000 MET min/week) levels (19.4% (n = 12,826); p < 0.0001). Adjusted analyses revealed that a higher InterMAT (OR 1.22 per 2-unit Z-score; 95% CI 1.13-1.30; p < 0.0001) was associated with an increased likelihood of chronic back pain (CBP), whereas higher lean muscle mass (LMM) (OR 0.87 per 2-unit Z-score; 95% CI 0.79-0.95; p = 0.003) was associated with a reduced likelihood of CBP. Stratified analyses confirmed these associations persisted in individuals with osteoarthritis (OA-CBP LMM: 22.9 cm³/kg/m; InterMAT: 7.53% vs OA-No CBP LMM: 24.3 cm³/kg/m; InterMAT: 6.96% both p < 0.0001) and osteoporosis (OP-CBP LMM: 20.9 cm³/kg/m; InterMAT: 8.43% vs OP-No CBP LMM: 21.3 cm³/kg/m; InterMAT: 7.9% p = 0.16 and p = 0.0019). Higher pain intensity (Pain Intensity Numerical Rating Scale ≥4) correlated with lower LMM (2-unit Z-score deviation = OR, 0.63; 95% CI, 0.57-0.70; p < 0.0001) and higher InterMAT (2-unit Z-score deviation = OR, 1.22; 95% CI, 1.13-1.30; p < 0.0001), independent of physical activity, osteoporosis and osteoarthritis. This large, population-based study highlights the associations of InterMAT and LMM with CBP. Given the limitations of the cross-sectional design, our findings can be seen as an impetus for further causal investigations within a broader, multidisciplinary framework to guide future research toward improved prevention and treatment. The NAKO is funded by the Federal Ministry of Education and Research (BMBF) [project funding reference numbers: 01ER1301A/B/C, 01ER1511D, 01ER1801A/B/C/D and 01ER2301A/B/C], federal states of Germany and the Helmholtz Association, the participating universities and the institutes of the Leibniz Association.

Cone-beam computed tomography (CBCT) for image-guided radiotherapy (IGRT) during liver stereotactic ablative radiotherapy (SABR) is degraded by respiratory motion artefacts, potentially jeopardising treatment accuracy. Mechanically assisted non-invasive ventilation-induced breath-hold (MANIV-BH) can reduce these artefacts. This study compares MANIV-BH and free-breathing CBCTs regarding image quality, IGRT variability, automatic registration accuracy, and deep-learning auto-segmentation performance. Liver SABR CBCTs were presented blindly to 14 operators: 25 patients with FB and 25 with MANIV-BH. They rated CBCT quality and IGRT ease (rigid registration with planning CT). Interoperator IGRT variability was compared between FB and MANIV-BH. Automatic gross tumour volume (GTV) mapping accuracy was compared using automatic rigid registration and image-guided deformable registration. Deep-learning organ-at-risk (OAR) auto-segmentation was rated by an operator, who recorded the time dedicated for manual correction of these volumes. MANIV-BH significantly improved CBCT image quality ("Excellent"/"Good": 83.4 % versus 25.4 % with FB, p < 0.001), facilitated IGRT ("Very easy"/"Easy": 68.0 % versus 38.9 % with FB, p < 0.001), and reduced IGRT variability, particularly for trained operators (overall variability of 3.2 mm versus 4.6 mm with FB, p = 0.010). MANIV-BH improved deep-learning auto-segmentation performance (80.0 % rated "Excellent"/"Good" versus 4.0 % with FB, p < 0.001), and reduced median manual correction time by 54.2 % compared to FB (p < 0.001). However, automatic GTV mapping accuracy was not significantly different between MANIV-BH and FB. In liver SABR, MANIV-BH significantly improves CBCT quality, reduces interoperator IGRT variability, and enhances OAR auto-segmentation. Beyond being safe and effective for respiratory motion mitigation, MANIV increases accuracy during treatment delivery, although its implementation requires resources.