Cerebrovascular accident (CVA), commonly known as stroke, stands as a significant contributor to contemporary mortality and morbidity rates, often leading to lasting disabilities. Early identification is crucial in mitigating its impact and reducing mortality. Non-contrast computed tomography (NCCT) remains the primary diagnostic tool in stroke emergencies due to its speed, accessibility, and cost-effectiveness. NCCT enables the exclusion of hemorrhage and directs attention to ischemic causes resulting from arterial flow obstruction. Quantification of NCCT findings employs the Alberta Stroke Program Early Computed Tomography Score (ASPECTS), which evaluates affected brain structures. This study seeks to identify early alterations in NCCT density in patients with stroke symptoms using a binary classifier distinguishing NCCT scans with and without stroke. To achieve this, various well-known deep learning architectures, namely VGG3D, ResNet3D, and DenseNet3D, validated in the ImageNet challenges, are implemented with 3D images covering the entire brain volume. The training results of these networks are presented, wherein diverse parameters are examined for optimal performance. The DenseNet3D network emerges as the most effective model, attaining a training set accuracy of 98% and a test set accuracy of 95%. The aim is to alert medical professionals to potential stroke cases in their early stages based on NCCT findings displaying altered density patterns.

Intracerebral haemorrhage (ICH) is a common form of stroke that affects millions of people worldwide. The incidence is associated with a high rate of mortality and morbidity. Accurate diagnosis using brain non-contrast computed tomography (NCCT) is crucial for decision-making on potentially life-saving surgery. Limited access to expert readers and inter-observer variability imposes barriers to timeous and accurate ICH diagnosis. We proposed a hybrid deep learning model for automated ICH diagnosis using NCCT images, which comprises a convolutional autoencoder (CAE) to extract features with reduced data dimensionality and a dense neural network (DNN) for classification. In order to ensure that the model generalizes to new data, we trained it using tenfold cross-validation and holdout methods. Principal component analysis (PCA) based dimensionality reduction and classification is systematically implemented for comparison. The study dataset comprises 1645 ("ICH" class) and 1648 ("Normal" class belongs to patients with non-hemorrhagic stroke) labelled images obtained from 108 patients, who had undergone CT examination on a 64-slice computed tomography scanner at Kalinga Institute of Medical Sciences between 2020 and 2023. Our developed CAE-DNN hybrid model attained 99.84% accuracy, 99.69% sensitivity, 100% specificity, 100% precision, and 99.84% F1-score, which outperformed the comparator PCA-DNN model as well as the published results in the literature. In addition, using saliency maps, our CAE-DNN model can highlight areas on the images that are closely correlated with regions of ICH, which have been manually contoured by expert readers. The CAE-DNN model demonstrates the proof-of-concept for accurate ICH detection and localization, which can potentially be implemented to prioritize the treatment using NCCT images in clinical settings.

Accurately predicting hematoma enlargement (HE) is crucial for improving the prognosis of patients with cerebral haemorrhage. Artificial intelligence (AI) is a potentially reliable assistant for medical image recognition. This study systematically reviews medical imaging articles on the predictive performance of AI in HE. Retrieved relevant studies published before October, 2024 from Embase, Institute of Electrical and Electronics Engineers (IEEE), PubMed, Web of Science, and Cochrane Library databases. The diagnostic test of predicting hematoma enlargement based on CT image training artificial intelligence model, and reported 2 × 2 contingency tables or provided sensitivity (SE) and specificity (SP) for calculation. Two reviewers independently screened the retrieved citations and extracted data. The methodological quality of studies was assessed using the QUADAS-AI, and Preferred Reporting Items for Systematic reviews and Meta-Analyses was used to ensure standardised reporting of studies. Subgroup analysis was performed based on sample size, risk of bias, year of publication, ratio of training set to test set, and number of centres involved. 36 articles were included in this Systematic review to qualitative analysis, of which 23 have sufficient information for further quantitative analysis. Among these articles, there are a total of 7 articles used deep learning (DL) and 16 articles used machine learning (ML). The comprehensive SE and SP of ML are 78% (95% CI: 69-85%) and 85% (78-90%), respectively, while the AUC is 0.89 (0.86-0.91). The SE and SP of DL was 87% (95% CI: 80-92%) and 75% (67-81%), respectively, with an AUC of 0.88 (0.85-0.91). The subgroup analysis found that when the ratio of the training set to the test set is 7:3, the sensitivity is 0.77(0.62-0.91), <i>p</i> = 0.03; In terms of specificity, the group with sample size more than 200 has higher specificity, which is 0.83 (0.75-0.92), <i>p</i> = 0.02; among the risk groups in the study design, the specificity of the risk group was higher, which was 0.83 (0.76-0.89), <i>p</i> = 0.02. The group specificity of articles published before 2021 was higher, 0.84 (0.77-0.90); and the specificity of data from a single research centre was higher, which was 0.85 (0.80-0.91), <i>p</i> < 0.001. Artificial intelligence algorithms based on imaging have shown good performance in predicting HE.

The accurate assessment of computed tomography (CT) image quality is crucial for ensuring diagnostic reliability while minimizing radiation dose. Radiologists' evaluations are time-consuming and labor-intensive. Existing automated approaches often require large CT datasets with predefined image quality assessment (IQA) scores, which often do not align well with clinical evaluations. We aim to develop a reference-free, automated method for CT IQA that closely reflects radiologists' evaluations, reducing the dependency on large annotated datasets. We propose Task-Focused Knowledge Transfer (TFKT), a deep learning-based IQA method leveraging knowledge transfer from task-similar natural image datasets. TFKT incorporates a hybrid convolutional neural network-transformer model, enabling accurate quality predictions by learning from natural image distortions with human-annotated mean opinion scores. The model is pre-trained on natural image datasets and fine-tuned on low-dose computed tomography perceptual image quality assessment data to ensure task-specific adaptability. Extensive evaluations demonstrate that the proposed TFKT method effectively predicts IQA scores aligned with radiologists' assessments on in-domain datasets and generalizes well to out-of-domain clinical pediatric CT exams. The model achieves robust performance without requiring high-dose reference images. Our model is capable of assessing the quality of <math xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mo>∼</mo> <mn>30</mn></mrow> </math> CT image slices in a second. The proposed TFKT approach provides a scalable, accurate, and reference-free solution for CT IQA. The model bridges the gap between traditional and deep learning-based IQA, offering clinically relevant and computationally efficient assessments applicable to real-world clinical settings.

This study aims to develop a radiomics machine learning (ML) model that uses preoperative computed tomography angiography (CTA) data to predict the prognosis of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) patients. In this retrospective study, 164 AAA patients underwent EVAR and were categorized into shrinkage (good prognosis) or stable (poor prognosis) groups based on post-EVAR sac regression. From preoperative AAA and perivascular adipose tissue (PVAT) image, radiomics features (RFs) were extracted for model creation. Patients were split into 80 % training and 20 % test sets. A support vector machine model was constructed for prediction. Accuracy is evaluated via the area under the receiver operating characteristic curve (AUC). Demographics and comorbidities showed no significant differences between shrinkage and stable groups. The model containing 5 AAA RFs (which are original_firstorder_InterquartileRange, log-sigma-3-0-mm-3D_glrlm_GrayLevelNonUniformityNormalized, log-sigma-3-0-mm-3D_glrlm_RunPercentage, log-sigma-4-0-mm-3D_glrlm_ShortRunLowGrayLevelEmphasis, wavelet-LLH_glcm_SumEntropy) had AUCs of 0.86 (training) and 0.77 (test). The model containing 7 PVAT RFs (which are log-sigma-3-0-mm-3D_firstorder_InterquartileRange, log-sigma-3-0-mm-3D_glcm_Correlation, wavelet-LHL_firstorder_Energy, wavelet-LHL_firstorder_TotalEnergy, wavelet-LHH_firstorder_Mean, wavelet-LHH_glcm_Idmn, wavelet-LHH_glszm_GrayLevelNonUniformityNormalized) had AUCs of 0.76 (training) and 0.78 (test). Combining AAA and PVAT RFs yielded the highest accuracy: AUCs of 0.93 (training) and 0.87 (test). Radiomics-based CTA model predicts aneurysm sac regression post-EVAR in AAA patients. PVAT RFs from preoperative CTA images were closely related to AAA prognosis after EVAR, enhancing accuracy when combined with AAA RFs. This preliminary study explores a predictive model designed to assist clinicians in optimizing therapeutic strategies during clinical decision-making processes.

Accurate segmentation of pancreatic ductal adenocarcinoma (PDAC) and surrounding anatomical structures is critical for diagnosis, treatment planning, and outcome assessment. This study proposes a deep learning-based framework to automate multi-class segmentation in CT images, comparing the performance of four state-of-the-art architectures. This retrospective multi-center study included 3265 patients from six institutions. Four deep learning models-UNet, nnU-Net, UNETR, and Swin-UNet-were trained using five-fold cross-validation on data from five centers and tested independently on a sixth center (n = 569). Preprocessing included intensity normalization, voxel resampling, and standardized annotation for six structures: PDAC lesion, pancreas, veins, arteries, pancreatic duct, and common bile duct. Evaluation metrics included Dice Similarity Coefficient (DSC), Intersection over Union (IoU), directed Hausdorff Distance (dHD), Average Symmetric Surface Distance (ASSD), and Volume Overlap Error (VOE). Statistical comparisons were made using Wilcoxon signed-rank tests with Bonferroni correction. Swin-UNet outperformed all models with a mean validation DSC of 92.4% and test DSC of 90.8%, showing minimal overfitting. It also achieved the lowest dHD (4.3 mm), ASSD (1.2 mm), and VOE (6.0%) in cross-validation. Per-class DSCs for Swin-UNet were consistently higher across all anatomical targets, including challenging structures like the pancreatic duct (91.0%) and bile duct (91.8%). Statistical analysis confirmed the superiority of Swin-UNet (p < 0.001). All models showed generalization capability, but Swin-UNet provided the most accurate and robust segmentation across datasets. Transformer-based architectures, particularly Swin-UNet, enable precise and generalizable multi-class segmentation of PDAC and surrounding anatomy. This framework has potential for clinical integration in PDAC diagnosis, staging, and therapy planning.

Segmentation of target volumes and organs at risk on computed tomography (CT) images constitutes an important step in the radiotherapy workflow. Artificial intelligence-based methods have significantly improved organ segmentation in medical images. Automatic segmentations are frequently evaluated using geometric metrics. Before a clinical implementation in the radiotherapy workflow, automatic segmentations must also be evaluated by clinicians. The aim of this study was to investigate the correlation between geometric metrics used for segmentation evaluation and the assessment performed by clinicians. In this study, we used the U-Net model to segment the liver in CT images from a publicly available dataset. The model's performance was evaluated using two geometric metrics: the Dice similarity coefficient and the Hausdorff distance. Additionally, a qualitative evaluation was performed by clinicians who reviewed the automatic segmentations to rate their clinical acceptability for use in the radiotherapy workflow. The correlation between the geometric metrics and the clinicians' evaluations was studied. The results showed that while the Dice coefficient and Hausdorff distance are reliable indicators of segmentation accuracy, they do not always align with clinician segmentation. In some cases, segmentations with high Dice scores still required clinician corrections before clinical use in the radiotherapy workflow. This study highlights the need for more comprehensive evaluation metrics beyond geometric measures to assess the clinical acceptability of artificial intelligence-based segmentation. Although the deep learning model provided promising segmentation results, the present study shows that standardized validation methodologies are crucial for ensuring the clinical viability of automatic segmentation systems.

Early identification of unresectable hepatocellular carcinoma (HCC) patients who may benefit from immune checkpoint inhibitors (ICIs) is crucial for optimizing outcomes. Here, we developed a multimodal fusion (MMF) system integrating CT-derived deep learning features and clinical data to predict overall survival (OS) and progression-free survival (PFS). Using retrospective multicenter data (n = 859), the MMF combining an ensemble deep learning (Ensemble-DL) model with clinical variables achieved strong external validation performance (C-index: OS = 0.74, PFS = 0.69), outperforming radiomics (29.8% OS improvement), mRECIST (27.6% OS improvement), clinical benchmarks (C-index: OS = 0.67, p = 0.0011; PFS = 0.65, p = 0.033), and Ensemble-DL (C-index: OS = 0.69, p = 0.0028; PFS = 0.66, p = 0.044). The MMF system effectively stratified patients across clinical subgroups and demonstrated interpretability through activation maps and radiomic correlations. Differential gene expression analysis revealed enrichment of the PI3K/Akt pathway in patients identified by the MMF system. The MMF system provides an interpretable, clinically applicable approach to guide personalized ICI treatment in unresectable HCC.

Fenestration and dehiscence (FD) pose significant challenges in dental treatments as they adversely affect oral health. Although cone-beam computed tomography (CBCT) provides precise diagnostics, its extensive time requirements and radiation exposure limit its routine use for monitoring. Currently, there is no public dataset that combines intraoral photographs and corresponding CBCT images; this limits the development of deep learning algorithms for the automated detection of FD and other potential diseases. In this paper, we present FDTooth, a dataset that includes both intraoral photographs and CBCT images of 241 patients aged between 9 and 55 years. FDTooth contains 1,800 precise bounding boxes annotated on intraoral photographs, with gold-standard ground truth extracted from CBCT. We developed a baseline model for automated FD detection in intraoral photographs. The developed dataset and model can serve as valuable resources for research on interdisciplinary dental diagnostics, offering clinicians a non-invasive, efficient method for early FD screening without invasive procedures.

Coronary computed tomography angiography (CCTA) has emerged as the first-line noninvasive imaging test for patients at high risk of coronary artery disease (CAD). When combined with machine learning (ML), it provides more valid evidence in diagnosing major adverse cardiovascular events (MACEs). Radiomics provides informative multidimensional features that can help identify high-risk populations and can improve the diagnostic performance of CCTA. However, its role in predicting MACEs remains highly debated. We evaluated the diagnostic value of ML models constructed using radiomic features extracted from CCTA in predicting MACEs, and compared the performance of different learning algorithms and models, thereby providing clinical recommendations for the diagnosis, treatment, and prognosis of MACEs. We comprehensively searched 5 online databases, Cochrane Library, Web of Science, Elsevier, CNKI, and PubMed, up to September 10, 2024, for original studies that used ML models among patients who underwent CCTA to predict MACEs and reported clinical outcomes and endpoints related to it. Risk of bias in the ML models was assessed by the Prediction Model Risk of Bias Assessment Tool, while the radiomics quality score (RQS) was used to evaluate the methodological quality of the radiomics prediction model development and validation. We also followed the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) guidelines to ensure transparency of ML models included. Meta-analysis was performed using Meta-DiSc software (version 1.4), which included the I² score and Cochran Q test, along with StataMP 17 (StataCorp) to assess heterogeneity and publication bias. Due to the high heterogeneity observed, subgroup analysis was conducted based on different model groups. Ten studies were included in the analysis, 5 (50%) of which differentiated between training and testing groups, where the training set collected 17 kinds of models and the testing set gathered 26 models. The pooled area under the receiver operating characteristic (AUROC) curve for ML models predicting MACEs was 0.7879 in the training set and 0.7981 in the testing set. Logistic regression (LR), the most commonly used algorithm, achieved an AUROC of 0.8229 in the testing group and 0.7983 in the training group. Non-LR models yielded AUROCs of 0.7390 in the testing set and 0.7648 in the training set, while the random forest (RF) models reached an AUROC of 0.8444 in the training group. Study limitations included a limited number of studies, high heterogeneity, and the types of included studies. The performance of ML models for predicting MACEs was found to be superior to that of general models based on basic feature extraction and integration from CCTA. Specifically, LR-based ML diagnostic models demonstrated significant clinical potential, particularly when combined with clinical features, and are worth further validation through more clinical trials. PROSPERO CRD42024596364; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024596364.