radiology teams

Abstract: Multi-task deep learning has been developed to ensure explainability in computer-aided diagnosis (CAD) systems. These systems simultaneously predict interpretable characteristics of findings in auxiliary tasks to help radiologists assess the reliability of the diagnostic prediction. However, the CAD's opinion would not be referred to when the auxiliary task prediction deviates from the radiologist's expectation. To further leverage CAD's knowledge in the above situation, we proposed a multi-task gradient assist (MGA) method that brings interactivity to multi-task models without additional training. MGA allows radiologists to give feedback to the CAD and ask for additional diagnostic suggestions. Using two datasets of mammography and CT, we show that MGA successfully improves diagnostic accuracy upon feedback on various auxiliary tasks. Compared to an existing method using forward propagation only, MGA performs more robustly and can be combined to further improve accuracy. Our method paves a promising way for integrating artificial intelligence into image diagnosis.

Abstract: Pathologic complete response (pCR) after neoadjuvant chemotherapy is a key prognostic indicator in aggressive breast cancer, yet existing prediction approaches either rely on pretreatment imaging alone, missing the patient's evolving response, or optimize multi-visit classifiers under direct outcome supervision, coupling representation learning with the clinical endpoint. We formulate longitudinal pCR prediction as a world-modeling problem and propose Conditioned Response-state World Modeling (CoRe-WM), which learns a latent state-transition model that predicts the next imaging state from the observed sequence. The transition function is conditioned on patient clinical profile and assigned therapy through additive shift and feature-wise modulation, enabling patient- and treatment-specific dynamics. A Factorized Response State pathway further decouples treatment-response dynamics from imaging appearance by encoding the structural prior that response manifests primarily in lesion morphology. After pretraining, all parameters are frozen and a linear readout predicts pCR at each clinical decision point. We evaluate CoRe-WM on I-SPY2 under five-fold cross-validation and assess cross-cohort transfer on I-SPY1. CoRe-WM achieves the highest discrimination among all evaluated methods at every prospective decision point, and demonstrates robust cross-cohort transfer. Ablation studies identify patient-profile conditioning and the factorized response pathway as the principal contributors. These results establish world-model-based representation learning as a promising framework for outcome prediction in oncology and beyond.

Abstract: Serial MRI is routinely performed in current clinical practice for disease surveillance and applications such as MR-guided radiotherapy. However, long MRI scan times increase costs and limit patient access, making accelerated image reconstruction of broad clinical importance. Previous scans of the same patient contain image information highly correlated with the current exam, yet existing reconstruction methods rarely exploit this information. Major challenges in the effective use of prior scans include inter-visit misregistration, pathological changes, and image phase variation. In this work, we propose Longitudinal Guided Group Sparsity (LGGS), an interpretable deep-learning framework for longitudinally informed MRI reconstruction derived from classical group sparsity. The prior scan is incorporated into the reconstruction regularizer through learned phase-invariant circulant attention that identifies corresponding features across exams. This formulation provides robustness to local in-plane and through-plane misregistration as well as inter-visit phase variation. Across acceleration rates, LGGS achieves state-of-the-art performance on longitudinal T1-weighted multi-coil brain MRI data, outperforming the evaluated unguided and longitudinally informed reconstruction methods, with substantially fewer learned parameters. We further evaluated the contributions of multiple guide slices and phase-invariant similarity and demonstrated that accelerated prior images can also serve as effective guides with minimal degradation in reconstruction quality.

Abstract: Contrast-enhanced magnetic resonance imaging (CE-MRI) is crucial for accurately diagnosing and segmenting brain tumors. However, the acquisition of CE-MRI requires injecting contrast agents, which poses potential health risks and increases scan costs. Here, we propose a CE-MRI synthesis method from non-contrast sequences, reducing both risk and cost. Unlike existing methods that rely on channel-wise concatenation to fuse multi-sequence information for synthesis, we introduce a Mixture of Feature Difference (MoFD) module. The proposed module uses a dynamic weighting strategy to adaptively select and aggregate informative features from both individual source sequences and explicit differences among them. Quantitative and qualitative evaluations demonstrate that our proposed method outperforms baselines in terms of image fidelity and perceptual quality on the UCSF-PDGM and UPenn-GBM datasets. Our method successfully reconstructs tumor regions and achieves segmentation performance comparable to that obtained with real CE-MRI. Our ablation studies show that although adversarial learning improves perceptual quality, a regression-based variant of our method achieves higher structural fidelity.

Abstract: Low dose Computed Tomography (CT) is the standard imaging modality for lung cancer screening. On CT scans, lung cancer typically manifests as pulmonary nodules, whose manual identification is time-consuming and prone to observer variability, image quality limitations, and suboptimal reading conditions. Moreover, subtle temporal changes are often difficult to quantify reliably in CT scans from the same patient across follow-up examinations. Deep learning-based approaches for the automatic detection and segmentation of lung nodules have demonstrated improved accuracy and efficiency. However, most existing approaches provide only coarse region-of-interest localisation, rely on prior lesion annotations or human supervision, or treat detection and segmentation as separate tasks. In this work, we present NoduleFlow, a framework for lung nodule detection, classification, and segmentation directly from series of CT volumes. Our proposal consists of four interconnected modules and operates in an automated manner at inference time, without requiring prior lesion annotations, manual initialisation, or region-of-interest pre-selection. We further investigate whether nodule localization benefits from the propagation of candidate regions across follow-up scans through inter-scan registration fields, as opposed to conventional independent per-scan analysis. The generalisability of the framework is systematically evaluated across four independent datasets. The results underscore the potential of automated pipelines for lung nodule analysis in screening and diagnostic settings.

Abstract: Purpose : To develop and evaluate CAPTOR, a deep-learning vision-language foundation model for oncologic chest-abdomen-pelvis (CAP) CT interpretation. Materials & Methods : CAPTOR (Chest-Abdomen-Pelvis foundaTion model for Oncologic Radiology) is a contrastive vision-language model, trained using a pretraining strategy for oncologic CAP CT (in single- or multiple-series acquisitions), on a multicenter retrospective dataset from North America, Europe and Asia, predominantly from tumor lesion examinations. CAPTOR was compared with state-of-the-art CT foundation models on three downstream tasks: disease detection, survival prediction using TumorImagingBench and image retrieval. Classification and retrieval were both evaluated on held-out internal and public test sets, stratified by anatomical coverage and indication. Bootstrap resampling was used to estimate confidence intervals, and pairwise comparisons were performed using permutation tests. Results : CAPTOR was trained and tested on 25,512 and 10,794 CT-report pairs respectively. TumorImagingBench datasets comprised between 134 and 421 studies each. CAPTOR outperformed all baseline models, on the classification task, on the CAP subset (AUC 0.767, 95%CI: 0.734-0.793, vs. 0.695, 95%CI: 0.645-0.736 for the next-best, p<0.001) and oncologic subset (AUC 0.784, 95%CI: 0.759-0.805, vs. 0.734, 95%CI: 0.703-0.767 p<0.001), ranked first on three of the four oncologic prognostic benchmarks, and achieved superior retrieval performance on CAP and oncologic subsets. Conclusion : A foundation model trained on oncology-enriched CAP CT data outperformed relevant state-of-the-art models in its target clinical context, underscoring the importance of clinically aligned pretraining. We release our preprocessing, training and inference code : https://github.com/Guerbet-AI/CAPTOR and model weights : https://huggingface.co/Guerbet-AI/CAPTOR

Abstract: Enlarged perivascular spaces (PVS) visible in brain magnetic resonance imaging (MRI) are increasingly thought to be linked to poor brain health. PVS are elongated structures of less than 3 mm in diameter and can be numerous. To reflect the incidence of PVS, radiologists visually score their burden following a clinical grading scale - a task that would benefit from automation to accelerate analyses and overcome the influence of inter-observer differences. We developed and evaluated methods for training machine learning models to score PVS incidence in the basal ganglia (BG) and centrum semiovale (CSO) leveraging the Potters/Wardlaw scale. The novelty in our work lies in the use of imperfect, semi-automatically generated "silver-standard" PVS segmentation masks during training, in addition to PVS radiological scores. We comparatively evaluated a conditional convolutional neural network (CNN) which accepts PVS masks as an extra input channel, a multi-task CNN which performs both PVS segmentation and scoring, and a logistic regression model which utilises features derived from PVS masks to predict PVS scores. Multi-task learning was the most effective method, achieving a mean average precision of 64.08% compared to 60.22% for the conditional CNN, 52.11% for a baseline CNN trained only to predict PVS scores, and 49.32% for the logistic regression model. The multi-task model showed an ability to localise individual PVS not shown by the other CNNs, and behaved in a probabilistically sensible way, predicting with lower confidence on inherently harder classes. Age, sex, hypertension status, white matter hyperintensity volume, and ischaemic stroke lesion status were shown to be associated with the multi-task model's PVS score predictions and the ground truth in a similar way.

Abstract: Background: Clear cell renal cell carcinoma (ccRCC) exhibits substantial clinical heterogeneity, and accurate grade assessment is essential for risk stratification and treatment planning. However, conventional grading requires invasive tissue sampling. We developed RCC-Align, a cross-modal contrastive learning framework that leverages paired histopathology and computed tomography (CT) data during training to improve noninvasive CT-based ccRCC grade prediction. Methods: RCC-Align aligns paired whole-slide histopathology images (WSIs) and CT scans through contrastive cross-modal objectives, transferring grade-discriminative information from microscopic tissue morphology to macroscopic radiologic representations. The framework was trained and evaluated on paired TCGA and CPTAC cohorts using patient-level five-fold cross-validation. Performance for low- versus high-grade ccRCC classification was compared against CT-only baselines (DINOv2-Base and DINOv2-Finetuned) and a WSI-based reference model (GigaPath-Finetuned). Cross-modal alignment was assessed using cosine similarity analysis. Results: RCC-Align achieved an AUC of 0.601 (95% CI, 0.524-0.673) and AUPRC of 0.599 (95% CI, 0.541-0.676), outperforming DINOv2-Finetuned (AUC 0.545; AUPRC 0.543) with significantly improved low-grade prediction (p = 0.004). RCC-Align also demonstrated stronger paired WSI-CT embedding alignment compared with baselines. The WSI-based GigaPath reference achieved an AUC of 0.719. Conclusion: Pathology-guided contrastive learning improves CT-based ccRCC grading while requiring only CT at inference. This approach may complement tissue diagnosis when biopsy is unsafe, infeasible, or limited by intratumoral heterogeneity. Validation in larger, multi-institutional cohorts with external testing is needed before clinical translation.

Abstract: Foundation model embeddings of screening mammograms may encode pre-diagnostic tissue change without task-specific adaptation. We tested whether embeddings move faster along a data-derived "cancer direction" in women later biopsied for cancer than in matched screen-negative controls, and whether this depends on pretraining domain. We studied 1,773 biopsied women (785 malignant, 988 biopsy-negative) and 1,773 matched controls, each with at least two annual screening exams before their index exam. An identical pipeline was applied to four 2D models: Mammo-CLIP (MC, out-of-distribution mammography), HOPPR (in-distribution mammography), MedImageInsight (MII, general medical imaging), and BiomedCLIP (biomedical vision-language pretraining on literature figures). Breast-level embeddings quantified longitudinal movement along the cancer direction. We compared cases and controls using a between-patient design with complementary mixed-effects analysis, and biopsied versus healthy contralateral breasts within patients. Under matched modality in MII embedding space, malignant cases drifted significantly faster than controls in the first two screening intervals preceding the index exam; biopsy-negative cases showed significance only in the first. MC differences were significant in the first interval for both biopsy groups. Within-patient comparisons showed a broadly similar pattern, with MC significance extending to the second interval in both groups and HOPPR showing significance at interval 1. BiomedCLIP showed no significant differences in either design or biopsy group. Overall, directional embedding velocity emerges as a property of clinically grounded rather than general biomedical pretraining, showing that foundation model embeddings can encode pre-diagnostic mammographic change without task-specific adaptation.

Abstract: Accurate preoperative subtype classification of renal cell carcinoma (RCC) from contrast-enhanced CT remains clinically challenging because clear cell RCC (ccRCC) and non-clear cell RCC often show overlapping imaging appearances. This study evaluates whether foundation representations reduce reliance on handcrafted radiomics, or whether radiomics remains complementary for interpretable tumour characterisation. We compared radiomics, conventional CNN features, MedicalNet-pretrained features, MedVAE representations, and fusion variants for binary ccRCC classification on KiTS23, reporting area under the receiver operating characteristic curve (AUC) with bootstrap confidence intervals and average precision (AP) as a complementary class-imbalance-sensitive metric. We further assessed branch-removal ablation, TCGA/AIMI external transfer, and interpretability using radiomics permutation importance and gate-level analysis. Internally, 3D MedVAE gated fusion achieved the best performance, with an AUC of 82.7% and AP of 92.2%. On the external TCGA cohort, the same model achieved an AUC of 79.5% and AP of 98.9%, although specificity remains uncertain because only two external non-ccRCC cases were available. Gate analysis showed a radiomics-dominant fusion regime, suggesting that foundation representations acted as case-dependent refinement signals rather than replacements for structured tumour descriptors. These findings support radiomics as a complementary and clinically interpretable component of CT-based RCC characterisation in the foundation-model era.

Abstract: Medical image interpretation is high-volume and time-consuming, and while AI interpretation can reduce workload, fully autonomous deployment carries potential safety concerns and low specificity may in practice lead to increased clinician workload. Learning to Defer (L2D) addresses this by selectively routing cases between autonomous prediction and human experts by learning from input features and AI model and human performance. While theoretical guarantees have been proven for L2D, its performance has not been validated on real-world medical datasets with human reader annotations. We evaluate the predictor-rejector formulation of two-stage L2D, where the AI predictor model is fixed and separate from the trainable routing or rejector model, on Collab-CXR, a multilabel chest X-ray dataset with multiple human annotations per case. This is the first work to look at L2D in the context of real-world medical imaging data with human annotations. We further introduce a new setup, L2D with Guidance, where the decision space is extended to three choices: predict autonomously, defer to a human expert, or defer to a human expert and provide AI guidance. We compare multiple rejector architectures and loss functions, and different input feature availabilities. This is reproduced on two larger datasets, VinDr-CXR and CheXpert. Our results show that two-stage L2D with Guidance outperforms classic two-stage learning to defer, as well as human-alone, AI-alone and AI-guided human baselines. Notably, this performance is achieved with simpler loss functions compared to formally defined L2D surrogate loss functions in current literature.

Abstract: Background: Microvascular invasion (MVI) predicts recurrence and survival in hepatocellular carcinoma (HCC) but requires postoperative histopathology for diagnosis. We developed and validated a model integrating multimodal ultrasound and clinical data for preoperative MVI prediction. Methods: This multicenter study included 489 patients with HCC from eight centers. All patients had B-mode ultrasound (BUS), color Doppler flow imaging (CDFI), dynamic contrast-enhanced ultrasound (DCE-US), and clinical information. Data from seven centers (n = 421) were used for model development with five-fold cross-validation; data from the remaining center (n = 68) formed an independent external validation cohort. The proposed multimodal information fusion network used modality-specific encoders, a hemodynamic temporal change module for bidirectional DCE-US perfusion changes, and a representation consistency learning module to align heterogeneous ultrasound representations before Transformer-based fusion. Results: In external validation, DCE-US achieved the highest single-modality area under the receiver operating characteristic curve (AUC; 0.8545+/-0.0198), versus clinical information (0.6715+/-0.0156), CDFI (0.6435+/-0.0344), and BUS (0.6087+/-0.0417). Pixel-difference sampling and the proposed temporal module outperformed alternative sampling and video representation methods. The full model achieved the best performance, with an AUC of 0.8953+/-0.0180, accuracy of 81.18%+/-2.83%, sensitivity of 86.40%+/-6.69%, and specificity of 78.14%+/-6.28. Conclusions: Integrating multimodal ultrasound and clinical information enabled promising preoperative MVI prediction in HCC. DCE-US was the main source of predictive information, while BUS, CDFI, and clinical information provided complementary value. The proposed framework may support preoperative risk stratification and individualized clinical decision-making.

Abstract: Most medical vision-language models (VLMs) excel at open-ended report generation and VQA but provide limited support for structured, fine-grained clinical perception within a unified interface. We present QwenVLConnector, a Qwen2.5-VL-based medical chatbot that unifies classification, multi-label classification, textualized detection, counting, regression, and free-form report generation under a single next-token objective. Our key component is a lightweight dense multi-layer Connector that aggregates low- and high-level visual features, aligns them through the pretrained vision Merger, and fuses them with the final visual representation without increasing sequence length. This design enriches visual tokens with complementary spatial and semantic cues while preserving efficiency. On FLARE-2D, QwenVLConnector improves detection F1 from 0.55 to 0.85, raises single-label classification from 0.37 to 0.51, and boosts report-generation GREEN by up to 18.3 points over the Qwen2.5-VL baseline. We further explore multimodal in-context learning for report generation, showing additional improvements without updating model parameters. Overall, QwenVLConnector offers a unified and efficient framework for combining structured medical perception with open-ended clinical text generation. Our code can be found at https://github.com/plnguyen2908/QwenConnector.

Abstract: Purpose: A vertebra at the lumbosacral junction is named by counting caudally from C2 on whole-spine imaging, but a lumbar case is planned on lumbar-only imaging (T12 to S1), without C2. Abdominopelvic CT holds that span plus the lowest ribs and pelvis. Where a lumbosacral transitional vertebra (LSTV) alters the count, the local anatomy is ambiguous: four rib-free vertebrae may be an L1 with a lumbar rib or an L5 assimilated to the sacrum, and six may be a sixth lumbar vertebra, a T12 with aplastic ribs, or a lumbarized S1. CTSpinoPelvic1K asks whether local morphology resolves it without the count. CTSpine1K's vertebrae and CTPelvic1K's pelvis covered these patients but were never joined; this release joins them on one series and adds the bones neither had. It provides 802 CT records with per-level ribs and femora, levels anchored on the lowest rib-bearing vertebra and S1, and classes for L6, T13, a separate S1 and lumbar ribs, so anomalies are recorded as such. Acquisition and Validation Methods: Records pair CTSpine1K and CTPelvic1K labels on each patient's bone-richest series under a VerSe-native scheme. Validation covered geometric invariants (802/802 pass), rib-vertebra incidence across 5,749 ribs (0.035% offset), and spinopelvic measures matching published values. Data Format and Usage Notes: NIfTI image/label pairs with patient-grouped LSTV-stratified five-fold splits and a loader; archived at https://doi.org/10.5281/zenodo.22139642. Potential Applications: Classifying a vertebra from local features; updating cadaveric morphometry; spinopelvic assessment; opportunistic screening; and, absent a public preoperative lumbar cohort, surgical planning research (377 records prone). Limitations: thoracic ground truth is field-of-view limited; postural angles supine; no held-out test set; ribs are triaged-review pseudolabels; Castellvi grades two-reader consensus on 33 records.

Abstract: Perineural invasion (PNI) is an adverse histopathologic marker in intrahepatic cholangiocarcinoma (ICC), but it is usually confirmed only after resection. Preoperative T2-weighted MRI may provide noninvasive imaging cues predictive of PNI, although labels are available only at the patient level without slice- or voxel-level annotations. We propose Order-Aware Slab Multiple Instance Learning (OAS-MIL), a weakly supervised framework for patient-level PNI prediction. Each tumor-centered MRI crop is represented as an ordered sequence of overlapping 2.5D slabs formed from contiguous axial slices. A shared encoder extracts slab-level features, which are aggregated by a permutation-invariant set-attention branch and a bidirectional sequence-attention branch. Using five-fold label-stratified cross-validation at the patient level, OAS-MIL achieved a mean AUROC of 0.770, outperforming the evaluated volumetric and MIL baselines. These results suggest that axial order provides a useful inductive bias for weakly supervised PNI prediction from MRI.

Abstract: Few-shot medical image segmentation (FSMIS) seeks to delineate unseen structures from a small support set, but its standard formulation fixes task-defining evidence before inference. This assumption is fragile when query cases exhibit acquisition shift, atypical pathology, ambiguous boundaries, or poor image quality. Prototype learning, cross-domain matching, interactive segmentation, uncertainty estimation, test-time adaptation, and promptable foundation models address parts of this problem, yet have not been jointly evaluated under a common model of expert attention and clinical risk. This Perspective reframes FSMIS as a sequential clinician-model decision problem with a static support budget $K$ and a distinct interaction budget $B$. At each step, a system accepts the current segmentation, requests feedback, or defers to full expert review. Queries vary in location and modality and are selected by response-conditioned net expected value of information; clinician-provided feedback informs bounded adaptation only after prespecified provenance, consistency, and safety gates. The framework separates distributional atypicality from predicted clinical failure and treats clinician responses as informative but fallible observations. We synthesize the transition from few-shot and cross-domain segmentation to interactive and selective adaptation, delineate the integration gap, and define four research directions with falsifiable hypotheses. Evaluation spans external-domain calibration, quality-effort trade-offs, reader studies, and prospective workflow assessment. The central claim is not that interaction alone resolves domain shift, but that scarce expert attention should be allocated only when it is expected to reduce clinically relevant risk.