Disease grading is a crucial task in medical image analysis. Due to the continuous progression of diseases, i.e., the variability within the same level and the similarity between adjacent stages, accurate grading is highly challenging.Furthermore, in real-world scenarios, models trained on limited source domain datasets should also be capable of handling data from unseen target domains.Due to the cross-domain variants, the feature distribution between source and unseen target domains can be dramatically different, leading to a substantial decrease in model performance.To address these challenges in cross-domain disease grading, we propose a Severity-aware Recurrent Modeling (Samba) method in this paper.As the core objective of most staging tasks is to identify the most severe lesions, which may only occupy a small portion of the image, we propose to encode image patches in a sequential and recurrent manner.Specifically, a state space model is tailored to store and transport the severity information by hidden states.Moreover, to mitigate the impact of cross-domain variants, an Expectation-Maximization (EM) based state recalibration mechanism is designed to map the patch embeddings into a more compact space.We model the feature distributions of different lesions through the Gaussian Mixture Model (GMM) and reconstruct the intermediate features based on learnable severity bases.Extensive experiments show the proposed Samba outperforms the VMamba baseline by an average accuracy of 23.5\%, 5.6\% and 4.1\% on the cross-domain grading of fatigue fracture, breast cancer and diabetic retinopathy, respectively. Source code is available at \url{https://github.com/BiQiWHU/Samba}.

Diabetic Retinopathy (DR) affects individuals with long-term diabetes. Without early diagnosis, DR can lead to vision loss. Fundus photography captures the structure of the retina along with abnormalities indicative of the stage of the disease. Artificial Intelligence (AI) can support clinicians in identifying these lesions, reducing manual workload, but models require high-quality annotated datasets. Due to the complexity of retinal structures, errors in image acquisition and lesion interpretation of manual annotators can occur. We proposed a quality-control framework, ensuring only high-standard data is used for evaluation and AI training. First, an explainable feature-based classifier is used to filter inadequate images. The features are extracted both using image processing and contrastive learning. Then, the images are enhanced and put subject to annotation, using deep-learning-based assistance. Lastly, the agreement between annotators calculated using derived formulas determines the usability of the annotations.

Coronary angiography is the main tool for assessing coronary artery disease, but visual grading of stenosis is variable and only moderately related to ischaemia. Wire based fractional flow reserve (FFR) improves lesion selection but is not used systematically. Angiography derived indices such as quantitative flow ratio (QFR) offer wire free physiology, yet many tools are workflow intensive and separate from automated anatomy analysis and virtual PCI planning. We developed AngioAI-QFR, an end to end angiography only pipeline combining deep learning stenosis detection, lumen segmentation, centreline and diameter extraction, per millimetre Relative Flow Capacity profiling, and virtual stenting with automatic recomputation of angiography derived QFR. The system was evaluated in 100 consecutive vessels with invasive FFR as reference. Primary endpoints were agreement with FFR (correlation, mean absolute error) and diagnostic performance for FFR <= 0.80. On held out frames, stenosis detection achieved precision 0.97 and lumen segmentation Dice 0.78. Across 100 vessels, AngioAI-QFR correlated strongly with FFR (r = 0.89, MAE 0.045). The AUC for detecting FFR <= 0.80 was 0.93, with sensitivity 0.88 and specificity 0.86. The pipeline completed fully automatically in 93 percent of vessels, with median time to result 41 s. RFC profiling distinguished focal from diffuse capacity loss, and virtual stenting predicted larger QFR gain in focal than in diffuse disease. AngioAI-QFR provides a practical, near real time pipeline that unifies computer vision, functional profiling, and virtual PCI with automated angiography derived physiology.

In the field of healthcare, precise skin lesion segmentation is crucial for the early detection and accurate diagnosis of skin diseases. Despite significant advances in deep learning for image processing, existing methods have yet to effectively address the challenges of irregular lesion shapes and low contrast. To address these issues, this paper proposes an innovative encoder-decoder network architecture based on multi-scale residual structures, capable of extracting rich feature information from different receptive fields to effectively identify lesion areas. By introducing a Multi-Resolution Multi-Channel Fusion (MRCF) module, our method captures cross-scale features, enhancing the clarity and accuracy of the extracted information. Furthermore, we propose a Cross-Mix Attention Module (CMAM), which redefines the attention scope and dynamically calculates weights across multiple contexts, thus improving the flexibility and depth of feature capture and enabling deeper exploration of subtle features. To overcome the information loss caused by skip connections in traditional U-Net, an External Attention Bridge (EAB) is introduced, facilitating the effective utilization of information in the decoder and compensating for the loss during upsampling. Extensive experimental evaluations on several skin lesion segmentation datasets demonstrate that the proposed model significantly outperforms existing transformer and convolutional neural network-based models, showcasing exceptional segmentation accuracy and robustness.

Accurate segmentation of vertebral metastasis in CT is clinically important yet difficult to scale, as voxel-level annotations are scarce and both lytic and blastic lesions often resemble benign degenerative changes. We introduce a weakly supervised method trained solely on vertebra-level healthy/malignant labels, without any lesion masks. The method combines a Diffusion Autoencoder (DAE) that produces a classifier-guided healthy edit of each vertebra with pixel-wise difference maps that propose candidate lesion regions. To determine which regions truly reflect malignancy, we introduce Hide-and-Seek Attribution: each candidate is revealed in turn while all others are hidden, the edited image is projected back to the data manifold by the DAE, and a latent-space classifier quantifies the isolated malignant contribution of that component. High-scoring regions form the final lytic or blastic segmentation. On held-out radiologist annotations, we achieve strong blastic/lytic performance despite no mask supervision (F1: 0.91/0.85; Dice: 0.87/0.78), exceeding baselines (F1: 0.79/0.67; Dice: 0.74/0.55). These results show that vertebra-level labels can be transformed into reliable lesion masks, demonstrating that generative editing combined with selective occlusion supports accurate weakly supervised segmentation in CT.

Coronary artery disease (CAD) remains a major global health burden. Accurate identification of the culprit vessel and assessment of stenosis severity are essential for guiding individualized therapy. Although coronary CT angiography (CCTA) is the first-line non-invasive modality for CAD diagnosis, its dependence on high-end equipment, radiation exposure, and strict patient cooperation limits large-scale use. With advances in artificial intelligence (AI) and the widespread availability of electrocardiography (ECG), AI-ECG offers a promising alternative for CAD screening. In this study, we developed an interpretable AI-ECG model to predict severe or complete stenosis of the four major coronary arteries on CCTA. On the internal validation set, the model's AUCs for the right coronary artery (RCA), left main coronary artery (LM), left anterior descending artery (LAD), and left circumflex artery (LCX) were 0.794, 0.818, 0.744, and 0.755, respectively; on the external validation set, the AUCs reached 0.749, 0.971, 0.667, and 0.727, respectively. Performance remained stable in a clinically normal-ECG subset, indicating robustness beyond overt ECG abnormalities. Subgroup analyses across demographic and acquisition-time strata further confirmed model stability. Risk stratification based on vessel-specific incidence thresholds showed consistent separation on calibration and cumulative event curves. Interpretability analyses revealed distinct waveform differences between high- and low-risk groups, highlighting key electrophysiological regions contributing to model decisions and offering new insights into the ECG correlates of coronary stenosis.

Objective: To evaluate large language models (LLMs) against supervised baselines for fine-grained, lesion-level detection of incidentalomas requiring follow-up, addressing the limitations of current document-level classification systems. Methods: We utilized a dataset of 400 annotated radiology reports containing 1,623 verified lesion findings. We compared three supervised transformer-based encoders (BioClinicalModernBERT, ModernBERT, Clinical Longformer) against four generative LLM configurations (Llama 3.1-8B, GPT-4o, GPT-OSS-20b). We introduced a novel inference strategy using lesion-tagged inputs and anatomy-aware prompting to ground model reasoning. Performance was evaluated using class-specific F1-scores. Results: The anatomy-informed GPT-OSS-20b model achieved the highest performance, yielding an incidentaloma-positive macro-F1 of 0.79. This surpassed all supervised baselines (maximum macro-F1: 0.70) and closely matched the inter-annotator agreement of 0.76. Explicit anatomical grounding yielded statistically significant performance gains across GPT-based models (p < 0.05), while a majority-vote ensemble of the top systems further improved the macro-F1 to 0.90. Error analysis revealed that anatomy-aware LLMs demonstrated superior contextual reasoning in distinguishing actionable findings from benign lesions. Conclusion: Generative LLMs, when enhanced with structured lesion tagging and anatomical context, significantly outperform traditional supervised encoders and achieve performance comparable to human experts. This approach offers a reliable, interpretable pathway for automated incidental finding surveillance in radiology workflows. Introduction Incidental findings, or incidentalomas, refer to unexpected abnormalities discovered during imaging studies performed for unrelated reasons [1]. Their detection has increased as imaging utilization has grown across healthcare. These findings create a clinical dilemma, since most are benign while some represent early-stage disease that requires intervention.

Accurate and timely diagnosis of multi-class skin lesions is hampered by subjective methods, inherent data imbalance in datasets like HAM10000, and the "black box" nature of Deep Learning (DL) models. This study proposes a trustworthy and highly accurate Computer-Aided Diagnosis (CAD) system to overcome these limitations. The approach utilizes Deep Convolutional Generative Adversarial Networks (DCGANs) for per class data augmentation to resolve the critical class imbalance problem. A fine-tuned ResNet-50 classifier is then trained on the augmented dataset to classify seven skin disease categories. Crucially, LIME and SHAP Explainable AI (XAI) techniques are integrated to provide transparency by confirming that predictions are based on clinically relevant features like irregular morphology. The system achieved a high overall Accuracy of 92.50 % and a Macro-AUC of 98.82 %, successfully outperforming various prior benchmarked architectures. This work successfully validates a verifiable framework that combines high performance with the essential clinical interpretability required for safe diagnostic deployment. Future research should prioritize enhancing discrimination for critical categories, such as Melanoma NOS (F1-Score is 0.8602).

Cardiovascular disease is the leading global cause of mortality, with coronary artery disease (CAD) as its most prevalent form, necessitating early risk prediction. While 3D coronary artery digital twins reconstructed from imaging offer detailed anatomy for personalized assessment, their analysis relies on computationally intensive computational fluid dynamics (CFD), limiting scalability. Data-driven approaches are hindered by scarce labeled data and lack of physiological priors. To address this, we present PINS-CAD, a physics-informed self-supervised learning framework. It pre-trains graph neural networks on 200,000 synthetic coronary digital twins to predict pressure and flow, guided by 1D Navier-Stokes equations and pressure-drop laws, eliminating the need for CFD or labeled data. When fine-tuned on clinical data from 635 patients in the multicenter FAME2 study, PINS-CAD predicts future cardiovascular events with an AUC of 0.73, outperforming clinical risk scores and data-driven baselines. This demonstrates that physics-informed pretraining boosts sample efficiency and yields physiologically meaningful representations. Furthermore, PINS-CAD generates spatially resolved pressure and fractional flow reserve curves, providing interpretable biomarkers. By embedding physical priors into geometric deep learning, PINS-CAD transforms routine angiography into a simulation-free, physiology-aware framework for scalable, preventive cardiology.