Generating automated reports for 3D positron emission tomography (PET) is an important and challenging task in medical imaging. PET plays a vital role in oncology, but automating report generation is difficult due to the complexity of whole-body 3D volumes, the wide range of potential clinical findings, and the limited availability of annotated datasets. To address these challenges, we introduce PETARSeg-11K, the first large-scale, publicly available dataset that provides lesion-level correspondence between 3D PET/CT volumes and free-text radiological findings. It comprises 11,356 lesion descriptions paired with 3D segmentations. Second, we propose PETAR-4B, a 3D vision-language model designed for mask-aware, spatially grounded PET/CT reporting. PETAR-4B jointly encodes PET, CT, and 3D lesion segmentation masks, using a 3D focal prompt to capture fine-grained details of lesions that normally comprise less than 0.1% of the volume. Evaluations using automated metrics show PETAR-4B substantially outperforming all 2D and 3D baselines. A human study involving five physicians -- the first of its kind for automated PET reporting -- confirms the model's clinical utility and establishes correlations between automated metrics and expert judgment. This work provides a foundational dataset and a novel architecture, advancing 3D medical vision-language understanding in PET.

Understanding the relationship between pathological and healthy brain structures is fundamental to neuroimaging, connecting disease diagnosis and detection with modeling, prediction, and treatment planning. However, paired pathological-healthy data are extremely difficult to obtain, as they rely on pre- and post-treatment imaging, constrained by clinical outcomes and longitudinal data availability. Consequently, most existing brain image generation and editing methods focus on visual quality yet remain domain-specific, treating pathological and healthy image modeling independently. We introduce USB (Unified Synthetic Brain), the first end-to-end framework that unifies bidirectional generation and editing of pathological and healthy brain images. USB models the joint distribution of lesions and brain anatomy through a paired diffusion mechanism and achieves both pathological and healthy image generation. A consistency guidance algorithm further preserves anatomical consistency and lesion correspondence during bidirectional pathology-healthy editing. Extensive experiments on six public brain MRI datasets including healthy controls, stroke, and Alzheimer's patients, demonstrate USB's ability to produce diverse and realistic results. By establishing the first unified benchmark for brain image generation and editing, USB opens opportunities for scalable dataset creation and robust neuroimaging analysis. Code is available at https://github.com/jhuldr/USB.

$\textbf{Purpose}$: Automatic quantification of longitudinal changes in PET scans for lymphoma patients has proven challenging, as residual disease in interim-therapy scans is often subtle and difficult to detect. Our goal was to develop a longitudinally-aware segmentation network (LAS-Net) that can quantify serial PET/CT images for pediatric Hodgkin lymphoma patients. $\textbf{Materials and Methods}$: This retrospective study included baseline (PET1) and interim (PET2) PET/CT images from 297 patients enrolled in two Children's Oncology Group clinical trials (AHOD1331 and AHOD0831). LAS-Net incorporates longitudinal cross-attention, allowing relevant features from PET1 to inform the analysis of PET2. Model performance was evaluated using Dice coefficients for PET1 and detection F1 scores for PET2. Additionally, we extracted and compared quantitative PET metrics, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in PET1, as well as qPET and $\Delta$SUVmax in PET2, against physician measurements. We quantified their agreement using Spearman's $\rho$ correlations and employed bootstrap resampling for statistical analysis. $\textbf{Results}$: LAS-Net detected residual lymphoma in PET2 with an F1 score of 0.606 (precision/recall: 0.615/0.600), outperforming all comparator methods (P<0.01). For baseline segmentation, LAS-Net achieved a mean Dice score of 0.772. In PET quantification, LAS-Net's measurements of qPET, $\Delta$SUVmax, MTV and TLG were strongly correlated with physician measurements, with Spearman's $\rho$ of 0.78, 0.80, 0.93 and 0.96, respectively. The performance remained high, with a slight decrease, in an external testing cohort. $\textbf{Conclusion}$: LAS-Net achieved high performance in quantifying PET metrics across serial scans, highlighting the value of longitudinal awareness in evaluating multi-time-point imaging datasets.

Data augmentation has become a de facto component of deep learning-based medical image segmentation methods. Most data augmentation techniques used in medical imaging focus on spatial and intensity transformations to improve the diversity of training images. They are often designed at the image level, augmenting the full image, and do not pay attention to specific abnormalities within the image. Here, we present LesionMix, a novel and simple lesion-aware data augmentation method. It performs augmentation at the lesion level, increasing the diversity of lesion shape, location, intensity and load distribution, and allowing both lesion populating and inpainting. Experiments on different modalities and different lesion datasets, including four brain MR lesion datasets and one liver CT lesion dataset, demonstrate that LesionMix achieves promising performance in lesion image segmentation, outperforming several recent Mix-based data augmentation methods. The code will be released at https://github.com/dogabasaran/lesionmix.

As the world progresses in technology and health, awareness of disease by revealing asymptomatic signs improves. It is important to detect and treat tumors in early stage as it can be life-threatening. Computer-aided technologies are used to overcome lingering limitations facing disease diagnosis, while brain tumor segmentation remains a difficult process, especially when multi-modality data is involved. This is mainly attributed to ineffective training due to lack of data and corresponding labelling. This work investigates the feasibility of employing deep-fake image generation for effective brain tumor segmentation. To this end, a Generative Adversarial Network was used for image-to-image translation for increasing dataset size, followed by image segmentation using a U-Net-based convolutional neural network trained with deepfake images. Performance of the proposed approach is compared with ground truth of four publicly available datasets. Results show improved performance in terms of image segmentation quality metrics, and could potentially assist when training with limited data.

A major challenge in stroke research and stroke recovery predictions is the determination of a stroke lesion's extent and its impact on relevant brain systems. Manual segmentation of stroke lesions from 3D magnetic resonance (MR) imaging volumes, the current gold standard, is not only very time-consuming, but its accuracy highly depends on the operator's experience. As a result, there is a need for a fully automated segmentation method that can efficiently and objectively measure lesion extent and the impact of each lesion to predict impairment and recovery potential which might be beneficial for clinical, translational, and research settings. We have implemented and tested a fully automatic method for stroke lesion segmentation which was developed using eight different 2D-model architectures trained via transfer learning (TL) and mixed data approaches. Additionally, the final prediction was made using a novel ensemble method involving stacking and agreement window. Our novel method was evaluated in a novel in-house dataset containing 22 T1w brain MR images, which were challenging in various perspectives, but mostly because they included T1w MR images from the subacute (which typically less well defined T1 lesions) and chronic stroke phase (which typically means well defined T1-lesions). Cross-validation results indicate that our new method can efficiently and automatically segment lesions fast and with high accuracy compared to ground truth. In addition to segmentation, we provide lesion volume and weighted lesion load of relevant brain systems based on the lesions' overlap with a canonical structural motor system that stretches from the cortical motor region to the lowest end of the brain stem.

Focal cortical dysplasia (FCD) is a leading cause of drug-resistant focal epilepsy, which can be cured by surgery. These lesions are extremely subtle and often missed even by expert neuroradiologists. "Ground truth" manual lesion masks are therefore expensive, limited and have large inter-rater variability. Existing FCD detection methods are limited by high numbers of false positive predictions, primarily due to vertex- or patch-based approaches that lack whole-brain context. Here, we propose to approach the problem as semantic segmentation using graph convolutional networks (GCN), which allows our model to learn spatial relationships between brain regions. To address the specific challenges of FCD identification, our proposed model includes an auxiliary loss to predict distance from the lesion to reduce false positives and a weak supervision classification loss to facilitate learning from uncertain lesion masks. On a multi-centre dataset of 1015 participants with surface-based features and manual lesion masks from structural MRI data, the proposed GCN achieved an AUC of 0.74, a significant improvement against a previously used vertex-wise multi-layer perceptron (MLP) classifier (AUC 0.64). With sensitivity thresholded at 67%, the GCN had a specificity of 71% in comparison to 49% when using the MLP. This improvement in specificity is vital for clinical integration of lesion-detection tools into the radiological workflow, through increasing clinical confidence in the use of AI radiological adjuncts and reducing the number of areas requiring expert review.

Understanding the intensity characteristics of brain lesions is key for defining image-based biomarkers in neurological studies and for predicting disease burden and outcome. In this work, we present a novel foreground-based generative method for modelling the local lesion characteristics that can both generate synthetic lesions on healthy images and synthesize subject-specific pseudo-healthy images from pathological images. Furthermore, the proposed method can be used as a data augmentation module to generate synthetic images for training brain image segmentation networks. Experiments on multiple sclerosis (MS) brain images acquired on magnetic resonance imaging (MRI) demonstrate that the proposed method can generate highly realistic pseudo-healthy and pseudo-pathological brain images. Data augmentation using the synthetic images improves the brain image segmentation performance compared to traditional data augmentation methods as well as a recent lesion-aware data augmentation technique, CarveMix. The code will be released at https://github.com/dogabasaran/lesion-synthesis.

Purpose: Lesion segmentation in medical imaging is key to evaluating treatment response. We have recently shown that reinforcement learning can be applied to radiological images for lesion localization. Furthermore, we demonstrated that reinforcement learning addresses important limitations of supervised deep learning; namely, it can eliminate the requirement for large amounts of annotated training data and can provide valuable intuition lacking in supervised approaches. However, we did not address the fundamental task of lesion/structure-of-interest segmentation. Here we introduce a method combining unsupervised deep learning clustering with reinforcement learning to segment brain lesions on MRI. Materials and Methods: We initially clustered images using unsupervised deep learning clustering to generate candidate lesion masks for each MRI image. The user then selected the best mask for each of 10 training images. We then trained a reinforcement learning algorithm to select the masks. We tested the corresponding trained deep Q network on a separate testing set of 10 images. For comparison, we also trained and tested a U-net supervised deep learning network on the same set of training/testing images. Results: Whereas the supervised approach quickly overfit the training data and predictably performed poorly on the testing set (16% average Dice score), the unsupervised deep clustering and reinforcement learning achieved an average Dice score of 83%. Conclusion: We have demonstrated a proof-of-principle application of unsupervised deep clustering and reinforcement learning to segment brain tumors. The approach represents human-allied AI that requires minimal input from the radiologist without the need for hand-traced annotation.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) that results in focal injury to the grey and white matter. The presence of white matter lesions biases morphometric analyses such as registration, individual longitudinal measurements and tissue segmentation for brain volume measurements. Lesion-inpainting with intensities derived from surround healthy tissue represent one approach to alleviate such problems. However, existing methods inpaint lesions based on texture information derived from local surrounding tissue, often leading to inconsistent inpainting and the generation of artifacts such as intensity discrepancy and blurriness. Based on these observations, we propose non-local partial convolutions (NLPC) which integrates a Unet-like network with the non-local module. The non-local module is exploited to capture long range dependencies between the lesion area and remaining normal-appearing brain regions. Then, the lesion area is filled by referring to normal-appearing regions with more similar features. This method generates inpainted regions that appear more realistic and natural. Our quantitative experimental results also demonstrate superiority of this technique of existing state-of-the-art inpainting methods.