Ling Zhang

Chunli Li, Xiaoming Zhang, Yuan Gao et al.

Esophageal varices (EV), a serious health concern resulting from portal hypertension, are traditionally diagnosed through invasive endoscopic procedures. Despite non-contrast computed tomography (NC-CT) imaging being a less expensive and non-invasive imaging modality, it has yet to gain full acceptance as a primary clinical diagnostic tool for EV evaluation. To overcome existing diagnostic challenges, we present the Multi-Organ-cOhesion-Network (MOON), a novel framework enhancing the analysis of critical organ features in NC-CT scans for effective assessment of EV. Drawing inspiration from the thorough assessment practices of radiologists, MOON establishes a cohesive multiorgan analysis model that unifies the imaging features of the related organs of EV, namely esophagus, liver, and spleen. This integration significantly increases the diagnostic accuracy for EV. We have compiled an extensive NC-CT dataset of 1,255 patients diagnosed with EV, spanning three grades of severity. Each case is corroborated by endoscopic diagnostic results. The efficacy of MOON has been substantiated through a validation process involving multi-fold cross-validation on 1,010 cases and an independent test on 245 cases, exhibiting superior diagnostic performance compared to methods focusing solely on the esophagus (for classifying severe grade: AUC of 0.864 versus 0.803, and for moderate to severe grades: AUC of 0.832 versus 0.793). To our knowledge, MOON is the first work to incorporate a synchronized multi-organ NC-CT analysis for EV assessment, providing a more acceptable and minimally invasive alternative for patients compared to traditional endoscopy.

Guangyu Guo, Jiawen Yao, Yingda Xia et al.

The absence of adequately sufficient expert-level tumor annotations hinders the effectiveness of supervised learning based opportunistic cancer screening on medical imaging. Clinical reports (that are rich in descriptive textual details) can offer a "free lunch'' supervision information and provide tumor location as a type of weak label to cope with screening tasks, thus saving human labeling workloads, if properly leveraged. However, predicting cancer only using such weak labels can be very changeling since tumors are usually presented in small anatomical regions compared to the whole 3D medical scans. Weakly semi-supervised learning (WSSL) utilizes a limited set of voxel-level tumor annotations and incorporates alongside a substantial number of medical images that have only off-the-shelf clinical reports, which may strike a good balance between minimizing expert annotation workload and optimizing screening efficacy. In this paper, we propose a novel text-guided learning method to achieve highly accurate cancer detection results. Through integrating diagnostic and tumor location text prompts into the text encoder of a vision-language model (VLM), optimization of weakly supervised learning can be effectively performed in the latent space of VLM, thereby enhancing the stability of training. Our approach can leverage clinical knowledge by large-scale pre-trained VLM to enhance generalization ability, and produce reliable pseudo tumor masks to improve cancer detection. Our extensive quantitative experimental results on a large-scale cancer dataset, including 1,651 unique patients, validate that our approach can reduce human annotation efforts by at least 70% while maintaining comparable cancer detection accuracy to competing fully supervised methods (AUC value 0.961 versus 0.966).

Jiacheng Hao, Xiaoming Zhang, Wei Liu et al.

Focal liver lesions (FLL) are common clinical findings during physical examination. Early diagnosis and intervention of liver malignancies are crucial to improving patient survival. Although the current 3D segmentation paradigm can accurately detect lesions, it faces limitations in distinguishing between malignant and benign liver lesions, primarily due to its inability to differentiate subtle variations between different lesions. Furthermore, existing methods predominantly rely on specialized imaging modalities such as multi-phase contrast-enhanced CT and magnetic resonance imaging, whereas non-contrast CT (NCCT) is more prevalent in routine abdominal imaging. To address these limitations, we propose PLUS, a plug-and-play framework that enhances FLL analysis on NCCT images for arbitrary 3D segmentation models. In extensive experiments involving 8,651 patients, PLUS demonstrated a significant improvement with existing methods, improving the lesion-level F1 score by 5.66%, the malignant patient-level F1 score by 6.26%, and the benign patient-level F1 score by 4.03%. Our results demonstrate the potential of PLUS to improve malignant FLL screening using widely available NCCT imaging substantially.