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Abstract Objectives To investigate the relationship between low kidney volume and subsequent estimated glomerular filtration rate (eGFR) decline in eGFR category G2 (60–89 mL/min/1.73 m2) population. Methods In this retrospective study, we evaluated 5531 individuals with eGFR category G2 who underwent medical checkups at our institution between November 2006 and October 2017. Exclusion criteria were absent for follow-up visit, missing data, prior renal surgery, current renal disease under treatment, large renal masses, and horseshoe kidney. We developed a 3D U-net-based automated system for renal volumetry on CT images. Participants were grouped by sex-specific kidney volume deviations set at mean minus one standard deviation. After 1:1 propensity score matching, we obtained 397 pairs of individuals in the low kidney volume (LKV) and control groups. The primary endpoint was progression of eGFR categories within 5 years, assessed using Cox regression analysis. Results This study included 3220 individuals (mean age, 60.0 ± 9.7 years; men, n = 2209). The kidney volume was 404.6 ± 67.1 and 376.8 ± 68.0 cm3 in men and women, respectively. The low kidney volume (LKV) cutoff was 337.5 and 308.8 cm3 for men and women, respectively. LKV was a significant risk factor for the endpoint with an adjusted hazard ratio of 1.64 (95% confidence interval: 1.09–2.45; p = 0.02). Conclusion Low kidney volume may adversely affect subsequent eGFR maintenance; hence, the use of imaging metrics may help predict eGFR decline. Critical relevance statement Low kidney volume is a significant predictor of reduced kidney function over time; thus, kidney volume measurements could aid in early identification of individuals at risk for declining kidney health. Key points • This study explores how kidney volume affects subsequent kidney function maintenance. • Low kidney volume was associated with estimated glomerular filtration rate decreases. • Low kidney volume is a prognostic indicator of estimated glomerular filtration rate decline. Graphical Abstract

To release medical images that can be freely used in downstream processes while maintaining their utility, it is necessary to remove personal features from the images while preserving the lesion structures. Unlike previous studies that focused on removing lesion structures while preserving the individuality of medical images, this study proposes and validates a new framework that maintains the lesion structures while diffusing individual characteristics. In this framework, we apply local differential privacy techniques to provide theoretical guarantees of privacy protection. Additionally, to enhance the utility of protected medical images, we perform denoising using a diffusion model on the noise-contaminated medical images. Numerous chest X-rays generated by the proposed method were evaluated by physicians, revealing a trade-off between the level of privacy protection and utility. In other words, it was confirmed that increasing the level of personal information protection tends to result in relatively lower utility. This study potentially enables the release of certain types of medical images that were previously difficult to share.

BackgroundPrevious research applying large language models (LLMs) to medicine was focused on text-based information. Recently, multimodal variants of LLMs acquired the capability of recognizing images. ObjectiveWe aim to evaluate the image recognition capability of generative pretrained transformer (GPT)-4V, a recent multimodal LLM developed by OpenAI, in the medical field by testing how visual information affects its performance to answer questions in the 117th Japanese National Medical Licensing Examination. MethodsWe focused on 108 questions that had 1 or more images as part of a question and presented GPT-4V with the same questions under two conditions: (1) with both the question text and associated images and (2) with the question text only. We then compared the difference in accuracy between the 2 conditions using the exact McNemar test. ResultsAmong the 108 questions with images, GPT-4V’s accuracy was 68% (73/108) when presented with images and 72% (78/108) when presented without images (P=.36). For the 2 question categories, clinical and general, the accuracies with and those without images were 71% (70/98) versus 78% (76/98; P=.21) and 30% (3/10) versus 20% (2/10; P≥.99), respectively. ConclusionsThe additional information from the images did not significantly improve the performance of GPT-4V in the Japanese National Medical Licensing Examination.

A general-purpose method of emphasizing abnormal lesions in chest radiographs, named EGGPALE (Extrapolative, Generative and General-Purpose Abnormal Lesion Emphasizer), is presented. The proposed EGGPALE method is composed of a flow-based generative model and L-infinity-distance-based extrapolation in a latent space. The flow-based model is trained using only normal chest radiographs, and an invertible mapping function from the image space to the latent space is determined. In the latent space, a given unseen image is extrapolated so that the image point moves away from the normal chest X-ray hyperplane. Finally, the moved point is mapped back to the image space and the corresponding emphasized image is created. The proposed method was evaluated by an image interpretation experiment with nine radiologists and 1,000 chest radiographs, of which positive suspected lung cancer cases and negative cases were validated by computed tomography examinations. The sensitivity of EGGPALE-processed images showed +0.0559 average improvement compared with that of the original images, with -0.0192 deterioration of average specificity. The area under the receiver operating characteristic curve of the ensemble of nine radiologists showed a statistically significant improvement. From these results, the feasibility of EGGPALE for enhancing abnormal lesions was validated. Our code is available at https://github.com/utrad-ical/Eggpale.

Local differential privacy algorithms combined with deep generative models can enhance secure medical image sharing among researchers in the public domain without central administrators; however, these images were limited to the generation of low-resolution images, which are very insufficient for diagnosis by medical doctors. To enhance the performance of deep generative models so that they can generate high-resolution medical images, we propose a large-scale diffusion model that can, for the first time, unconditionally generate high-resolution (256×256×256) volumetric medical images (head magnetic resonance images). This diffusion model has 19 billion parameters, but to make it easy to train it, we temporally divided the model into 200 submodels, each of which has 95 million parameters. Moreover, on the basis of this new diffusion model, we propose another formulation of image anonymization with which the processed images can satisfy provable Gaussian local differential privacy and with which we can generate images semantically different from the original image but belonging to the same class. We believe that the formulation of this new diffusion model and the implementation of local differential privacy algorithms combined with the diffusion models can contribute to the secure sharing of practical images upstream of data processing.

Objective: This study aimed to determine a standardized cut-off value for abnormal 18F-fluorodeoxyglucose (FDG) accumulation in the thyroid gland. Methods: Herein, 7013 FDG–PET/CT scans were included. An automatic thy roid segmentation method using two U-nets (2D- and 3D-U-net) was con structed; mean FDG standardized uptake value (SUV), CT value, and volume of th e thyroid gland were obtained from each participant. The values were categorized by thyroid function into three groups based on serum thyroid-stimulating hormone levels. Thyroid function and mean SUV with increments of 1 were analyzed, and risk for thyro id dysfunction was calculated. Thyroid dysfunction detection ability was examined using a machine learning method (LightGBM, Microsoft) with age, sex, height, weight, CT value, volume, and mean SUV as explanatory variables. Results: Mean SUV was significantly higher in females with hypothyroidi sm. Almost 98.9% of participants in the normal group had mean SUV < 2 and 93.8% participants with mean SUV < 2 had normal thyroid function. The hypothyroidism group h ad more cases with mean SUV ≥ 2. The relative risk of having abnormal thyroid function was 4 .6 with mean SUV ≥ 2. The sensitivity and specificity for detecting thyroid dysfun ction using LightGBM (Microsoft) were 14.5 and 99%, respectively. Conclusions: Mean SUV ≥ 2 was strongly associated with abnormal thyroid function in this large cohort, indicating that mean SUV with FDG–PET/CT can be used as a criterion for thyroid evaluation. Preliminarily, this study shows the pot ential utility of detecting thyroid dysfunction based on imaging findings.

Resting-state functional magnetic resonance imaging (rsfMRI) has been widely applied to investigate spontaneous neural activity, often based on its macroscopic organization that is termed resting-state networks (RSNs). Although the neurophysiological mechanisms underlying the RSN organization remain largely unknown, accumulating evidence points to a substantial contribution from the global signals to their structured synchronization. This study further explored the phenomenon by taking advantage of the inter- and intra-subject variations of the time delay and correlation coefficient of the signal timeseries in each region using the global mean signal as the reference signal. Consistent with the hypothesis based on the empirical and theoretical findings, the time lag and correlation, which have consistently been proven to represent local hemodynamic status, were shown to organize networks equivalent to RSNs. The results not only provide further evidence that the local hemodynamic status could be the direct source of the RSNs’ spatial patterns but also explain how the regional variations in the hemodynamics, combined with the changes in the global events’ power spectrum, lead to the observations. While the findings pose challenges to interpretations of rsfMRI studies, they further support the view that rsfMRI can offer detailed information related to global neurophysiological phenomena as well as local hemodynamics that would have great potential as biomarkers.

Ultra-sparse-view computed tomography (CT) algorithms can reduce radiation exposure for patients, but these algorithms lack an explicit cycle consistency loss minimization and an explicit log-likelihood maximization in testing. Here, we propose X2CT-FLOW for the maximum a posteriori (MAP) reconstruction of a three-dimensional (3D) chest CT image from a single or a few two-dimensional (2D) projection images using a progressive flow-based deep generative model, especially for ultra-low-dose protocols. The MAP reconstruction can simultaneously optimize the cycle consistency loss and the log-likelihood. We applied X2CT-FLOW for the reconstruction of 3D chest CT images from biplanar projection images without noise contamination (assuming a standard-dose protocol) and with strong noise contamination (assuming an ultra-low-dose protocol). We simulated an ultra-low-dose protocol. With the standard-dose protocol, our images reconstructed from 2D projected images and 3D ground-truth CT images showed good agreement in terms of structural similarity (SSIM, 0.7675 on average), peak signal-to-noise ratio (PSNR, 25.89 dB on average), mean absolute error (MAE, 0.02364 on average), and normalized root mean square error (NRMSE, 0.05731 on average). Moreover, with the ultra-low-dose protocol, our images reconstructed from 2D projected images and the 3D ground-truth CT images also showed good agreement in terms of SSIM (0.7008 on average), PSNR (23.58 dB on average), MAE (0.02991 on average), and NRMSE (0.07349 on average).

This study aimed to explore the relationship between thyroid-stimulating hormone (TSH) elevation and the baseline computed tomography (CT) density and volume of the thyroid. We examined 86 cases with new-onset hypothyroidism (TSH > 4.5 IU/mL) and 1071 controls from a medical check-up database over 5 years. A deep learning-based thyroid segmentation method was used to assess CT density and volume. Statistical tests and logistic regression were employed to determine differences and odds ratios. Initially, the case group showed a higher CT density (89.8 vs. 81.7 Hounsfield units (HUs)) and smaller volume (13.0 vs. 15.3 mL) than those in the control group. For every +10 HU in CT density and −3 mL in volume, the odds of developing hypothyroidism increased by 1.40 and 1.35, respectively. Over the course of the study, the case group showed a notable CT density reduction (median: −8.9 HU), whereas the control group had a minor decrease (−2.9 HU). Thyroid volume remained relatively stable for both groups. Higher CT density and smaller thyroid volume at baseline are correlated with future TSH elevation. Over time, there was a substantial and minor decrease in CT density in the case and control groups, respectively. Thyroid volumes remained consistent in both cohorts.

Diagnostic radiologists need artificial intelligence (AI) for medical imaging, but access to medical images required for training in AI has become increasingly restrictive. To release and use medical images, we need an algorithm that can simultaneously protect privacy and preserve pathologies in medical images. To address this, we introduce DP-GLOW, a hybrid that combines the local differential privacy (LDP) algorithm with GLOW, one of the flow-based deep generative models. By applying a GLOW model, we disentangle the pixelwise correlation of images, which makes it difficult to protect privacy with straightforward LDP algorithms for images. Specifically, we map images to the latent vector of the GLOW model, where each element follows an independent normal distribution. We then apply the Laplace mechanism to this latent vector to achieve ϵ-LDP, which is one of the LDP algorithms. Moreover, we applied DP-GLOW to chest X-ray images to generate LDP images while preserving pathologies. The ϵ-LDP-processed chest X-ray images obtained with DP-GLOW indicate that we have obtained a powerful tool for releasing and using medical images for training AI.

Abstract Background It is essential for radiologists to communicate actionable findings to the referring clinicians reliably. Natural language processing (NLP) has been shown to help identify free-text radiology reports including actionable findings. However, the application of recent deep learning techniques to radiology reports, which can improve the detection performance, has not been thoroughly examined. Moreover, free-text that clinicians input in the ordering form (order information) has seldom been used to identify actionable reports. This study aims to evaluate the benefits of two new approaches: (1) bidirectional encoder representations from transformers (BERT), a recent deep learning architecture in NLP, and (2) using order information in addition to radiology reports. Methods We performed a binary classification to distinguish actionable reports (i.e., radiology reports tagged as actionable in actual radiological practice) from non-actionable ones (those without an actionable tag). 90,923 Japanese radiology reports in our hospital were used, of which 788 (0.87%) were actionable. We evaluated four methods, statistical machine learning with logistic regression (LR) and with gradient boosting decision tree (GBDT), and deep learning with a bidirectional long short-term memory (LSTM) model and a publicly available Japanese BERT model. Each method was used with two different inputs, radiology reports alone and pairs of order information and radiology reports. Thus, eight experiments were conducted to examine the performance. Results Without order information, BERT achieved the highest area under the precision-recall curve (AUPRC) of 0.5138, which showed a statistically significant improvement over LR, GBDT, and LSTM, and the highest area under the receiver operating characteristic curve (AUROC) of 0.9516. Simply coupling the order information with the radiology reports slightly increased the AUPRC of BERT but did not lead to a statistically significant improvement. This may be due to the complexity of clinical decisions made by radiologists. Conclusions BERT was assumed to be useful to detect actionable reports. More sophisticated methods are required to use order information effectively.

Abstract Purpose The purpose of this study is to introduce the new concept of a four-dimensional (4D) cone-beam computed tomography (CBCT) reconstruction approach for non-periodic organ motion in cooperation with the time-ordered chain graph model (TCGM) and to compare it with previously developed methods such as total variation-based compressed sensing (TVCS) and prior-image constrained compressed sensing (PICCS). Materials and Methods Our proposed reconstruction is based on a model including the constraint originating from the images of neighboring time phases. Namely, the reconstructed time-series images depend on each other in this TCGM scheme, and the time-ordered images are concurrently reconstructed in the iterative reconstruction approach. In this study, iterative reconstruction with the TCGM was carried out with 90° projection ranges. The images reconstructed by the TCGM were compared with the images reconstructed by TVCS (200° projection ranges) and PICCS (90° projection ranges). Two kinds of projection data sets–an elliptic-cylindrical digital phantom and two clinical patients’ data–were used. For the digital phantom, an air sphere was contained and virtually moved along the longitudinal axis by 3 cm/30 s and 3 cm/60 s; the temporal resolution was evaluated by measuring the penumbral width of the air sphere. The clinical feasibility of the non-periodic time-ordered 4D CBCT image reconstruction was examined with the patient data in the pelvic region. Results In the evaluation of the digital-phantom reconstruction, the penumbral widths of the TCGM yielded the narrowest result; the results obtained by PICCS and TCGM using 90° projection ranges were 2.8% and 18.2% for 3 cm/30 s, and 5.0% and 23.1% for 3 cm/60 s narrower than that of TVCS using 200° projection ranges. This suggests that the TCGM has a better temporal resolution, whereas PICCS seems similar to TVCS. These reconstruction methods were also compared using patients’ projection data sets. Although all three reconstruction results showed motion related to rectal gas or stool, the result obtained by the TCGM was visibly clearer with less blurring. Conclusion The TCGM is a feasible approach to visualize non-periodic organ motion. The digital-phantom results demonstrated that the proposed method provides 4D image series with a better temporal resolution compared to TVCS and PICCS. The clinical patients’ results also showed that the present method enables us to visualize motion related to rectal gas and flatus in the rectum.