Is an Ultra Large Natural Image-Based Foundation Model Superior to a Retina-Specific Model for Detecting Ocular and Systemic Diseases?

The advent of foundation models (FMs) is transforming medical domain. In ophthalmology, RETFound, a retina-specific FM pre-trained sequentially on 1.4 million natural images and 1.6 million retinal images, has demonstrated high adaptability across clinical applications. Conversely, DINOv2, a general-purpose vision FM pre-trained on 142 million natural images, has shown promise in non-medical domains. However, its applicability to clinical tasks remains underexplored. To address this, we conducted head-to-head evaluations by fine-tuning RETFound and three DINOv2 models (large, base, small) for ocular disease detection and systemic disease prediction tasks, across eight standardized open-source ocular datasets, as well as the Moorfields AlzEye and the UK Biobank datasets. DINOv2-large model outperformed RETFound in detecting diabetic retinopathy (AUROC=0.850-0.952 vs 0.823-0.944, across three datasets, all P<=0.007) and multi-class eye diseases (AUROC=0.892 vs. 0.846, P<0.001). In glaucoma, DINOv2-base model outperformed RETFound (AUROC=0.958 vs 0.940, P<0.001). Conversely, RETFound achieved superior performance over all DINOv2 models in predicting heart failure, myocardial infarction, and ischaemic stroke (AUROC=0.732-0.796 vs 0.663-0.771, all P<0.001). These trends persisted even with 10% of the fine-tuning data. These findings showcase the distinct scenarios where general-purpose and domain-specific FMs excel, highlighting the importance of aligning FM selection with task-specific requirements to optimise clinical performance.

Deep Learning Pipeline for Fully Automated Myocardial Infarct Segmentation from Clinical Cardiac MR Scans

Purpose: To develop and evaluate a deep learning-based method that allows to perform myocardial infarct segmentation in a fully-automated way. Materials and Methods: For this retrospective study, a cascaded framework of two and three-dimensional convolutional neural networks (CNNs), specialized on identifying ischemic myocardial scars on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) images, was trained on an in-house training dataset consisting of 144 examinations. On a separate test dataset from the same institution, including images from 152 examinations obtained between 2021 and 2023, a quantitative comparison between artificial intelligence (AI)-based segmentations and manual segmentations was performed. Further, qualitative assessment of segmentation accuracy was evaluated for both human and AI-generated contours by two CMR experts in a blinded experiment. Results: Excellent agreement could be found between manually and automatically calculated infarct volumes ($\rho_c$ = 0.9). The qualitative evaluation showed that compared to human-based measurements, the experts rated the AI-based segmentations to better represent the actual extent of infarction significantly (p < 0.001) more often (33.4% AI, 25.1% human, 41.5% equal). On the contrary, for segmentation of microvascular obstruction (MVO), manual measurements were still preferred (11.3% AI, 55.6% human, 33.1% equal). Conclusion: This fully-automated segmentation pipeline enables CMR infarct size to be calculated in a very short time and without requiring any pre-processing of the input images while matching the segmentation quality of trained human observers. In a blinded experiment, experts preferred automated infarct segmentations more often than manual segmentations, paving the way for a potential clinical application.

Causally-informed Deep Learning towards Explainable and Generalizable Outcomes Prediction in Critical Care

Recent advances in deep learning (DL) have prompted the development of high-performing early warning score (EWS) systems, predicting clinical deteriorations such as acute kidney injury, acute myocardial infarction, or circulatory failure. DL models have proven to be powerful tools for various tasks but come with the cost of lacking interpretability and limited generalizability, hindering their clinical applications. To develop a practical EWS system applicable to various outcomes, we propose causally-informed explainable early prediction model, which leverages causal discovery to identify the underlying causal relationships of prediction and thus owns two unique advantages: demonstrating the explicit interpretation of the prediction while exhibiting decent performance when applied to unfamiliar environments. Benefiting from these features, our approach achieves superior accuracy for 6 different critical deteriorations and achieves better generalizability across different patient groups, compared to various baseline algorithms. Besides, we provide explicit causal pathways to serve as references for assistant clinical diagnosis and potential interventions. The proposed approach enhances the practical application of deep learning in various medical scenarios.

A Learnable Multi-views Contrastive Framework with Reconstruction Discrepancy for Medical Time-Series

In medical time series disease diagnosis, two key challenges are identified.First, the high annotation cost of medical data leads to overfitting in models trained on label-limited, single-center datasets. To address this, we propose incorporating external data from related tasks and leveraging AE-GAN to extract prior knowledge,providing valuable references for downstream tasks. Second, many existing studies employ contrastive learning to derive more generalized medical sequence representations for diagnostic tasks, usually relying on manually designed diverse positive and negative sample pairs.However, these approaches are complex, lack generalizability, and fail to adaptively capture disease-specific features across different conditions.To overcome this, we introduce LMCF (Learnable Multi-views Contrastive Framework), a framework that integrates a multi-head attention mechanism and adaptively learns representations from different views through inter-view and intra-view contrastive learning strategies.Additionally, the pre-trained AE-GAN is used to reconstruct discrepancies in the target data as disease probabilities, which are then integrated into the contrastive learning process.Experiments on three target datasets demonstrate that our method consistently outperforms seven other baselines, highlighting its significant impact on healthcare applications such as the diagnosis of myocardial infarction, Alzheimer's disease, and Parkinson's disease.

High-Accuracy ECG Image Interpretation using Parameter-Efficient LoRA Fine-Tuning with Multimodal LLaMA 3.2

Electrocardiogram (ECG) interpretation is a cornerstone of cardiac diagnostics. This paper explores a practical approach to enhance ECG image interpretation using the multimodal LLaMA 3.2 model. We used a parameter-efficient fine-tuning strategy, Low-Rank Adaptation (LoRA), specifically designed to boost the model's ability to understand ECG images and achieve better outcomes across a wide range of cardiac conditions. Our method is tailored for ECG analysis and leverages ECGInstruct, a large-scale instruction dataset with 1 Million samples. This dataset is a rich collection of synthesized ECG images, generated from raw ECG data from trusted open-source repositories like MIMIC-IV ECG and PTB-XL. Each ECG image in ECGInstruct comes with expert-written questions and detailed answers, covering diverse ECG interpretation scenarios, including complex cardiac conditions like Myocardial Infarction and Conduction Disturbances. Our fine-tuning approach efficiently adapts the LLaMA 3.2 model (built upon LLaMA 3) by integrating low-rank adaptation techniques, focusing on efficiency by updating only a small set of parameters, specifically ignoring the `lm_head` and `embed_tokens` layers. This paper details the model setup, our efficient fine-tuning method, and implementation specifics. We provide a thorough evaluation through extensive experiments, demonstrating the effectiveness of our method across various ECG interpretation tasks. The results convincingly show that our parameter-efficient LoRA fine-tuning achieves excellent performance in ECG image interpretation, significantly outperforming baseline models and reaching accuracy comparable to or exceeding traditional CNN-based methods in identifying a wide range of cardiac abnormalities, including over 70 conditions from the PTB-XL dataset.

High-dimensional multimodal uncertainty estimation by manifold alignment:Application to 3D right ventricular strain computations

Confidence in the results is a key ingredient to improve the adoption of machine learning methods by clinicians. Uncertainties on the results have been considered in the literature, but mostly those originating from the learning and processing methods. Uncertainty on the data is hardly challenged, as a single sample is often considered representative enough of each subject included in the analysis. In this paper, we propose a representation learning strategy to estimate local uncertainties on a physiological descriptor (here, myocardial deformation) previously obtained from medical images by different definitions or computations. We first use manifold alignment to match the latent representations associated to different high-dimensional input descriptors. Then, we formulate plausible distributions of latent uncertainties, and finally exploit them to reconstruct uncertainties on the input high-dimensional descriptors. We demonstrate its relevance for the quantification of myocardial deformation (strain) from 3D echocardiographic image sequences of the right ventricle, for which a lack of consensus exists in its definition and which directional component to use. We used a database of 100 control subjects with right ventricle overload, for which different types of strain are available at each point of the right ventricle endocardial surface mesh. Our approach quantifies local uncertainties on myocardial deformation from different descriptors defining this physiological concept. Such uncertainties cannot be directly estimated by local statistics on such descriptors, potentially of heterogeneous types. Beyond this controlled illustrative application, our methodology has the potential to be generalized to many other population analyses considering heterogeneous high-dimensional descriptors.

Utilizing AI Language Models to Identify Prognostic Factors for Coronary Artery Disease: A Study in Mashhad Residents

Abstract: Background: Understanding cardiovascular artery disease risk factors, the leading global cause of mortality, is crucial for influencing its etiology, prevalence, and treatment. This study aims to evaluate prognostic markers for coronary artery disease in Mashhad using Naive Bayes, REP Tree, J48, CART, and CHAID algorithms. Methods: Using data from the 2009 MASHAD STUDY, prognostic factors for coronary artery disease were determined with Naive Bayes, REP Tree, J48, CART, CHAID, and Random Forest algorithms using R 3.5.3 and WEKA 3.9.4. Model efficiency was compared by sensitivity, specificity, and accuracy. Cases were patients with coronary artery disease; each had three controls (totally 940). Results: Prognostic factors for coronary artery disease in Mashhad residents varied by algorithm. CHAID identified age, myocardial infarction history, and hypertension. CART included depression score and physical activity. REP added education level and anxiety score. NB included diabetes and family history. J48 highlighted father's heart disease and weight loss. CHAID had the highest accuracy (0.80). Conclusion: Key prognostic factors for coronary artery disease in CART and CHAID models include age, myocardial infarction history, hypertension, depression score, physical activity, and BMI. NB, REP Tree, and J48 identified numerous factors. CHAID had the highest accuracy, sensitivity, and specificity. CART offers simpler interpretation, aiding physician and paramedic model selection based on specific. Keywords: RF, Na\"ive Bayes, REP, J48 algorithms, Coronary Artery Disease (CAD).

Contrast-Free Myocardial Scar Segmentation in Cine MRI using Motion and Texture Fusion

Late gadolinium enhancement MRI (LGE MRI) is the gold standard for the detection of myocardial scars for post myocardial infarction (MI). LGE MRI requires the injection of a contrast agent, which carries potential side effects and increases scanning time and patient discomfort. To address these issues, we propose a novel framework that combines cardiac motion observed in cine MRI with image texture information to segment the myocardium and scar tissue in the left ventricle. Cardiac motion tracking can be formulated as a full cardiac image cycle registration problem, which can be solved via deep neural networks. Experimental results prove that the proposed method can achieve scar segmentation based on non-contrasted cine images with comparable accuracy to LGE MRI. This demonstrates its potential as an alternative to contrast-enhanced techniques for scar detection.

ScarNet: A Novel Foundation Model for Automated Myocardial Scar Quantification from LGE in Cardiac MRI

Background: Late Gadolinium Enhancement (LGE) imaging is the gold standard for assessing myocardial fibrosis and scarring, with left ventricular (LV) LGE extent predicting major adverse cardiac events (MACE). Despite its importance, routine LGE-based LV scar quantification is hindered by labor-intensive manual segmentation and inter-observer variability. Methods: We propose ScarNet, a hybrid model combining a transformer-based encoder from the Medical Segment Anything Model (MedSAM) with a convolution-based U-Net decoder, enhanced by tailored attention blocks. ScarNet was trained on 552 ischemic cardiomyopathy patients with expert segmentations of myocardial and scar boundaries and tested on 184 separate patients. Results: ScarNet achieved robust scar segmentation in 184 test patients, yielding a median Dice score of 0.912 (IQR: 0.863--0.944), significantly outperforming MedSAM (median Dice = 0.046, IQR: 0.043--0.047) and nnU-Net (median Dice = 0.638, IQR: 0.604--0.661). ScarNet demonstrated lower bias (-0.63%) and coefficient of variation (4.3%) compared to MedSAM (bias: -13.31%, CoV: 130.3%) and nnU-Net (bias: -2.46%, CoV: 20.3%). In Monte Carlo simulations with noise perturbations, ScarNet achieved significantly higher scar Dice (0.892 \pm 0.053, CoV = 5.9%) than MedSAM (0.048 \pm 0.112, CoV = 233.3%) and nnU-Net (0.615 \pm 0.537, CoV = 28.7%). Conclusion: ScarNet outperformed MedSAM and nnU-Net in accurately segmenting myocardial and scar boundaries in LGE images. The model exhibited robust performance across diverse image qualities and scar patterns.

Cech Complex Generation with Homotopy Equivalence Framework for Myocardial Infarction Diagnosis using Electrocardiogram Signals

Early and optimal identification of cardiac anomalies, especially Myocardial infarction (MCI) can aid the individual in obtaining prompt medical attention to mitigate the severity. Electrocardiogram (ECG) is a simple non-invasive physiological signal modality, that can be used to examine the electrical activity of heart tissue. Existing methods for MCI detection mostly rely on the temporal, frequency, and spatial domain analysis of the ECG signals. These conventional techniques lack in effective identification of cardiac cycle inter-dependency during diagnosis. Hence, there is an emerging need for incorporating the underlying connectivity of the intra-sessional cardiac cycles for improved anomaly detection. This article proposes a novel framework for ECG signal analysis and classification using persistent homological features through Cech Complex generation with homotopy equivalence check, by taking the above-mentioned emerging needs into account. Homological features like persistent birth-death rates, betti curves, and persistent entropy provide transparency of the regional and cardiac cycle connectivity when combined with Machine Learning (ML) models. The proposed framework is assessed using publicly available datasets (MIT-BIH and PTB), and the performance metrics of machine learning models indicate its efficacy in classifying Normal Sinus Rhythm (NSR), MCI, and non-MCI subjects, achieving a 2.8% mean improvement in AUC (area under the ROC curve) over existing approaches.