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Multi-sequence Magnetic Resonance Imaging (MRI) offers remarkable versatility, enabling the distinct visualization of different tissue types. Nevertheless, the inherent heterogeneity among MRI sequences poses significant challenges to the generalization capability of deep learning models. These challenges undermine model performance when faced with varying acquisition parameters, thereby severely restricting their clinical utility. In this study, we present PRISM, a foundation model PRe-trained with large-scale multI-Sequence MRI. We collected a total of 64 datasets from both public and private sources, encompassing a wide range of whole-body anatomical structures, with scans spanning diverse MRI sequences. Among them, 336,476 volumetric MRI scans from 34 datasets (8 public and 26 private) were curated to construct the largest multi-organ multi-sequence MRI pretraining corpus to date. We propose a novel pretraining paradigm that disentangles anatomically invariant features from sequence-specific variations in MRI, while preserving high-level semantic representations. We established a benchmark comprising 44 downstream tasks, including disease diagnosis, image segmentation, registration, progression prediction, and report generation. These tasks were evaluated on 32 public datasets and 5 private cohorts. PRISM consistently outperformed both non-pretrained models and existing foundation models, achieving first-rank results in 39 out of 44 downstream benchmarks with statistical significance improvements. These results underscore its ability to learn robust and generalizable representations across unseen data acquired under diverse MRI protocols. PRISM provides a scalable framework for multi-sequence MRI analysis, thereby enhancing the translational potential of AI in radiology. It delivers consistent performance across diverse imaging protocols, reinforcing its clinical applicability.

Remarkable strides in computational pathology have been made in the task-agnostic foundation model that advances the performance of a wide array of downstream clinical tasks. Despite the promising performance, there are still several challenges. First, prior works have resorted to either vision-only or image-caption data, disregarding pathology reports with more clinically authentic information from pathologists and gene expression profiles which respectively offer distinct knowledge for versatile clinical applications. Second, the current progress in pathology FMs predominantly concentrates on the patch level, where the restricted context of patch-level pretraining fails to capture whole-slide patterns. Even recent slide-level FMs still struggle to provide whole-slide context for patch representation. In this study, for the first time, we develop a pathology foundation model incorporating three levels of modalities: pathology slides, pathology reports, and gene expression data, which resulted in 26,169 slide-level modality pairs from 10,275 patients across 32 cancer types, amounting to over 116 million pathological patch images. To leverage these data for CPath, we propose a novel whole-slide pretraining paradigm that injects the multimodal whole-slide context into the patch representation, called Multimodal Self-TAught PRetraining (mSTAR). The proposed paradigm revolutionizes the pretraining workflow for CPath, enabling the pathology FM to acquire the whole-slide context. To the best of our knowledge, this is the first attempt to incorporate three modalities at the whole-slide context for enhancing pathology FMs. To systematically evaluate the capabilities of mSTAR, we built the largest spectrum of oncological benchmark, spanning 7 categories of oncological applications in 15 types of 97 practical oncological tasks.

Automatic report generation has arisen as a significant research area in computer-aided diagnosis, aiming to alleviate the burden on clinicians by generating reports automatically based on medical images. In this work, we propose a novel framework for automatic ultrasound report generation, leveraging a combination of unsupervised and supervised learning methods to aid the report generation process. Our framework incorporates unsupervised learning methods to extract potential knowledge from ultrasound text reports, serving as the prior information to guide the model in aligning visual and textual features, thereby addressing the challenge of feature discrepancy. Additionally, we design a global semantic comparison mechanism to enhance the performance of generating more comprehensive and accurate medical reports. To enable the implementation of ultrasound report generation, we constructed three large-scale ultrasound image-text datasets from different organs for training and validation purposes. Extensive evaluations with other state-of-the-art approaches exhibit its superior performance across all three datasets. Code and dataset are valuable at this link.

The emergence of pathology foundation models has revolutionized computational histopathology, enabling highly accurate, generalized whole-slide image analysis for improved cancer diagnosis, and prognosis assessment. While these models show remarkable potential across cancer diagnostics and prognostics, their clinical translation faces critical challenges including variability in optimal model across cancer types, potential data leakage in evaluation, and lack of standardized benchmarks. Without rigorous, unbiased evaluation, even the most advanced PFMs risk remaining confined to research settings, delaying their life-saving applications. Existing benchmarking efforts remain limited by narrow cancer-type focus, potential pretraining data overlaps, or incomplete task coverage. We present PathBench, the first comprehensive benchmark addressing these gaps through: multi-center in-hourse datasets spanning common cancers with rigorous leakage prevention, evaluation across the full clinical spectrum from diagnosis to prognosis, and an automated leaderboard system for continuous model assessment. Our framework incorporates large-scale data, enabling objective comparison of PFMs while reflecting real-world clinical complexity. All evaluation data comes from private medical providers, with strict exclusion of any pretraining usage to avoid data leakage risks. We have collected 15,888 WSIs from 8,549 patients across 10 hospitals, encompassing over 64 diagnosis and prognosis tasks. Currently, our evaluation of 19 PFMs shows that Virchow2 and H-Optimus-1 are the most effective models overall. This work provides researchers with a robust platform for model development and offers clinicians actionable insights into PFM performance across diverse clinical scenarios, ultimately accelerating the translation of these transformative technologies into routine pathology practice.

Multimodal data provides heterogeneous information for a holistic understanding of the tumor microenvironment. However, existing AI models often struggle to harness the rich information within multimodal data and extract poorly generalizable representations. Here we present MICE (Multimodal data Integration via Collaborative Experts), a multimodal foundation model that effectively integrates pathology images, clinical reports, and genomics data for precise pan-cancer prognosis prediction. Instead of conventional multi-expert modules, MICE employs multiple functionally diverse experts to comprehensively capture both cross-cancer and cancer-specific insights. Leveraging data from 11,799 patients across 30 cancer types, we enhanced MICE's generalizability by coupling contrastive and supervised learning. MICE outperformed both unimodal and state-of-the-art multi-expert-based multimodal models, demonstrating substantial improvements in C-index ranging from 3.8% to 11.2% on internal cohorts and 5.8% to 8.8% on independent cohorts, respectively. Moreover, it exhibited remarkable data efficiency across diverse clinical scenarios. With its enhanced generalizability and data efficiency, MICE establishes an effective and scalable foundation for pan-cancer prognosis prediction, holding strong potential to personalize tailored therapies and improve treatment outcomes.

Multimodal large language models (MLLMs) have emerged as powerful tools for computational pathology, offering unprecedented opportunities to integrate pathological images with language context for comprehensive diagnostic analysis. These models hold particular promise for automating complex tasks that traditionally require expert interpretation of pathologists. However, current MLLM approaches in pathology demonstrate significantly constrained reasoning capabilities, primarily due to their reliance on expensive chain-of-thought annotations. Additionally, existing methods remain limited to simplex application of visual question answering (VQA) at the region-of-interest (ROI) level, failing to address the full spectrum of diagnostic needs such as ROI classification, detection, segmentation, whole-slide-image (WSI) classification and VQA in clinical practice. In this study, we present SmartPath-R1, a versatile MLLM capable of simultaneously addressing both ROI-level and WSI-level tasks while demonstrating robust pathological reasoning capability. Our framework combines scale-dependent supervised fine-tuning and task-aware reinforcement fine-tuning, which circumvents the requirement for chain-of-thought supervision by leveraging the intrinsic knowledge within MLLM. Furthermore, SmartPath-R1 integrates multiscale and multitask analysis through a mixture-of-experts mechanism, enabling dynamic processing for diverse tasks. We curate a large-scale dataset comprising 2.3M ROI samples and 188K WSI samples for training and evaluation. Extensive experiments across 72 tasks validate the effectiveness and superiority of the proposed approach. This work represents a significant step toward developing versatile, reasoning-enhanced AI systems for precision pathology.

Clinical trials are pivotal for developing new medical treatments but typically carry risks such as patient mortality and enrollment failure that waste immense efforts spanning over a decade. Applying artificial intelligence (AI) to predict key events in clinical trials holds great potential for providing insights to guide trial designs. However, complex data collection and question definition requiring medical expertise have hindered the involvement of AI thus far. This paper tackles these challenges by presenting a comprehensive suite of 23 meticulously curated AI-ready datasets covering multi-modal input features and 8 crucial prediction challenges in clinical trial design, encompassing prediction of trial duration, patient dropout rate, serious adverse event, mortality rate, trial approval outcome, trial failure reason, drug dose finding, design of eligibility criteria. Furthermore, we provide basic validation methods for each task to ensure the datasets' usability and reliability. We anticipate that the availability of such open-access datasets will catalyze the development of advanced AI approaches for clinical trial design, ultimately advancing clinical trial research and accelerating medical solution development.

Tumor is a leading cause of death worldwide, with an estimated 10 million deaths attributed to tumor-related diseases every year. AI-driven tumor recognition unlocks new possibilities for more precise and intelligent tumor screening and diagnosis. However, the progress is heavily hampered by the scarcity of annotated datasets, which demands extensive annotation efforts by radiologists. To tackle this challenge, we introduce FreeTumor, an innovative Generative AI (GAI) framework to enable large-scale tumor synthesis for mitigating data scarcity. Specifically, FreeTumor effectively leverages a combination of limited labeled data and large-scale unlabeled data for tumor synthesis training. Unleashing the power of large-scale data, FreeTumor is capable of synthesizing a large number of realistic tumors on images for augmenting training datasets. To this end, we create the largest training dataset for tumor synthesis and recognition by curating 161,310 publicly available Computed Tomography (CT) volumes from 33 sources, with only 2.3% containing annotated tumors. To validate the fidelity of synthetic tumors, we engaged 13 board-certified radiologists in a Visual Turing Test to discern between synthetic and real tumors. Rigorous clinician evaluation validates the high quality of our synthetic tumors, as they achieved only 51.1% sensitivity and 60.8% accuracy in distinguishing our synthetic tumors from real ones. Through high-quality tumor synthesis, FreeTumor scales up the recognition training datasets by over 40 times, showcasing a notable superiority over state-of-the-art AI methods including various synthesis methods and foundation models. These findings indicate promising prospects of FreeTumor in clinical applications, potentially advancing tumor treatments and improving the survival rates of patients.

Visualizing subtle vascular motions in endoscopic surgery is crucial for surgical precision and decision-making, yet remains challenging due to the complex and dynamic nature of surgical scenes. To address this, we introduce EndoControlMag, a training-free, Lagrangian-based framework with mask-conditioned vascular motion magnification tailored to endoscopic environments. Our approach features two key modules: a Periodic Reference Resetting (PRR) scheme that divides videos into short overlapping clips with dynamically updated reference frames to prevent error accumulation while maintaining temporal coherence, and a Hierarchical Tissue-aware Magnification (HTM) framework with dual-mode mask dilation. HTM first tracks vessel cores using a pretrained visual tracking model to maintain accurate localization despite occlusions and view changes. It then applies one of two adaptive softening strategies to surrounding tissues: motion-based softening that modulates magnification strength proportional to observed tissue displacement, or distance-based exponential decay that simulates biomechanical force attenuation. This dual-mode approach accommodates diverse surgical scenarios-motion-based softening excels with complex tissue deformations while distance-based softening provides stability during unreliable optical flow conditions. We evaluate EndoControlMag on our EndoVMM24 dataset spanning four different surgery types and various challenging scenarios, including occlusions, instrument disturbance, view changes, and vessel deformations. Quantitative metrics, visual assessments, and expert surgeon evaluations demonstrate that EndoControlMag significantly outperforms existing methods in both magnification accuracy and visual quality while maintaining robustness across challenging surgical conditions. The code, dataset, and video results are available at this https URL.

The segmentation of the hepatic vasculature in surgical videos holds substantial clinical significance in the context of hepatectomy procedures. However, owing to the dearth of an appropriate dataset and the inherently complex task characteristics, few researches have been reported in this domain. To address this issue, we first introduce a high quality frame-by-frame annotated hepatic vasculature dataset containing 35 long hepatectomy videos and 11442 high-resolution frames. On this basis, we propose a novel high-resolution video vasculature segmentation network, dubbed as HRVVS. We innovatively embed a pretrained visual autoregressive modeling (VAR) model into different layers of the hierarchical encoder as prior information to reduce the information degradation generated during the downsampling process. In addition, we designed a dynamic memory decoder on a multi-view segmentation network to minimize the transmission of redundant information while preserving more details between frames. Extensive experiments on surgical video datasets demonstrate that our proposed HRVVS significantly outperforms the state-of-the-art methods. The source code and dataset will be publicly available at \{this https URL}.

Cardiovascular disease (CVD) remains the leading cause of death worldwide, requiring urgent development of effective risk assessment methods for timely intervention. While current research has introduced non-invasive and efficient approaches to predict CVD risk from retinal imaging with deep learning models, the commonly used fundus photographs and Optical Coherence Tomography (OCT) fail to capture detailed vascular features critical for CVD assessment compared with OCT angiography (OCTA) images. Moreover, existing methods typically classify CVD risk only as high or low, without providing a deeper analysis on CVD-related blood factor conditions, thus limiting prediction accuracy and clinical utility. As a result, we propose a novel multi-purpose paradigm of CVD risk assessment that jointly performs CVD risk and CVD-related condition prediction, aligning with clinical experiences. Based on this core idea, we introduce OCTA-CVD, the first OCTA dataset for CVD risk assessment, and a Vessel-Aware Mamba-based Prediction model with Informative Enhancement (VAMPIRE) based on OCTA enface images. Our proposed model aims to extract crucial vascular characteristics through two key components: (1) a Mamba-Based Directional (MBD) Module that captures fine-grained vascular trajectory features and (2) an Information-Enhanced Morphological (IEM) Module that incorporates comprehensive vessel morphology knowledge. Experimental results demonstrate that our method can surpass standard classification backbones, OCTA-based detection methods, and ophthalmologic foundation models. Our codes and the collected OCTA-CVD dataset are available at this https URL.

Surgical triplet detection is a critical task in surgical video analysis. However, existing datasets like CholecT50 lack precise spatial bounding box annotations, rendering triplet classification at the image level insufficient for practical applications. The inclusion of bounding box annotations is essential to make this task meaningful, as they provide the spatial context necessary for accurate analysis and improved model generalizability. To address these shortcomings, we introduce ProstaTD, a large-scale, multi-institutional dataset for surgical triplet detection, developed from the technically demanding domain of robot-assisted prostatectomy. ProstaTD offers clinically defined temporal boundaries and high-precision bounding box annotations for each structured triplet activity. The dataset comprises 71,775 video frames and 196,490 annotated triplet instances, collected from 21 surgeries performed across multiple institutions, reflecting a broad range of surgical practices and intraoperative conditions. The annotation process was conducted under rigorous medical supervision and involved more than 60 contributors, including practicing surgeons and medically trained annotators, through multiple iterative phases of labeling and verification. To further facilitate future general-purpose surgical annotation, we developed two tailored labeling tools to improve efficiency and scalability in our annotation workflows. In addition, we created a surgical triplet detection evaluation toolkit that enables standardized and reproducible performance assessment across studies. ProstaTD is the largest and most diverse surgical triplet dataset to date, moving the field from simple classification to full detection with precise spatial and temporal boundaries and thereby providing a robust foundation for fair benchmarking.

Metal artifacts caused by the presence of metallic implants tremendously degrade the reconstructed computed tomography (CT) image quality, affecting clinical diagnosis or reducing the accuracy of organ delineation and dose calculation in radiotherapy. Recently, deep learning methods in sinogram and image domains have been rapidly applied on metal artifact reduction (MAR) task. The supervised dual-domain methods perform well on synthesized data, while unsupervised methods with unpaired data are more generalized on clinical data. However, most existing methods intend to restore the corrupted sinogram within metal trace, which essentially remove beam hardening artifacts but ignore other components of metal artifacts, such as scatter, non-linear partial volume effect and noise. In this paper, we mathematically derive a physical property of metal artifacts which is verified via Monte Carlo (MC) simulation and propose a novel physics based non-local dual-domain network (PND-Net) for MAR in CT imaging. Specifically, we design a novel non-local sinogram decomposition network (NSD-Net) to acquire the weighted artifact component, and an image restoration network (IR-Net) is proposed to reduce the residual and secondary artifacts in the image domain. To facilitate the generalization and robustness of our method on clinical CT images, we employ a trainable fusion network (F-Net) in the artifact synthesis path to achieve unpaired learning. Furthermore, we design an internal consistency loss to ensure the integrity of anatomical structures in the image domain, and introduce the linear interpolation sinogram as prior knowledge to guide sinogram decomposition. Extensive experiments on simulation and clinical data demonstrate that our method outperforms the state-of-the-art MAR methods.

Heart diseases rank among the leading causes of global mortality, demonstrating a crucial need for early diagnosis and intervention. Most traditional electrocardiogram (ECG) based automated diagnosis methods are trained at population level, neglecting the customization of personalized ECGs to enhance individual healthcare management. A potential solution to address this limitation is to employ digital twins to simulate symptoms of diseases in real patients. In this paper, we present an innovative prospective learning approach for personalized heart disease detection, which generates digital twins of healthy individuals' anomalous ECGs and enhances the model sensitivity to the personalized symptoms. In our approach, a vector quantized feature separator is proposed to locate and isolate the disease symptom and normal segments in ECG signals with ECG report guidance. Thus, the ECG digital twins can simulate specific heart diseases used to train a personalized heart disease detection model. Experiments demonstrate that our approach not only excels in generating high-fidelity ECG signals but also improves personalized heart disease detection. Moreover, our approach ensures robust privacy protection, safeguarding patient data in model development.

Medical image synthesis remains challenging due to misalignment noise during training. Existing methods have attempted to address this challenge by incorporating a registration-guided module. However, these methods tend to overlook the task-specific constraints on the synthetic and registration modules, which may cause the synthetic module to still generate spatially aligned images with misaligned target images during training, regardless of the registration module's function. Therefore, this paper proposes registration-guided consistency and incorporates disentanglement learning for medical image synthesis. The proposed registration-guided consistency architecture fosters task-specificity within the synthetic and registration modules by applying identical deformation fields before and after synthesis, while enforcing output consistency through an alignment loss. Moreover, the synthetic module is designed to possess the capability of disentangling anatomical structures and specific styles across various modalities. An anatomy consistency loss is introduced to further compel the synthetic module to preserve geometrical integrity within latent spaces. Experiments conducted on both an in-house abdominal CECT-CT dataset and a publicly available pelvic MR-CT dataset have demonstrated the superiority of the proposed method.

Accurate histopathological diagnosis often requires multiple differently stained tissue sections, a process that is time-consuming, labor-intensive, and environmentally taxing due to the use of multiple chemical stains. Recently, virtual staining has emerged as a promising alternative that is faster, tissue-conserving, and environmentally friendly. However, existing virtual staining methods face significant challenges in clinical applications, primarily due to their reliance on well-aligned paired data. Obtaining such data is inherently difficult because chemical staining processes can distort tissue structures, and a single tissue section cannot undergo multiple staining procedures without damage or loss of information. As a result, most available virtual staining datasets are either unpaired or roughly paired, making it difficult for existing methods to achieve accurate pixel-level supervision. To address this challenge, we propose a robust virtual staining framework featuring cascaded registration mechanisms to resolve spatial mismatches between generated outputs and their corresponding ground truth. Experimental results demonstrate that our method significantly outperforms state-of-the-art models across five datasets, achieving an average improvement of 3.2% on internal datasets and 10.1% on external datasets. Moreover, in datasets with substantial misalignment, our approach achieves a remarkable 23.8% improvement in peak signal-to-noise ratio compared to baseline models. The exceptional robustness of the proposed method across diverse datasets simplifies the data acquisition process for virtual staining and offers new insights for advancing its development.

Despite the impressive performance across a wide range of applications, current computational pathology models face significant diagnostic efficiency challenges due to their reliance on high-magnification whole-slide image analysis. This limitation severely compromises their clinical utility, especially in time-sensitive diagnostic scenarios and situations requiring efficient data transfer. To address these issues, we present a novel computation- and communication-efficient framework called Magnification-Aligned Global-Local Transformer (MAG-GLTrans). Our approach significantly reduces computational time, file transfer requirements, and storage overhead by enabling effective analysis using low-magnification inputs rather than high-magnification ones. The key innovation lies in our proposed magnification alignment (MAG) mechanism, which employs self-supervised learning to bridge the information gap between low and high magnification levels by effectively aligning their feature representations. Through extensive evaluation across various fundamental CPath tasks, MAG-GLTrans demonstrates state-of-the-art classification performance while achieving remarkable efficiency gains: up to 10.7 times reduction in computational time and over 20 times reduction in file transfer and storage requirements. Furthermore, we highlight the versatility of our MAG framework through two significant extensions: (1) its applicability as a feature extractor to enhance the efficiency of any CPath architecture, and (2) its compatibility with existing foundation models and histopathology-specific encoders, enabling them to process low-magnification inputs with minimal information loss. These advancements position MAG-GLTrans as a particularly promising solution for time-sensitive applications, especially in the context of intraoperative frozen section diagnosis where both accuracy and efficiency are paramount.