The emergence of radiomics and deep learning technologies has catalyzed a paradigm shift in medical imaging, transitioning from conventional visual assessment to quantitative feature-based mining. Focusing on colorectal cancer, this article systematically delineates the groundbreaking advances in imaging-based artificial intelligence(AI) in supporting tumor diagnosis and treatment decision-making, and critically examines the core challenges encountered during its clinical translation. Looking forward, conducting prospective, multicenter randomized controlled trials to validate the efficacy and safety of imaging AI tools in real-world clinical settings, alongside actively exploring the integration of autonomous intelligent systems into complex clinical workflows, will constitute pivotal pathways for facilitating the clinical deployment of medical imaging AI.
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Open Access
Issue
The accurate segmentation of lung tumors plays a crucial role in tumor diagnosis and treatment. However, lung tumor segmentation is often challenged by several issues such as low contrast between lesions and surrounding tissues, tumor-normal tissue adhesion, and high background noise. To address these, this study introduces a lung tumor segmentation method based on Transformer and attention mechanisms. In the Transformer encoder stage, both global and local attention mechanisms are incorporated to enable the network to simultaneously focus on both global and local contextual information. In the skip connection stage, a channel-prior convolutional attention mechanism is utilized to enhance the spatial perception ability for complex lesions and reduce the channel dimension redundancy, such that the tumor segmentation accuracy can be improved. The experimental results on the private GDPH and public LUNG1 datasets demonstrate that the proposed method outperforms eight comparative methods in terms of the Dice metric by achieving approximately 90.96% and 88.18% on the two datasets, respectively. The proposed method can provide reliable assistance for clinical diagnosis and treatment.
Open Access
Original Article
Issue
With the advance in digital pathology and artificial intelligence (AI)-powered approaches, necrosis is proposed as a marker of poor prognosis in colorectal cancer (CRC). However, most previous studies quantified necrosis merely as a tissue type and patch-level segmentation. Thus, it was worth exploring and validating the prognostic and predictive value of necrosis proportion with a pixel-level segmentation in large multicenter cohorts.
A semantic segmentation model was trained with 12 tissue types labeled by pathologists. Segmentation was performed using the U-net model with a subsequently derived necrosis tumor ratio (NTR). We proposed the NTR score (NTR-low or NTR-high) to evaluate the prognostic and predictive value of necrosis for disease-free survival (DFS) and overall survival (OS) in the development (N = 443) and validation cohorts (N = 333) using 75% as a threshold.
The 2-category NTR was an independent prognostic factor and NTR-low was associated with significant prolonged DFS (unadjusted HR for high vs. low 1.72 [95% CI 1.19–2.49] and 1.98 [1.22–3.23] in the development and validation cohorts). Similar trends were observed for OS. The prognostic value of NTR was maintained in the multivariate analysis for both cohorts. Furthermore, a stratified analysis showed that NTR-high was a high risk with adjuvant chemotherapy for OS in stage Ⅱ CRC (p = 0.047).
AI-based pixel-level quantified NTR has a stable prognostic value in CRC associated with unfavorable survival. Additionally, adjuvant chemotherapy provided survival benefits for patients with a high NTR score in stage Ⅱ CRC.
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