Annotation-free deep learning for detection and segmentation of fetal germinal matrix-intraventricular hemorrhage in brain MRI

Background: Prenatal germinal matrix-intraventricular hemorrhage (GMH-IVH) is a leading cause of infant mortality and neurodevelopmental impairment. Manual diagnosis and lesion segmentation are labor-intensive and error-prone. Deep learning models offer potential for automation but typically require large annotated datasets, which are challenging to obtain. Purpose: To develop and validate an annotation-free deep learning framework for automated detection and segmentation of GMH-IVH on brain MRI. Materials and Methods: This retrospective study analyzed 2D T2-weighted MRI data from pregnant women collected from October 2015 to October 2023 at one hospital (internal validation) and two hospitals (external validation). Eligible participants included healthy fetuses and those with GMH-IVH. FreeHemoSeg was developed and trained using pseudo GMH-IVH images synthesized from normal fetal data guided by medical priors. Primary outcomes included diagnostic accuracy (area under the ROC curve [AUROC], sensitivity, specificity) and segmentation accuracy (Dice similarity coefficient [DSC]). A reader study evaluated clinical utility. Results: A total of 1674 stacks from 558 pregnant women were analyzed. FreeHemoSeg achieved the highest performance in both internal (sensitivity: 0.914, 95% CI 0.869-0.945; specificity: 0.966, 95% CI 0.946-0.978; DSC: 0.559, 95% CI 0.546-0.571) and external validation (sensitivity: 0.824, 95% CI 0.739-0.885; specificity: 0.943, 95% CI 0.913-0.964; DSC: 0.512, 95% CI 0.497-0.526), outperforming supervised and unsupervised methods. FreeHemoSeg assistance improved radiologists' sensitivity (from 0.882 to 0.941-1.000) and diagnostic confidence while reducing interpretation time by 16.0-52.7%. Conclusion: FreeHemoSeg accurately detects and localizes fetal brain hemorrhages without annotated training data, enabling earlier diagnosis and supporting timely clinical management.

EXACT: an explainable anomaly-aware vision foundation model for analysis of 3D chest CT

Chest computed tomography (CT) is central to the detection and management of thoracic disease, yet the growing scale and complexity of volumetric imaging increasingly exceed what can be addressed by scan-level prediction alone. Clinically useful AI for CT must not only recognize disease across the whole volume, but also localize abnormalities and provide interpretable visual evidence. Existing vision-language foundation models typically compress scans and reports into global image-text representations, limiting their ability to preserve spatial evidence and support clinically meaningful interpretation. Here we developed EXACT, an explainable anomaly-aware foundation model for three-dimensional chest CT that learns spatially resolved representations from paired clinical scans and radiology reports. EXACT was pre-trained on 25,692 CT-reports pairs using anatomy-aware weak supervision, jointly learning organ segmentation and multi-instance anomaly localization without manual voxel-level annotations. The resulting organ-specific anomaly-aware maps assign each voxel a disease-specific anomaly score confined to its corresponding anatomy, jointly encoding lesion extent and organ-level context. In retrospective multinational and multi-center evaluations, EXACT showed broad and consistent improvements across clinically relevant CT tasks, spanning multi-disease diagnosis, zero-shot anomaly localization, downstream adaptation, and visually grounded report generation, outperforming existing three-dimensional medical foundation models. By transforming routine clinical CT scans and free-text reports into explainable voxel-level representations, EXACT establishes a scalable paradigm for trustworthy volumetric medical AI.

FetalAgents: A Multi-Agent System for Fetal Ultrasound Image and Video Analysis

Fetal ultrasound (US) is the primary imaging modality for prenatal screening, yet its interpretation relies heavily on the expertise of the clinician. Despite advances in deep learning and foundation models, existing automated tools for fetal US analysis struggle to balance task-specific accuracy with the whole-process versatility required to support end-to-end clinical workflows. To address these limitations, we propose FetalAgents, the first multi-agent system for comprehensive fetal US analysis. Through a lightweight, agentic coordination framework, FetalAgents dynamically orchestrates specialized vision experts to maximize performance across diagnosis, measurement, and segmentation. Furthermore, FetalAgents advances beyond static image analysis by supporting end-to-end video stream summarization, where keyframes are automatically identified across multiple anatomical planes, analyzed by coordinated experts, and synthesized with patient metadata into a structured clinical report. Extensive multi-center external evaluations across eight clinical tasks demonstrate that FetalAgents consistently delivers the most robust and accurate performance when compared against specialized models and multimodal large language models (MLLMs), ultimately providing an auditable, workflow-aligned solution for fetal ultrasound analysis and reporting.