Mingxiang Wu

Luyang Luo, Mingxiang Wu, Mei Li et al.

Breast Magnetic Resonance Imaging (MRI) demonstrates the highest sensitivity for breast cancer detection among imaging modalities and is standard practice for high-risk women. Interpreting the multi-sequence MRI is time-consuming and prone to subjective variation. We develop a large mixture-of-modality-experts model (MOME) that integrates multiparametric MRI information within a unified structure, leveraging breast MRI scans from 5,205 female patients in China for model development and validation. MOME matches four senior radiologists' performance in identifying breast cancer and outperforms a junior radiologist. The model is able to reduce unnecessary biopsies in Breast Imaging-Reporting and Data System (BI-RADS) 4 patients, classify triple-negative breast cancer, and predict pathological complete response to neoadjuvant chemotherapy. MOME further supports inference with missing modalities and provides decision explanations by highlighting lesions and measuring modality contributions. To summarize, MOME exemplifies an accurate and robust multimodal model for noninvasive, personalized management of breast cancer patients via multiparametric MRI. Code is available at https://github.com/LLYXC/MOME/tree/main.

Yifeng Wang, Luyang Luo, Mingxiang Wu et al.

Collecting annotations from multiple independent sources could mitigate the impact of potential noises and biases from a single source, which is a common practice in medical image segmentation. Learning segmentation networks from multi-source annotations remains a challenge due to the uncertainties brought by the variance of annotations and the quality of images. In this paper, we propose an Uncertainty-guided Multi-source Annotation Network (UMA-Net), which guides the training process by uncertainty estimation at both the pixel and the image levels. First, we developed the annotation uncertainty estimation module (AUEM) to learn the pixel-wise uncertainty of each annotation, which then guided the network to learn from reliable pixels by weighted segmentation loss. Second, a quality assessment module (QAM) was proposed to assess the image-level quality of the input samples based on the former assessed annotation uncertainties. Importantly, we introduced an auxiliary predictor to learn from the low-quality samples instead of discarding them, which ensured the preservation of their representation knowledge in the backbone without directly accumulating errors within the primary predictor. Extensive experiments demonstrated the effectiveness and feasibility of our proposed UMA-Net on various datasets, including 2D chest X-ray segmentation, fundus image segmentation, and 3D breast DCE-MRI segmentation.

Sunan He, Yuxiang Nie, Hongmei Wang et al.

Generalist foundation models (GFMs) are renowned for their exceptional capability and flexibility in effectively generalizing across diverse tasks and modalities. In the field of medicine, while GFMs exhibit superior generalizability based on their extensive intrinsic knowledge as well as proficiency in instruction following and in-context learning, specialist models excel in precision due to their domain knowledge. In this work, for the first time, we explore the synergy between the GFM and specialist models, to enable precise medical image analysis on a broader scope. Specifically, we propose a cooperative framework, Generalist-Specialist Collaboration (GSCo), which consists of two stages, namely the construction of GFM and specialists, and collaborative inference on downstream tasks. In the construction stage, we develop MedDr, the largest open-source GFM tailored for medicine, showcasing exceptional instruction-following and in-context learning capabilities. Meanwhile, a series of lightweight specialists are crafted for downstream tasks with low computational cost. In the collaborative inference stage, we introduce two cooperative mechanisms, Mixture-of-Expert Diagnosis and Retrieval-Augmented Diagnosis, to harvest the generalist's in-context learning abilities alongside the specialists' domain expertise. For a comprehensive evaluation, we curate a large-scale benchmark featuring 28 datasets and about 250,000 images. Extensive results demonstrate that MedDr consistently outperforms state-of-the-art GFMs on downstream datasets. Furthermore, GSCo exceeds both GFMs and specialists across all out-of-domain disease diagnosis datasets. These findings indicate a significant paradigm shift in the application of GFMs, transitioning from separate models for specific tasks to a collaborative approach between GFMs and specialists, thereby advancing the frontiers of generalizable AI in medicine.

Xuefeng Ni, Linshan Wu, Jiaxin Zhuang et al.

3D medical image analysis is pivotal in numerous clinical applications. However, the scarcity of labeled data and limited generalization capabilities hinder the advancement of AI-empowered models. Radiology reports are easily accessible and can serve as weakly-supervised signals. However, large-scale vision-language pre-training (VLP) remains underexplored in 3D medical image analysis. Specifically, the insufficient investigation into multi-grained radiology semantics and their correlations across patients leads to underutilization of large-scale volume-report data. Considering intra-patient cross-modal semantic consistency and inter-patient semantic correlations, we propose a multi-task VLP method, MG-3D, pre-trained on large-scale data (47.1K), addressing the challenges by the following two aspects: 1) Establishing the correspondence between volume semantics and multi-grained medical knowledge of each patient with cross-modal global alignment and complementary modality-guided local reconstruction, ensuring intra-patient features of different modalities cohesively represent the same semantic content; 2) Correlating inter-patient visual semantics based on fine-grained report correlations across patients, and keeping sensitivity to global individual differences via contrastive learning, enhancing the discriminative feature representation. Furthermore, we delve into the scaling law to explore potential performance improvements. Comprehensive evaluations across nine uni- and cross-modal clinical tasks are carried out to assess model efficacy. Extensive experiments on both internal and external datasets demonstrate the superior transferability, scalability, and generalization of MG-3D, showcasing its potential in advancing feature representation for 3D medical image analysis. Code will be available: https://github.com/Xuefeng-Ni/MG-3D.

Linshan Wu, Jiaxin Zhuang, Yanning Zhou et al.

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.

Yuxiang Nie, Sunan He, Yequan Bie et al.

The clinical adoption of artificial intelligence (AI) in medical imaging requires models that are both diagnostically accurate and interpretable to clinicians. While current multimodal biomedical foundation models prioritize performance, their black-box nature hinders explaining the decision-making process in clinically meaningful concepts. Here, we present ConceptCLIP, the first explainable biomedical foundation model that achieves state-of-the-art diagnostic accuracy while delivering human-interpretable explanations across diverse imaging modalities. We curate MedConcept-23M, the largest pre-training dataset comprising 23 million image-text-concept triplets across diverse medical modalities, where clinical concepts are derived from the Unified Medical Language System. Leveraging this dataset, we develop ConceptCLIP through a novel dual-alignment approach that simultaneously learns global image-text representations and fine-grained region-concept associations for precise and interpretable medical image analysis. We curate the most extensive evaluation benchmark for multimodal biomedical foundation models, covering 52 clinical tasks spanning 10 imaging modalities. Extensive experiments demonstrate that ConceptCLIP outperforms existing state-of-the-art multimodal biomedical foundation models. Importantly, ConceptCLIP demonstrates superior diagnostic performance while providing human-understandable explanations validated by clinical experts. As the first precise and interpretable biomedical foundation model, ConceptCLIP represents a critical milestone toward the widespread clinical adoption of AI, thereby advancing trustworthy AI in medicine.

Siyi Xun, Yue Sun, Jingkun Chen et al.

Rapid advances in medical imaging technology underscore the critical need for precise and automated image quality assessment (IQA) to ensure diagnostic accuracy. Existing medical IQA methods, however, struggle to generalize across diverse modalities and clinical scenarios. In response, we introduce MedIQA, the first comprehensive foundation model for medical IQA, designed to handle variability in image dimensions, modalities, anatomical regions, and types. We developed a large-scale multi-modality dataset with plentiful manually annotated quality scores to support this. Our model integrates a salient slice assessment module to focus on diagnostically relevant regions feature retrieval and employs an automatic prompt strategy that aligns upstream physical parameter pre-training with downstream expert annotation fine-tuning. Extensive experiments demonstrate that MedIQA significantly outperforms baselines in multiple downstream tasks, establishing a scalable framework for medical IQA and advancing diagnostic workflows and clinical decision-making.

Fuxiang Huang, Jiayi Zhu, Yunfang Yu et al.

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related mortality in women globally. Mammography is essential for the early detection and diagnosis of breast lesions. Despite recent progress in foundation models (FMs) for mammogram analysis, their clinical translation remains constrained by several fundamental limitations, including insufficient diversity in training data, limited model generalizability, and a lack of comprehensive evaluation across clinically relevant tasks. Here, we introduce VersaMammo, a versatile foundation model for mammograms, designed to overcome these limitations. We curated the largest multi-institutional mammogram dataset to date, comprising 706,239 images from 21 sources. To improve generalization, we propose a two-stage pre-training strategy to develop VersaMammo, a mammogram foundation model. First, a teacher model is trained via self-supervised learning to extract transferable features from unlabeled mammograms. Then, supervised learning combined with knowledge distillation transfers both features and clinical knowledge into VersaMammo. To ensure a comprehensive evaluation, we established a benchmark comprising 92 specific tasks, including 68 internal tasks and 24 external validation tasks, spanning 5 major clinical task categories: lesion detection, segmentation, classification, image retrieval, and visual question answering. VersaMammo achieves state-of-the-art performance, ranking first in 50 out of 68 specific internal tasks and 20 out of 24 external validation tasks, with average ranks of 1.5 and 1.2, respectively. These results demonstrate its superior generalization and clinical utility, offering a substantial advancement toward reliable and scalable breast cancer screening and diagnosis.

Luyang Luo, Hao Chen, Yongjie Xiao et al.

Two DL models were developed using radiograph-level annotations (yes or no disease) and fine-grained lesion-level annotations (lesion bounding boxes), respectively named CheXNet and CheXDet. The models' internal classification performance and lesion localization performance were compared on a testing set (n=2,922), external classification performance was compared on NIH-Google (n=4,376) and PadChest (n=24,536) datasets, and external lesion localization performance was compared on NIH-ChestX-ray14 dataset (n=880). The models were also compared to radiologists on a subset of the internal testing set (n=496). Given sufficient training data, both models performed comparably to radiologists. CheXDet achieved significant improvement for external classification, such as in classifying fracture on NIH-Google (CheXDet area under the ROC curve [AUC]: 0.67, CheXNet AUC: 0.51; p<.001) and PadChest (CheXDet AUC: 0.78, CheXNet AUC: 0.55; p<.001). CheXDet achieved higher lesion detection performance than CheXNet for most abnormalities on all datasets, such as in detecting pneumothorax on the internal set (CheXDet jacknife alternative free-response ROC-figure of merit [JAFROC-FOM]: 0.87, CheXNet JAFROC-FOM: 0.13; p<.001) and NIH-ChestX-ray14 (CheXDet JAFROC-FOM: 0.55, CheXNet JAFROC-FOM: 0.04; p<.001). To summarize, fine-grained annotations overcame shortcut learning and enabled DL models to identify correct lesion patterns, improving the models' generalizability.