Wenxin Ma

Rongsheng Wang, Fenghe Tang, Zihang Jiang et al.

Learning transferable and interpretable representations from medical volumetric scans remains challenging due to complex anatomical structures and weak, heterogeneous supervision provided by radiology reports. In this paper, we propose Anatomy-aware Semantically-Adaptive Pre-training (ASAP), a principled vision-language pre-training framework for fine-grained medical volumetric representation learning from large-scale chest CT scans and their corresponding radiology reports. ASAP integrates three key components: (1) an anatomy-aware knowledge injection module that incorporates organ-level structural priors via off-the-shelf segmentation tool to encourage anatomically coherent representations; (2) a semantically-adaptive selective alignment mechanism that dynamically associates sentence-level findings with localized volumetric regions; and (3) a semantically-adaptive fusion module for effective interaction between anatomically informed visual features and grounded textual cues under dual-modal masked modeling paradigm. Beyond methodological contributions, we establish a comprehensive benchmark for medical volumetric vision-language pre-training on chest CT, covering 15 datasets and 22 downstream tasks spanning abnormality classification, segmentation, disease prognosis prediction, report generation, vocabulary classification, cross-modal retrieval and visual question answering. This benchmark provides standardized evaluation protocols to systematically assess representation quality under diverse clinical settings and data regimes. Extensive experiments demonstrate that ASAP consistently achieves state-of-the-art performance across tasks and datasets, with particularly pronounced gains under limited supervision and distribution shift, validating its effectiveness in learning transferable and clinically meaningful volumetric representations.

Haoyun Chen, Fenghe Tang, Wenxin Ma et al.

Universal medical image segmentation seeks to use a single foundational model to handle diverse tasks across multiple imaging modalities. However, existing approaches often rely heavily on manual visual prompts or retrieved reference images, which limits their automation and robustness. In addition, naive joint training across modalities often fails to address large domain shifts. To address these limitations, we propose Concept-to-Pixel (C2P), a novel prompt-free universal segmentation framework. C2P explicitly separates anatomical knowledge into two components: Geometric and Semantic representations. It leverages Multimodal Large Language Models (MLLMs) to distill abstract, high-level medical concepts into learnable Semantic Tokens and introduces explicitly supervised Geometric Tokens to enforce universal physical and structural constraints. These disentangled tokens interact deeply with image features to generate input-specific dynamic kernels for precise mask prediction. Furthermore, we introduce a Geometry-Aware Inference Consensus mechanism, which utilizes the model's predicted geometric constraints to assess prediction reliability and suppress outliers. Extensive experiments and analysis on a unified benchmark comprising eight diverse datasets across seven modalities demonstrate the significant superiority of our jointly trained approach, compared to universe- or single-model approaches. Remarkably, our unified model demonstrates strong generalization, achieving impressive results not only on zero-shot tasks involving unseen cases but also in cross-modal transfers across similar tasks. Code is available at: https://github.com/Yundi218/Concept-to-Pixel

Chenxu Wu, Qingpeng Kong, Peiang Zhao et al.

Recent advances in generative models, especially diffusion models, have significantly improved image restoration (IR) performance. However, existing problem-agnostic diffusion model-based image restoration (DMIR) methods face challenges in fully leveraging diffusion priors, resulting in suboptimal performance. In this paper, we address the limitations of current problem-agnostic DMIR methods by analyzing their sampling process and providing effective solutions. We introduce EquS, a DMIR method that imposes equivariant information through dual sampling trajectories. To further boost EquS, we propose the Timestep-Aware Schedule (TAS) and introduce EquS$^+$. TAS prioritizes deterministic steps to enhance certainty and sampling efficiency. Extensive experiments on benchmarks demonstrate that our method is compatible with previous problem-agnostic DMIR methods and significantly boosts their performance without increasing computational costs. Our code is available at https://github.com/FouierL/EquS.

Wenxin Ma, Xu Zhang, Qingsong Yao et al.

Anomaly detection (AD) identifies outliers for applications like defect and lesion detection. While CLIP shows promise for zero-shot AD tasks due to its strong generalization capabilities, its inherent Anomaly-Unawareness leads to limited discrimination between normal and abnormal features. To address this problem, we propose Anomaly-Aware CLIP (AA-CLIP), which enhances CLIP's anomaly discrimination ability in both text and visual spaces while preserving its generalization capability. AA-CLIP is achieved through a straightforward yet effective two-stage approach: it first creates anomaly-aware text anchors to differentiate normal and abnormal semantics clearly, then aligns patch-level visual features with these anchors for precise anomaly localization. This two-stage strategy, with the help of residual adapters, gradually adapts CLIP in a controlled manner, achieving effective AD while maintaining CLIP's class knowledge. Extensive experiments validate AA-CLIP as a resource-efficient solution for zero-shot AD tasks, achieving state-of-the-art results in industrial and medical applications. The code is available at https://github.com/Mwxinnn/AA-CLIP.

Wenxin Ma, Qingsong Yao, Xiang Zhang et al.

Unsupervised anomaly detection (UAD) from images strives to model normal data distributions, creating discriminative representations to distinguish and precisely localize anomalies. Despite recent advancements in the efficient and unified one-for-all scheme, challenges persist in accurately segmenting anomalies for further monitoring. Moreover, this problem is obscured by the widely-used AUROC metric under imbalanced UAD settings. This motivates us to emphasize the significance of precise segmentation of anomaly pixels using pAP and DSC as metrics. To address the unsolved segmentation task, we introduce the Unified Anomaly Segmentation (UniAS). UniAS presents a multi-level hybrid pipeline that progressively enhances normal information from coarse to fine, incorporating a novel multi-granularity gated CNN (MGG-CNN) into Transformer layers to explicitly aggregate local details from different granularities. UniAS achieves state-of-the-art anomaly segmentation performance, attaining 65.12/59.33 and 40.06/32.50 in pAP/DSC on the MVTec-AD and VisA datasets, respectively, surpassing previous methods significantly. The codes are shared at https://github.com/Mwxinnn/UniAS.

Fenghe Tang, Qingsong Yao, Wenxin Ma et al.

Medical image segmentation remains a formidable challenge due to the label scarcity. Pre-training Vision Transformer (ViT) through masked image modeling (MIM) on large-scale unlabeled medical datasets presents a promising solution, providing both computational efficiency and model generalization for various downstream tasks. However, current ViT-based MIM pre-training frameworks predominantly emphasize local aggregation representations in output layers and fail to exploit the rich representations across different ViT layers that better capture fine-grained semantic information needed for more precise medical downstream tasks. To fill the above gap, we hereby present Hierarchical Encoder-driven MAE (Hi-End-MAE), a simple yet effective ViT-based pre-training solution, which centers on two key innovations: (1) Encoder-driven reconstruction, which encourages the encoder to learn more informative features to guide the reconstruction of masked patches; and (2) Hierarchical dense decoding, which implements a hierarchical decoding structure to capture rich representations across different layers. We pre-train Hi-End-MAE on a large-scale dataset of 10K CT scans and evaluated its performance across seven public medical image segmentation benchmarks. Extensive experiments demonstrate that Hi-End-MAE achieves superior transfer learning capabilities across various downstream tasks, revealing the potential of ViT in medical imaging applications. The code is available at: https://github.com/FengheTan9/Hi-End-MAE

Xu Zhang, Kun Zhang, Wenxin Ma et al.

ICD Coding aims to assign a wide range of medical codes to a medical text document, which is a popular and challenging task in the healthcare domain. To alleviate the problems of long-tail distribution and the lack of annotations of code-specific evidence, many previous works have proposed incorporating code knowledge to improve coding performance. However, existing methods often focus on a single type of knowledge and design specialized modules that are complex and incompatible with each other, thereby limiting their scalability and effectiveness. To address this issue, we propose GKI-ICD, a novel, general knowledge injection framework that integrates three key types of knowledge, namely ICD Description, ICD Synonym, and ICD Hierarchy, without specialized design of additional modules. The comprehensive utilization of the above knowledge, which exhibits both differences and complementarity, can effectively enhance the ICD coding performance. Extensive experiments on existing popular ICD coding benchmarks demonstrate the effectiveness of GKI-ICD, which achieves the state-of-the-art performance on most evaluation metrics. Code is available at https://github.com/xuzhang0112/GKI-ICD.

Wenxin Ma, Chenlong Wang, Ruisheng Yuan et al.

Humans can look at a static scene and instantly predict what happens next -- will moving this object cause a collision? We call this ability Causal Spatial Reasoning. However, current multimodal large language models (MLLMs) cannot do this, as they remain largely restricted to static spatial perception, struggling to answer "what-if" questions in a 3D scene. We introduce CausalSpatial, a diagnostic benchmark evaluating whether models can anticipate consequences of object motions across four tasks: Collision, Compatibility, Occlusion, and Trajectory. Results expose a severe gap: humans score 84% while GPT-5 achieves only 54%. Why do MLLMs fail? Our analysis uncovers a fundamental deficiency: models over-rely on textual chain-of-thought reasoning that drifts from visual evidence, producing fluent but spatially ungrounded hallucinations. To address this, we propose the Causal Object World model (COW), a framework that externalizes the simulation process by generating videos of hypothetical dynamics. With explicit visual cues of causality, COW enables models to ground their reasoning in physical reality rather than linguistic priors. We make the dataset and code publicly available here: https://github.com/CausalSpatial/CausalSpatial

Fenghe Tang, Chengqi Dong, Wenxin Ma et al.

Over the past decade, U-Net has been the dominant architecture in medical image segmentation, leading to the development of thousands of U-shaped variants. Despite its widespread adoption, there is still no comprehensive benchmark to systematically evaluate their performance and utility, largely because of insufficient statistical validation and limited consideration of efficiency and generalization across diverse datasets. To bridge this gap, we present U-Bench, the first large-scale, statistically rigorous benchmark that evaluates 100 U-Net variants across 28 datasets and 10 imaging modalities. Our contributions are threefold: (1) Comprehensive Evaluation: U-Bench evaluates models along three key dimensions: statistical robustness, zero-shot generalization, and computational efficiency. We introduce a novel metric, U-Score, which jointly captures the performance-efficiency trade-off, offering a deployment-oriented perspective on model progress. (2) Systematic Analysis and Model Selection Guidance: We summarize key findings from the large-scale evaluation and systematically analyze the impact of dataset characteristics and architectural paradigms on model performance. Based on these insights, we propose a model advisor agent to guide researchers in selecting the most suitable models for specific datasets and tasks. (3) Public Availability: We provide all code, models, protocols, and weights, enabling the community to reproduce our results and extend the benchmark with future methods. In summary, U-Bench not only exposes gaps in previous evaluations but also establishes a foundation for fair, reproducible, and practically relevant benchmarking in the next decade of U-Net-based segmentation models. The project can be accessed at: https://fenghetan9.github.io/ubench. Code is available at: https://github.com/FengheTan9/U-Bench.

Yingtai Li, Haoran Lai, Xiaoqian Zhou et al.

The emergence of Large Language Models (LLMs) presents unprecedented opportunities to revolutionize medical contrastive vision-language pre-training. In this paper, we show how LLMs can facilitate large-scale supervised pre-training, thereby advancing vision-language alignment. We begin by demonstrate that modern LLMs can automatically extract diagnostic labels from radiology reports with remarkable precision (>96\% AUC in our experiments) without complex prompt engineering, enabling the creation of large-scale "silver-standard" datasets at a minimal cost (~\$3 for 50k CT image-report pairs). Further, we find that vision encoder trained on this "silver-standard" dataset achieves performance comparable to those trained on labels extracted by specialized BERT-based models, thereby democratizing the access to large-scale supervised pre-training. Building on this foundation, we proceed to reveal that supervised pre-training fundamentally improves contrastive vision-language alignment. Our approach achieves state-of-the-art performance using only a 3D ResNet-18 with vanilla CLIP training, including 83.8\% AUC for zero-shot diagnosis on CT-RATE, 77.3\% AUC on RAD-ChestCT, and substantial improvements in cross-modal retrieval (MAP@50=53.7\% for image-image, Recall@100=52.2\% for report-image). These results demonstrate the potential of utilizing LLMs to facilitate {\bf more performant and scalable} medical AI systems. Our code is avaiable at https://github.com/SadVoxel/More-performant-and-scalable.

Fenghe Tang, Bingkun Nian, Jianrui Ding et al.

In clinical practice, medical image analysis often requires efficient execution on resource-constrained mobile devices. However, existing mobile models-primarily optimized for natural images-tend to perform poorly on medical tasks due to the significant information density gap between natural and medical domains. Combining computational efficiency with medical imaging-specific architectural advantages remains a challenge when developing lightweight, universal, and high-performing networks. To address this, we propose a mobile model called Mobile U-shaped Vision Transformer (Mobile U-ViT) tailored for medical image segmentation. Specifically, we employ the newly purposed ConvUtr as a hierarchical patch embedding, featuring a parameter-efficient large-kernel CNN with inverted bottleneck fusion. This design exhibits transformer-like representation learning capacity while being lighter and faster. To enable efficient local-global information exchange, we introduce a novel Large-kernel Local-Global-Local (LGL) block that effectively balances the low information density and high-level semantic discrepancy of medical images. Finally, we incorporate a shallow and lightweight transformer bottleneck for long-range modeling and employ a cascaded decoder with downsample skip connections for dense prediction. Despite its reduced computational demands, our medical-optimized architecture achieves state-of-the-art performance across eight public 2D and 3D datasets covering diverse imaging modalities, including zero-shot testing on four unseen datasets. These results establish it as an efficient yet powerful and generalization solution for mobile medical image analysis. Code is available at https://github.com/FengheTan9/Mobile-U-ViT.

Baizhi Wang, Rui Yan, Wenxin Ma et al.

Histomorphology is crucial in breast cancer diagnosis. However, existing whole slide image (WSI) classification methods struggle to effectively incorporate histomorphology information, limiting their ability to capture key and fine-grained pathological features. To address this limitation, we propose a novel framework that explicitly incorporates histomorphology (tumor cellularity, cellular morphology, and tissue architecture) into WSI classification. Specifically, our approach consists of three key components: (1) estimating the importance of tumor-related histomorphology information at the patch level based on medical prior knowledge; (2) generating representative cluster-level features through histomorphology-driven cluster pooling; and (3) enabling WSI-level classification through histomorphology-driven multi-instance aggregation. With the incorporation of histomorphological information, our framework strengthens the model's ability to capture key and fine-grained pathological patterns, thereby enhancing WSI classification performance. Experimental results demonstrate its effectiveness, achieving high diagnostic accuracy for molecular subtyping and cancer subtyping. The code will be made available at https://github.com/Badgewho/HMDMIL.

Xu Zhang, Wenxin Ma, Chenxu Wu et al.

ICD coding is a critical yet challenging task in healthcare. Recently, LLM-based methods demonstrate stronger generalization than discriminative methods in ICD coding. However, fine-tuning LLMs for ICD coding faces three major challenges. First, existing public ICD coding datasets provide limited coverage of the ICD code space, restricting a model's ability to generalize to unseen codes. Second, naive fine-tuning diminishes the interpretability of LLMs, as few public datasets contain explicit supporting evidence for assigned codes. Third, ICD coding typically involves long clinical documents, making fine-tuning LLMs computationally expensive. To address these issues, we propose Code-Centric Learning, a training framework that shifts supervision from full clinical documents to scalable, short evidence spans. The key idea of this framework is that span-level learning improves LLMs' ability to perform document-level ICD coding. Our proposed framework consists of a mixed training strategy and code-centric data expansion, which substantially reduces training cost, improves accuracy on unseen ICD codes and preserves interpretability. Under the same LLM backbone, our method substantially outperforms strong baselines. Notably, our method enables small-scale LLMs to achieve performance comparable to much larger proprietary models, demonstrating its effectiveness and potential for fully automated ICD coding.

Fenghe Tang, Wenxin Ma, Zhiyang He et al.

With the advancement of Large Language Model (LLM) for natural language processing, this paper presents an intriguing finding: a frozen pre-trained LLM layer can process visual tokens for medical image segmentation tasks. Specifically, we propose a simple hybrid structure that integrates a pre-trained, frozen LLM layer within the CNN encoder-decoder segmentation framework (LLM4Seg). Surprisingly, this design improves segmentation performance with a minimal increase in trainable parameters across various modalities, including ultrasound, dermoscopy, polypscopy, and CT scans. Our in-depth analysis reveals the potential of transferring LLM's semantic awareness to enhance segmentation tasks, offering both improved global understanding and better local modeling capabilities. The improvement proves robust across different LLMs, validated using LLaMA and DeepSeek.