Wenjia Bai

Chen Chen, Zeju Li, Cheng Ouyang et al.

Convolutional neural networks (CNNs) have achieved remarkable segmentation accuracy on benchmark datasets where training and test sets are from the same domain, yet their performance can degrade significantly on unseen domains, which hinders the deployment of CNNs in many clinical scenarios. Most existing works improve model out-of-domain (OOD) robustness by collecting multi-domain datasets for training, which is expensive and may not always be feasible due to privacy and logistical issues. In this work, we focus on improving model robustness using a single-domain dataset only. We propose a novel data augmentation framework called MaxStyle, which maximizes the effectiveness of style augmentation for model OOD performance. It attaches an auxiliary style-augmented image decoder to a segmentation network for robust feature learning and data augmentation. Importantly, MaxStyle augments data with improved image style diversity and hardness, by expanding the style space with noise and searching for the worst-case style composition of latent features via adversarial training. With extensive experiments on multiple public cardiac and prostate MR datasets, we demonstrate that MaxStyle leads to significantly improved out-of-distribution robustness against unseen corruptions as well as common distribution shifts across multiple, different, unseen sites and unknown image sequences under both low- and high-training data settings. The code can be found at https://github.com/cherise215/MaxStyle.

Berke Doga Basaran, Mengyun Qiao, Paul M. Matthews et al.

Understanding the intensity characteristics of brain lesions is key for defining image-based biomarkers in neurological studies and for predicting disease burden and outcome. In this work, we present a novel foreground-based generative method for modelling the local lesion characteristics that can both generate synthetic lesions on healthy images and synthesize subject-specific pseudo-healthy images from pathological images. Furthermore, the proposed method can be used as a data augmentation module to generate synthetic images for training brain image segmentation networks. Experiments on multiple sclerosis (MS) brain images acquired on magnetic resonance imaging (MRI) demonstrate that the proposed method can generate highly realistic pseudo-healthy and pseudo-pathological brain images. Data augmentation using the synthetic images improves the brain image segmentation performance compared to traditional data augmentation methods as well as a recent lesion-aware data augmentation technique, CarveMix. The code will be released at https://github.com/dogabasaran/lesion-synthesis.

Siyi Du, Shaoming Zheng, Yinsong Wang et al.

Images and structured tables are essential parts of real-world databases. Though tabular-image representation learning is promising to create new insights, it remains a challenging task, as tabular data is typically heterogeneous and incomplete, presenting significant modality disparities with images. Earlier works have mainly focused on simple modality fusion strategies in complete data scenarios, without considering the missing data issue, and thus are limited in practice. In this paper, we propose TIP, a novel tabular-image pre-training framework for learning multimodal representations robust to incomplete tabular data. Specifically, TIP investigates a novel self-supervised learning (SSL) strategy, including a masked tabular reconstruction task for tackling data missingness, and image-tabular matching and contrastive learning objectives to capture multimodal information. Moreover, TIP proposes a versatile tabular encoder tailored for incomplete, heterogeneous tabular data and a multimodal interaction module for inter-modality representation learning. Experiments are performed on downstream multimodal classification tasks using both natural and medical image datasets. The results show that TIP outperforms state-of-the-art supervised/SSL image/multimodal algorithms in both complete and incomplete data scenarios. Our code is available at https://github.com/siyi-wind/TIP.

Berke Doga Basaran, Weitong Zhang, Mengyun Qiao et al.

Data augmentation has become a de facto component of deep learning-based medical image segmentation methods. Most data augmentation techniques used in medical imaging focus on spatial and intensity transformations to improve the diversity of training images. They are often designed at the image level, augmenting the full image, and do not pay attention to specific abnormalities within the image. Here, we present LesionMix, a novel and simple lesion-aware data augmentation method. It performs augmentation at the lesion level, increasing the diversity of lesion shape, location, intensity and load distribution, and allowing both lesion populating and inpainting. Experiments on different modalities and different lesion datasets, including four brain MR lesion datasets and one liver CT lesion dataset, demonstrate that LesionMix achieves promising performance in lesion image segmentation, outperforming several recent Mix-based data augmentation methods. The code will be released at https://github.com/dogabasaran/lesionmix.

Mengyun Qiao, Berke Doga Basaran, Huaqi Qiu et al.

Cardiovascular disease, the leading cause of death globally, is an age-related disease. Understanding the morphological and functional changes of the heart during ageing is a key scientific question, the answer to which will help us define important risk factors of cardiovascular disease and monitor disease progression. In this work, we propose a novel conditional generative model to describe the changes of 3D anatomy of the heart during ageing. The proposed model is flexible and allows integration of multiple clinical factors (e.g. age, gender) into the generating process. We train the model on a large-scale cross-sectional dataset of cardiac anatomies and evaluate on both cross-sectional and longitudinal datasets. The model demonstrates excellent performance in predicting the longitudinal evolution of the ageing heart and modelling its data distribution. The codes are available at https://github.com/MengyunQ/AgeHeart.

Che Liu, Sibo Cheng, Miaojing Shi et al.

In the field of medical Vision-Language Pre-training (VLP), significant efforts have been devoted to deriving text and image features from both clinical reports and associated medical images. However, most existing methods may have overlooked the opportunity in leveraging the inherent hierarchical structure of clinical reports, which are generally split into `findings' for descriptive content and `impressions' for conclusive observation. Instead of utilizing this rich, structured format, current medical VLP approaches often simplify the report into either a unified entity or fragmented tokens. In this work, we propose a novel clinical prior guided VLP framework named IMITATE to learn the structure information from medical reports with hierarchical vision-language alignment. The framework derives multi-level visual features from the chest X-ray (CXR) images and separately aligns these features with the descriptive and the conclusive text encoded in the hierarchical medical report. Furthermore, a new clinical-informed contrastive loss is introduced for cross-modal learning, which accounts for clinical prior knowledge in formulating sample correlations in contrastive learning. The proposed model, IMITATE, outperforms baseline VLP methods across six different datasets, spanning five medical imaging downstream tasks. Comprehensive experimental results highlight the advantages of integrating the hierarchical structure of medical reports for vision-language alignment. The code related to this paper is available at https://github.com/cheliu-computation/IMITATE-TMI2024.

Che Liu, Anand Shah, Wenjia Bai et al.

Medical Vision-Language Pre-training (VLP) learns representations jointly from medical images and paired radiology reports. It typically requires large-scale paired image-text datasets to achieve effective pre-training for both the image encoder and text encoder. The advent of text-guided generative models raises a compelling question: Can VLP be implemented solely with synthetic images generated from genuine radiology reports, thereby mitigating the need for extensively pairing and curating image-text datasets? In this work, we scrutinize this very question by examining the feasibility and effectiveness of employing synthetic images for medical VLP. We replace real medical images with their synthetic equivalents, generated from authentic medical reports. Utilizing three state-of-the-art VLP algorithms, we exclusively train on these synthetic samples. Our empirical evaluation across three subsequent tasks, namely image classification, semantic segmentation and object detection, reveals that the performance achieved through synthetic data is on par with or even exceeds that obtained with real images. As a pioneering contribution to this domain, we introduce a large-scale synthetic medical image dataset, paired with anonymized real radiology reports. This alleviates the need of sharing medical images, which are not easy to curate and share in practice. The code and the dataset can be found in \href{https://github.com/cheliu-computation/MedSyn-RepLearn/tree/main}{https://github.com/cheliu-computation/MedSyn-RepLearn/tree/main}.

Qingjie Meng, Chen Qin, Wenjia Bai et al.

Recovering the 3D motion of the heart from cine cardiac magnetic resonance (CMR) imaging enables the assessment of regional myocardial function and is important for understanding and analyzing cardiovascular disease. However, 3D cardiac motion estimation is challenging because the acquired cine CMR images are usually 2D slices which limit the accurate estimation of through-plane motion. To address this problem, we propose a novel multi-view motion estimation network (MulViMotion), which integrates 2D cine CMR images acquired in short-axis and long-axis planes to learn a consistent 3D motion field of the heart. In the proposed method, a hybrid 2D/3D network is built to generate dense 3D motion fields by learning fused representations from multi-view images. To ensure that the motion estimation is consistent in 3D, a shape regularization module is introduced during training, where shape information from multi-view images is exploited to provide weak supervision to 3D motion estimation. We extensively evaluate the proposed method on 2D cine CMR images from 580 subjects of the UK Biobank study for 3D motion tracking of the left ventricular myocardium. Experimental results show that the proposed method quantitatively and qualitatively outperforms competing methods.

Chen Qin, Shuo Wang, Chen Chen et al.

Myocardial motion and deformation are rich descriptors that characterize cardiac function. Image registration, as the most commonly used technique for myocardial motion tracking, is an ill-posed inverse problem which often requires prior assumptions on the solution space. In contrast to most existing approaches which impose explicit generic regularization such as smoothness, in this work we propose a novel method that can implicitly learn an application-specific biomechanics-informed prior and embed it into a neural network-parameterized transformation model. Particularly, the proposed method leverages a variational autoencoder-based generative model to learn a manifold for biomechanically plausible deformations. The motion tracking then can be performed via traversing the learnt manifold to search for the optimal transformations while considering the sequence information. The proposed method is validated on three public cardiac cine MRI datasets with comprehensive evaluations. The results demonstrate that the proposed method can outperform other approaches, yielding higher motion tracking accuracy with reasonable volume preservation and better generalizability to varying data distributions. It also enables better estimates of myocardial strains, which indicates the potential of the method in characterizing spatiotemporal signatures for understanding cardiovascular diseases.

Mengyun Qiao, Shuo Wang, Huaqi Qiu et al.

Two key questions in cardiac image analysis are to assess the anatomy and motion of the heart from images; and to understand how they are associated with non-imaging clinical factors such as gender, age and diseases. While the first question can often be addressed by image segmentation and motion tracking algorithms, our capability to model and to answer the second question is still limited. In this work, we propose a novel conditional generative model to describe the 4D spatio-temporal anatomy of the heart and its interaction with non-imaging clinical factors. The clinical factors are integrated as the conditions of the generative modelling, which allows us to investigate how these factors influence the cardiac anatomy. We evaluate the model performance in mainly two tasks, anatomical sequence completion and sequence generation. The model achieves a high performance in anatomical sequence completion, comparable to or outperforming other state-of-the-art generative models. In terms of sequence generation, given clinical conditions, the model can generate realistic synthetic 4D sequential anatomies that share similar distributions with the real data.

Che Liu, Sibo Cheng, Chen Chen et al.

Medical vision-language models enable co-learning and integrating features from medical imaging and clinical text. However, these models are not easy to train and the latent representation space can be complex. Here we propose a novel way for pre-training and regularising medical vision-language models. The proposed method, named Medical vision-language pre-training with Frozen language models and Latent spAce Geometry optimization (M-FLAG), leverages a frozen language model for training stability and efficiency and introduces a novel orthogonality loss to harmonize the latent space geometry. We demonstrate the potential of the pre-trained model on three downstream tasks: medical image classification, segmentation, and object detection. Extensive experiments across five public datasets demonstrate that M-FLAG significantly outperforms existing medical vision-language pre-training approaches and reduces the number of parameters by 78\%. Notably, M-FLAG achieves outstanding performance on the segmentation task while using only 1\% of the RSNA dataset, even outperforming ImageNet pre-trained models that have been fine-tuned using 100\% of the data.

Qingjie Meng, Wenjia Bai, Tianrui Liu et al.

3D motion estimation from cine cardiac magnetic resonance (CMR) images is important for the assessment of cardiac function and diagnosis of cardiovascular diseases. Most of the previous methods focus on estimating pixel-/voxel-wise motion fields in the full image space, which ignore the fact that motion estimation is mainly relevant and useful within the object of interest, e.g., the heart. In this work, we model the heart as a 3D geometric mesh and propose a novel deep learning-based method that can estimate 3D motion of the heart mesh from 2D short- and long-axis CMR images. By developing a differentiable mesh-to-image rasterizer, the method is able to leverage the anatomical shape information from 2D multi-view CMR images for 3D motion estimation. The differentiability of the rasterizer enables us to train the method end-to-end. One advantage of the proposed method is that by tracking the motion of each vertex, it is able to keep the vertex correspondence of 3D meshes between time frames, which is important for quantitative assessment of the cardiac function on the mesh. We evaluate the proposed method on CMR images acquired from the UK Biobank study. Experimental results show that the proposed method quantitatively and qualitatively outperforms both conventional and learning-based cardiac motion tracking methods.

Chengyan Wang, Jun Lyu, Shuo Wang et al.

Cardiac magnetic resonance imaging (CMR) has emerged as a valuable diagnostic tool for cardiac diseases. However, a limitation of CMR is its slow imaging speed, which causes patient discomfort and introduces artifacts in the images. There has been growing interest in deep learning-based CMR imaging algorithms that can reconstruct high-quality images from highly under-sampled k-space data. However, the development of deep learning methods requires large training datasets, which have not been publicly available for CMR. To address this gap, we released a dataset that includes multi-contrast, multi-view, multi-slice and multi-coil CMR imaging data from 300 subjects. Imaging studies include cardiac cine and mapping sequences. Manual segmentations of the myocardium and chambers of all the subjects are also provided within the dataset. Scripts of state-of-the-art reconstruction algorithms were also provided as a point of reference. Our aim is to facilitate the advancement of state-of-the-art CMR image reconstruction by introducing standardized evaluation criteria and making the dataset freely accessible to the research community. Researchers can access the dataset at https://www.synapse.org/#!Synapse:syn51471091/wiki/.

Cheng Ouyang, Shuo Wang, Chen Chen et al.

Probability calibration for deep models is highly desirable in safety-critical applications such as medical imaging. It makes output probabilities of deep networks interpretable, by aligning prediction probability with the actual accuracy in test data. In image segmentation, well-calibrated probabilities allow radiologists to identify regions where model-predicted segmentations are unreliable. These unreliable predictions often occur to out-of-domain (OOD) images that are caused by imaging artifacts or unseen imaging protocols. Unfortunately, most previous calibration methods for image segmentation perform sub-optimally on OOD images. To reduce the calibration error when confronted with OOD images, we propose a novel post-hoc calibration model. Our model leverages the pixel susceptibility against perturbations at the local level, and the shape prior information at the global level. The model is tested on cardiac MRI segmentation datasets that contain unseen imaging artifacts and images from an unseen imaging protocol. We demonstrate reduced calibration errors compared with the state-of-the-art calibration algorithm.

Qingjie Meng, Wenjia Bai, Declan P O'Regan et al.

3D motion estimation from cine cardiac magnetic resonance (CMR) images is important for the assessment of cardiac function and the diagnosis of cardiovascular diseases. Current state-of-the art methods focus on estimating dense pixel-/voxel-wise motion fields in image space, which ignores the fact that motion estimation is only relevant and useful within the anatomical objects of interest, e.g., the heart. In this work, we model the heart as a 3D mesh consisting of epi- and endocardial surfaces. We propose a novel learning framework, DeepMesh, which propagates a template heart mesh to a subject space and estimates the 3D motion of the heart mesh from CMR images for individual subjects. In DeepMesh, the heart mesh of the end-diastolic frame of an individual subject is first reconstructed from the template mesh. Mesh-based 3D motion fields with respect to the end-diastolic frame are then estimated from 2D short- and long-axis CMR images. By developing a differentiable mesh-to-image rasterizer, DeepMesh is able to leverage 2D shape information from multiple anatomical views for 3D mesh reconstruction and mesh motion estimation. The proposed method estimates vertex-wise displacement and thus maintains vertex correspondences between time frames, which is important for the quantitative assessment of cardiac function across different subjects and populations. We evaluate DeepMesh on CMR images acquired from the UK Biobank. We focus on 3D motion estimation of the left ventricle in this work. Experimental results show that the proposed method quantitatively and qualitatively outperforms other image-based and mesh-based cardiac motion tracking methods.

Jun Li, Mingxuan Liu, Jiazhen Pan et al.

Clinical abnormality grounding for rare diseases is often hindered by data scarcity, making supervised fine-tuning impractical and single-pass inference highly unstable. We propose Dynamic Decision Learning (DDL), a framework that enables frozen large vision-language models (LVLMs) to refine their decisions across both language and visual spaces by optimizing instructions and consolidating predictions under visual perturbations. This process improves localization quality and produces a consensus-based reliability score that quantifies model confidence. Results on brain imaging benchmarks, including a rare-disease dataset with 281 pathology types across models ranging from 3B to 72B parameters, show that DDL improves mAP@75 by up to 105% on rare-disease cases and outperforms adaptation baselines and supervised fine-tuning. Furthermore, DDL demonstrates stronger calibration between reliability scores and localization accuracy under severe distribution shifts and increasing task difficulty. Code is available at: https://lijunrio.github.io/DDL/

Shuo Wang, Chen Qin, Chengyan Wang et al.

The quality of cardiac magnetic resonance (CMR) imaging is susceptible to respiratory motion artifacts. The model robustness of automated segmentation techniques in face of real-world respiratory motion artifacts is unclear. This manuscript describes the design of extreme cardiac MRI analysis challenge under respiratory motion (CMRxMotion Challenge). The challenge aims to establish a public benchmark dataset to assess the effects of respiratory motion on image quality and examine the robustness of segmentation models. The challenge recruited 40 healthy volunteers to perform different breath-hold behaviors during one imaging visit, obtaining paired cine imaging with artifacts. Radiologists assessed the image quality and annotated the level of respiratory motion artifacts. For those images with diagnostic quality, radiologists further segmented the left ventricle, left ventricle myocardium and right ventricle. The images of training set (20 volunteers) along with the annotations are released to the challenge participants, to develop an automated image quality assessment model (Task 1) and an automated segmentation model (Task 2). The images of validation set (5 volunteers) are released to the challenge participants but the annotations are withheld for online evaluation of submitted predictions. Both the images and annotations of the test set (15 volunteers) were withheld and only used for offline evaluation of submitted containerized dockers. The image quality assessment task is quantitatively evaluated by the Cohen's kappa statistics and the segmentation task is evaluated by the Dice scores and Hausdorff distances.

Chengliang Dai, Shuo Wang, Yuanhan Mo et al.

Machine learning has been widely adopted for medical image analysis in recent years given its promising performance in image segmentation and classification tasks. The success of machine learning, in particular supervised learning, depends on the availability of manually annotated datasets. For medical imaging applications, such annotated datasets are not easy to acquire, it takes a substantial amount of time and resource to curate an annotated medical image set. In this paper, we propose an efficient annotation framework for brain MR images that can suggest informative sample images for human experts to annotate. We evaluate the framework on two different brain image analysis tasks, namely brain tumour segmentation and whole brain segmentation. Experiments show that for brain tumour segmentation task on the BraTS 2019 dataset, training a segmentation model with only 7% suggestively annotated image samples can achieve a performance comparable to that of training on the full dataset. For whole brain segmentation on the MALC dataset, training with 42% suggestively annotated image samples can achieve a comparable performance to training on the full dataset. The proposed framework demonstrates a promising way to save manual annotation cost and improve data efficiency in medical imaging applications.

Yuan Wang, Laura Blackie, Irene Miguel-Aliaga et al.

In recent years, 3D convolutional neural networks have become the dominant approach for volumetric medical image segmentation. However, compared to their 2D counterparts, 3D networks introduce substantially more training parameters and higher requirement for the GPU memory. This has become a major limiting factor for designing and training 3D networks for high-resolution volumetric images. In this work, we propose a novel memory-efficient network architecture for 3D high-resolution image segmentation. The network incorporates both global and local features via a two-stage U-net-based cascaded framework and at the first stage, a memory-efficient U-net (meU-net) is developed. The features learnt at the two stages are connected via post-concatenation, which further improves the information flow. The proposed segmentation method is evaluated on an ultra high-resolution microCT dataset with typically 250 million voxels per volume. Experiments show that it outperforms state-of-the-art 3D segmentation methods in terms of both segmentation accuracy and memory efficiency.

Yunguan Fu, Wenjia Bai, Wen Yan et al.

Diffusion-based unsupervised image registration has been explored for cardiac cine MR, but expensive multi-step inference limits practical use. We propose FlowReg, a flow-matching framework in displacement field space that achieves strong registration in as few as two steps and supports further refinement with more steps. FlowReg uses warmup-reflow training: a single-step network first acts as a teacher, then a student learns to refine from arbitrary intermediate states, removing the need for a pre-trained model as in existing methods. An Initial Guess strategy feeds back the model prediction as the next starting point, improving refinement from step two onward. On ACDC and MM2 across six tasks (including cross-dataset generalization), FlowReg outperforms the state of the art on five tasks (+0.6% mean Dice score on average), with the largest gain in the left ventricle (+1.09%), and reduces LVEF estimation error on all six tasks (-2.58 percentage points), using only 0.7% extra parameters and no segmentation labels. Code is available at https://github.com/mathpluscode/FlowReg.

Kate Čevora, Ben Glocker, Wenjia Bai

Deep learning-based medical image segmentation has seen tremendous progress over the last decade, but there is still relatively little transfer into clinical practice. One of the main barriers is the challenge of domain generalisation, which requires segmentation models to maintain high performance across a wide distribution of image data. This challenge is amplified by the many factors that contribute to the diverse appearance of medical images, such as acquisition conditions and patient characteristics. The impact of shifting patient characteristics such as age and sex on segmentation performance remains relatively under-studied, especially for abdominal organs, despite that this is crucial for ensuring the fairness of the segmentation model. We perform the first study to determine the impact of population shift with respect to age and sex on abdominal CT image segmentation, by leveraging two large public datasets, and introduce a novel metric to quantify the impact. We find that population shift is a challenge similar in magnitude to cross-dataset shift for abdominal organ segmentation, and that the effect is asymmetric and dataset-dependent. We conclude that dataset diversity in terms of known patient characteristics is not necessarily equivalent to dataset diversity in terms of image features. This implies that simple population matching to ensure good generalisation and fairness may be insufficient, and we recommend that fairness research should be directed towards better understanding and quantifying medical image dataset diversity in terms of performance-relevant characteristics such as organ morphology.

Zi Wang, Mingkai Huang, Zhang Shi et al.

Multimodal cardiovascular magnetic resonance (CMR) imaging provides comprehensive and non-invasive insights into cardiovascular disease (CVD) diagnosis and underlying mechanisms. Despite decades of advancements, its widespread clinical adoption remains constrained by prolonged scan times and heterogeneity across medical environments. This underscores the urgent need for a generalist reconstruction foundation model for ultra-fast CMR imaging, one capable of adapting across diverse imaging scenarios and serving as the essential substrate for all downstream analyses. To enable this goal, we curate MMCMR-427K, the largest and most comprehensive multimodal CMR k-space database to date, comprising 427,465 multi-coil k-space data paired with structured metadata across 13 international centers, 12 CMR modalities, 15 scanners, and 17 CVD categories in populations across three continents. Building on this unprecedented resource, we introduce CardioMM, a generalist reconstruction foundation model capable of dynamically adapting to heterogeneous fast CMR imaging scenarios. CardioMM unifies semantic contextual understanding with physics-informed data consistency to deliver robust reconstructions across varied scanners, protocols, and patient presentations. Comprehensive evaluations demonstrate that CardioMM achieves state-of-the-art performance in the internal centers and exhibits strong zero-shot generalization to unseen external settings. Even at imaging acceleration up to 24x, CardioMM reliably preserves key cardiac phenotypes, quantitative myocardial biomarkers, and diagnostic image quality, enabling a substantial increase in CMR examination throughput without compromising clinical integrity. Together, our open-access MMCMR-427K database and CardioMM framework establish a scalable pathway toward high-throughput, high-quality, and clinically accessible cardiovascular imaging.

Xinyu Bai, Wenjia Bai

Learning a medical image segmentation model is an inherently ambiguous task, as uncertainties exist in both images (noise) and manual annotations (human errors and bias) used for model training. To build a trustworthy image segmentation model, it is important to not just evaluate its performance but also estimate the uncertainty of the model prediction. Most state-of-the-art image segmentation networks adopt a hierarchical encoder architecture, extracting image features at multiple resolution levels from fine to coarse. In this work, we leverage this hierarchical image representation and propose a simple yet effective method for estimating uncertainties at multiple levels. The multi-level uncertainties are modelled via the skip-connection module and then sampled to generate an uncertainty map for the predicted image segmentation. We demonstrate that a deep learning segmentation network such as U-net, when implemented with such hierarchical uncertainty estimation module, can achieve a high segmentation performance, while at the same time provide meaningful uncertainty maps that can be used for out-of-distribution detection.

Mengyun Qiao, Kathryn A McGurk, Shuo Wang et al.

Understanding the structure and motion of the heart is crucial for diagnosing and managing cardiovascular diseases, the leading cause of global death. There is wide variation in cardiac shape and motion patterns, influenced by demographic, anthropometric and disease factors. Unravelling normal patterns of shape and motion, and understanding how each individual deviates from the norm, would facilitate accurate diagnosis and personalised treatment strategies. To this end, we developed a conditional generative model, MeshHeart, to learn the distribution of shape and motion patterns for the left and right ventricles of the heart. To model the high-dimensional spatio-temporal mesh data, MeshHeart employs a geometric encoder to represent cardiac meshes in a latent space, and a temporal Transformer to model the motion dynamics of latent representations. Based on MeshHeart, we investigate the latent space of 3D+t cardiac mesh sequences and propose a distance metric, latent delta, which quantifies the deviation of a real heart from its personalised normative pattern. In experiments using a large cardiac magnetic resonance image dataset of 38,309 subjects from the UK Biobank, MeshHeart demonstrates high performance in cardiac mesh sequence reconstruction and generation. Latent space features are discriminative for cardiac disease classification, whereas latent delta exhibits strong correlations with clinical phenotypes in phenome-wide association studies. The code and the trained model are released to support further research.

Che Liu, Zhongwei Wan, Cheng Ouyang et al.

Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL's versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL}) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10\% annotated training data, averaged across all six datasets. Code and models are available at https://github.com/cheliu-computation/MERL

Jianghao Wu, Yicheng Wu, Yutong Xie et al.

Universal medical image segmentation using the Segment Anything Model (SAM) remains challenging due to its limited adaptability to medical domains. Existing adaptations, such as MedSAM, enhance SAM's performance in medical imaging but at the cost of reduced generalization to unseen data. Therefore, in this paper, we propose SAM-aware Test-Time Adaptation (SAM-TTA), a fundamentally different pipeline that preserves the generalization of SAM while improving its segmentation performance in medical imaging via a test-time framework. SAM-TTA tackles two key challenges: (1) input-level discrepancies caused by differences in image acquisition between natural and medical images and (2) semantic-level discrepancies due to fundamental differences in object definition between natural and medical domains (e.g., clear boundaries vs. ambiguous structures). Specifically, our SAM-TTA framework comprises (1) Self-adaptive Bezier Curve-based Transformation (SBCT), which adaptively converts single-channel medical images into three-channel SAM-compatible inputs while maintaining structural integrity, to mitigate the input gap between medical and natural images, and (2) Dual-scale Uncertainty-driven Mean Teacher adaptation (DUMT), which employs consistency learning to align SAM's internal representations to medical semantics, enabling efficient adaptation without auxiliary supervision or expensive retraining. Extensive experiments on five public datasets demonstrate that our SAM-TTA outperforms existing TTA approaches and even surpasses fully fine-tuned models such as MedSAM in certain scenarios, establishing a new paradigm for universal medical image segmentation. Code can be found at https://github.com/JianghaoWu/SAM-TTA.

Yunguan Fu, Wenjia Bai, Weixi Yi et al.

Here we present a versatile foundation model that can perform a range of clinically-relevant image analysis tasks, including segmentation, landmark localisation, diagnosis, and prognostication. A multi-view convolution-transformer masked autoencoder, named as CineMA, was trained on 15 million cine images from 74,916 subjects. The model was validated on multiple image analysis tasks and compared to existing models on >4,500 images from eight independent datasets with diverse population characteristics, representing the largest benchmark study for cine CMR so far. CineMA consistently outperformed conventional convolutional neural networks (CNNs) in delineating ventricular boundaries and estimating ejection fraction, a key measure of cardiac function. The improved performance was preserved, even when the model only used half of fine-tuning data. CineMA also surpassed CNNs in disease detection and matched their performance in long-axis function measurement. Interestingly, we found that CineMA can also detect cardiac changes in systemic diseases, such as diabetes, hypertension and cancer, and can also predict mortality. Finally, we assessed model fairness and demonstrated consistent model performance across demographic subgroups. These findings highlight CineMA's accuracy, learning efficiency, adaptability, and fairness, underscoring its potential as a foundation model for automated cardiac image analysis to support clinical workflow and cardiovascular research. All training and inference code and models are made publicly available at https://github.com/mathpluscode/CineMA.

Long Chen, Ashiv Patel, Mengyun Qiao et al.

Personalized, accurate prediction of aortic aneurysm progression is essential for timely intervention but remains challenging due to the need to model both subtle local deformations and global anatomical changes within complex 3D geometries. We propose MCMeshGAN, the first multimodal conditional mesh-to-mesh generative adversarial network for 3D aneurysm growth prediction. MCMeshGAN introduces a dual-branch architecture combining a novel local KNN-based convolutional network (KCN) to preserve fine-grained geometric details and a global graph convolutional network (GCN) to capture long-range structural context, overcoming the over-smoothing limitations of deep GCNs. A dedicated condition branch encodes clinical attributes (age, sex) and the target time interval to generate anatomically plausible, temporally controlled predictions, enabling retrospective and prospective modeling. We curated TAAMesh, a new longitudinal thoracic aortic aneurysm mesh dataset consisting of 590 multimodal records (CT scans, 3D meshes, and clinical data) from 208 patients. Extensive experiments demonstrate that MCMeshGAN consistently outperforms state-of-the-art baselines in both geometric accuracy and clinically important diameter estimation. This framework offers a robust step toward clinically deployable, personalized 3D disease trajectory modeling. The source code for MCMeshGAN and the baseline methods is publicly available at https://github.com/ImperialCollegeLondon/MCMeshGAN.

Zuoou Li, Weitong Zhang, Jingyuan Wang et al.

Multimodal large language models (MLLMs) are widely used in vision-language reasoning tasks. However, their vulnerability to adversarial prompts remains a serious concern, as safety mechanisms often fail to prevent the generation of harmful outputs. Although recent jailbreak strategies report high success rates, many responses classified as "successful" are actually benign, vague, or unrelated to the intended malicious goal. This mismatch suggests that current evaluation standards may overestimate the effectiveness of such attacks. To address this issue, we introduce a four-axis evaluation framework that considers input on-topicness, input out-of-distribution (OOD) intensity, output harmfulness, and output refusal rate. This framework identifies truly effective jailbreaks. In a substantial empirical study, we reveal a structural trade-off: highly on-topic prompts are frequently blocked by safety filters, whereas those that are too OOD often evade detection but fail to produce harmful content. However, prompts that balance relevance and novelty are more likely to evade filters and trigger dangerous output. Building on this insight, we develop a recursive rewriting strategy called Balanced Structural Decomposition (BSD). The approach restructures malicious prompts into semantically aligned sub-tasks, while introducing subtle OOD signals and visual cues that make the inputs harder to detect. BSD was tested across 13 commercial and open-source MLLMs, where it consistently led to higher attack success rates, more harmful outputs, and fewer refusals. Compared to previous methods, it improves success rates by $67\%$ and harmfulness by $21\%$, revealing a previously underappreciated weakness in current multimodal safety systems.

Che Liu, Jiazhen Pan, Weixiang Shen et al.

Vision-Language Models (VLMs) trained on web-scale corpora excel at natural image tasks and are increasingly repurposed for healthcare; however, their competence in medical tasks remains underexplored. We present a comprehensive evaluation of open-source general-purpose and medically specialised VLMs, ranging from 3B to 72B parameters, across eight benchmarks: MedXpert, OmniMedVQA, PMC-VQA, PathVQA, MMMU, SLAKE, and VQA-RAD. To observe model performance across different aspects, we first separate it into understanding and reasoning components. Three salient findings emerge. First, large general-purpose models already match or surpass medical-specific counterparts on several benchmarks, demonstrating strong zero-shot transfer from natural to medical images. Second, reasoning performance is consistently lower than understanding, highlighting a critical barrier to safe decision support. Third, performance varies widely across benchmarks, reflecting differences in task design, annotation quality, and knowledge demands. No model yet reaches the reliability threshold for clinical deployment, underscoring the need for stronger multimodal alignment and more rigorous, fine-grained evaluation protocols.

Raghav Mehta, Angelos Filos, Ujjwal Baid et al.

Deep learning (DL) models have provided state-of-the-art performance in various medical imaging benchmarking challenges, including the Brain Tumor Segmentation (BraTS) challenges. However, the task of focal pathology multi-compartment segmentation (e.g., tumor and lesion sub-regions) is particularly challenging, and potential errors hinder translating DL models into clinical workflows. Quantifying the reliability of DL model predictions in the form of uncertainties could enable clinical review of the most uncertain regions, thereby building trust and paving the way toward clinical translation. Several uncertainty estimation methods have recently been introduced for DL medical image segmentation tasks. Developing scores to evaluate and compare the performance of uncertainty measures will assist the end-user in making more informed decisions. In this study, we explore and evaluate a score developed during the BraTS 2019 and BraTS 2020 task on uncertainty quantification (QU-BraTS) and designed to assess and rank uncertainty estimates for brain tumor multi-compartment segmentation. This score (1) rewards uncertainty estimates that produce high confidence in correct assertions and those that assign low confidence levels at incorrect assertions, and (2) penalizes uncertainty measures that lead to a higher percentage of under-confident correct assertions. We further benchmark the segmentation uncertainties generated by 14 independent participating teams of QU-BraTS 2020, all of which also participated in the main BraTS segmentation task. Overall, our findings confirm the importance and complementary value that uncertainty estimates provide to segmentation algorithms, highlighting the need for uncertainty quantification in medical image analyses. Finally, in favor of transparency and reproducibility, our evaluation code is made publicly available at: https://github.com/RagMeh11/QU-BraTS.

Jinming Duan, Jo Schlemper, Chen Qin et al.

In this work, we propose a deep learning approach for parallel magnetic resonance imaging (MRI) reconstruction, termed a variable splitting network (VS-Net), for an efficient, high-quality reconstruction of undersampled multi-coil MR data. We formulate the generalized parallel compressed sensing reconstruction as an energy minimization problem, for which a variable splitting optimization method is derived. Based on this formulation we propose a novel, end-to-end trainable deep neural network architecture by unrolling the resulting iterative process of such variable splitting scheme. VS-Net is evaluated on complex valued multi-coil knee images for 4-fold and 6-fold acceleration factors. We show that VS-Net outperforms state-of-the-art deep learning reconstruction algorithms, in terms of reconstruction accuracy and perceptual quality. Our code is publicly available at https://github.com/j-duan/VS-Net.

Chen Chen, Wenjia Bai, Daniel Rueckert

Segmentation of the left atrium (LA) is crucial for assessing its anatomy in both pre-operative atrial fibrillation (AF) ablation planning and post-operative follow-up studies. In this paper, we present a fully automated framework for left atrial segmentation in gadolinium-enhanced magnetic resonance images (GE-MRI) based on deep learning. We propose a fully convolutional neural network and explore the benefits of multi-task learning for performing both atrial segmentation and pre/post ablation classification. Our results show that, by sharing features between related tasks, the network can gain additional anatomical information and achieve more accurate atrial segmentation, leading to a mean Dice score of 0.901 on a test set of 20 3D MRI images. Code of our proposed algorithm is available at https://github.com/cherise215/atria_segmentation_2018/.

Xinru Zhang, Ni Ou, Berke Doga Basaran et al.

Brain lesion segmentation plays an essential role in neurological research and diagnosis. As brain lesions can be caused by various pathological alterations, different types of brain lesions tend to manifest with different characteristics on different imaging modalities. Due to this complexity, brain lesion segmentation methods are often developed in a task-specific manner. A specific segmentation model is developed for a particular lesion type and imaging modality. However, the use of task-specific models requires predetermination of the lesion type and imaging modality, which complicates their deployment in real-world scenarios. In this work, we propose a universal foundation model for 3D brain lesion segmentation, which can automatically segment different types of brain lesions for input data of various imaging modalities. We formulate a novel Mixture of Modality Experts (MoME) framework with multiple expert networks attending to different imaging modalities. A hierarchical gating network combines the expert predictions and fosters expertise collaboration. Furthermore, we introduce a curriculum learning strategy during training to avoid the degeneration of each expert network and preserve their specialization. We evaluated the proposed method on nine brain lesion datasets, encompassing five imaging modalities and eight lesion types. The results show that our model outperforms state-of-the-art universal models and provides promising generalization to unseen datasets.

Che Liu, Haozhe Wang, Jiazhen Pan et al.

Improving performance on complex tasks and enabling interpretable decision making in large language models (LLMs), especially for clinical applications, requires effective reasoning. Yet this remains challenging without supervised fine-tuning (SFT) on costly chain-of-thought (CoT) data distilled from closed-source models (e.g., GPT-4o). In this work, we present AlphaMed, the first medical LLM to show that reasoning capability can emerge purely through reinforcement learning (RL), using minimalist rule-based rewards on public multiple-choice QA datasets, without relying on SFT or distilled CoT data. AlphaMed achieves state-of-the-art results on six medical QA benchmarks, outperforming models trained with conventional SFT+RL pipelines. On challenging benchmarks (e.g., MedXpert), AlphaMed even surpasses larger or closed-source models such as DeepSeek-V3-671B and Claude-3.5-Sonnet. To understand the factors behind this success, we conduct a comprehensive data-centric analysis guided by three questions: (i) Can minimalist rule-based RL incentivize reasoning without distilled CoT supervision? (ii) How do dataset quantity and diversity impact reasoning? (iii) How does question difficulty shape the emergence and generalization of reasoning? Our findings show that dataset informativeness is a key driver of reasoning performance, and that minimalist RL on informative, multiple-choice QA data is effective at inducing reasoning without CoT supervision. We also observe divergent trends across benchmarks, underscoring limitations in current evaluation and the need for more challenging, reasoning-oriented medical QA benchmarks.

Che Liu, Yinda Chen, Haoyuan Shi et al.

The advent of large-scale vision foundation models, pre-trained on diverse natural images, has marked a paradigm shift in computer vision. However, how the frontier vision foundation models' efficacies transfer to specialized domains remains such as medical imaging remains an open question. This report investigates whether DINOv3, a state-of-the-art self-supervised vision transformer (ViT) that features strong capability in dense prediction tasks, can directly serve as a powerful, unified encoder for medical vision tasks without domain-specific pre-training. To answer this, we benchmark DINOv3 across common medical vision tasks, including 2D/3D classification and segmentation on a wide range of medical imaging modalities. We systematically analyze its scalability by varying model sizes and input image resolutions. Our findings reveal that DINOv3 shows impressive performance and establishes a formidable new baseline. Remarkably, it can even outperform medical-specific foundation models like BiomedCLIP and CT-Net on several tasks, despite being trained solely on natural images. However, we identify clear limitations: The model's features degrade in scenarios requiring deep domain specialization, such as in Whole-Slide Pathological Images (WSIs), Electron Microscopy (EM), and Positron Emission Tomography (PET). Furthermore, we observe that DINOv3 does not consistently obey scaling law in the medical domain; performance does not reliably increase with larger models or finer feature resolutions, showing diverse scaling behaviors across tasks. Ultimately, our work establishes DINOv3 as a strong baseline, whose powerful visual features can serve as a robust prior for multiple complex medical tasks. This opens promising future directions, such as leveraging its features to enforce multiview consistency in 3D reconstruction.

Cosmin I. Bercea, Jun Li, Philipp Raffler et al.

In many real-world applications, deployed models encounter inputs that differ from the data seen during training. Out-of-distribution detection identifies whether an input stems from an unseen distribution, while open-world recognition flags such inputs to ensure the system remains robust as ever-emerging, previously $unknown$ categories appear and must be addressed without retraining. Foundation and vision-language models are pre-trained on large and diverse datasets with the expectation of broad generalization across domains, including medical imaging. However, benchmarking these models on test sets with only a few common outlier types silently collapses the evaluation back to a closed-set problem, masking failures on rare or truly novel conditions encountered in clinical use. We therefore present $NOVA$, a challenging, real-life $evaluation-only$ benchmark of $\sim$900 brain MRI scans that span 281 rare pathologies and heterogeneous acquisition protocols. Each case includes rich clinical narratives and double-blinded expert bounding-box annotations. Together, these enable joint assessment of anomaly localisation, visual captioning, and diagnostic reasoning. Because NOVA is never used for training, it serves as an $extreme$ stress-test of out-of-distribution generalisation: models must bridge a distribution gap both in sample appearance and in semantic space. Baseline results with leading vision-language models (GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B) reveal substantial performance drops across all tasks, establishing NOVA as a rigorous testbed for advancing models that can detect, localize, and reason about truly unknown anomalies.

Jun Li, Che Liu, Wenjia Bai et al.

Visual Language Models (VLMs) have demonstrated impressive capabilities in visual grounding tasks. However, their effectiveness in the medical domain, particularly for abnormality detection and localization within medical images, remains underexplored. A major challenge is the complex and abstract nature of medical terminology, which makes it difficult to directly associate pathological anomaly terms with their corresponding visual features. In this work, we introduce a novel approach to enhance VLM performance in medical abnormality detection and localization by leveraging decomposed medical knowledge. Instead of directly prompting models to recognize specific abnormalities, we focus on breaking down medical concepts into fundamental attributes and common visual patterns. This strategy promotes a stronger alignment between textual descriptions and visual features, improving both the recognition and localization of abnormalities in medical images.We evaluate our method on the 0.23B Florence-2 base model and demonstrate that it achieves comparable performance in abnormality grounding to significantly larger 7B LLaVA-based medical VLMs, despite being trained on only 1.5% of the data used for such models. Experimental results also demonstrate the effectiveness of our approach in both known and previously unseen abnormalities, suggesting its strong generalization capabilities.

Che Liu, Cheng Ouyang, Zhongwei Wan et al.

Recent advances in multimodal ECG representation learning center on aligning ECG signals with paired free-text reports. However, suboptimal alignment persists due to the complexity of medical language and the reliance on a full 12-lead setup, which is often unavailable in under-resourced settings. To tackle these issues, we propose **K-MERL**, a knowledge-enhanced multimodal ECG representation learning framework. **K-MERL** leverages large language models to extract structured knowledge from free-text reports and employs a lead-aware ECG encoder with dynamic lead masking to accommodate arbitrary lead inputs. Evaluations on six external ECG datasets show that **K-MERL** achieves state-of-the-art performance in zero-shot classification and linear probing tasks, while delivering an average **16%** AUC improvement over existing methods in partial-lead zero-shot classification.

Kang Wang, Chen Qin, Zhang Shi et al.

Deep learning models have achieved state-of-the-art performance in automated Cardiac Magnetic Resonance (CMR) analysis. However, the efficacy of these models is highly dependent on the availability of high-quality, artifact-free images. In clinical practice, CMR acquisitions are frequently degraded by respiratory motion, yet the robustness of deep learning models against such artifacts remains an underexplored problem. To promote research in this domain, we organized the MICCAI CMRxMotion challenge. We curated and publicly released a dataset of 320 CMR cine series from 40 healthy volunteers who performed specific breathing protocols to induce a controlled spectrum of motion artifacts. The challenge comprised two tasks: 1) automated image quality assessment to classify images based on motion severity, and 2) robust myocardial segmentation in the presence of motion artifacts. A total of 22 algorithms were submitted and evaluated on the two designated tasks. This paper presents a comprehensive overview of the challenge design and dataset, reports the evaluation results for the top-performing methods, and further investigates the impact of motion artifacts on five clinically relevant biomarkers. All resources and code are publicly available at: https://github.com/CMRxMotion

Qiang Ma, Qingjie Meng, Xin Hu et al.

Surface registration plays an important role for anatomical shape analysis in medical imaging. Existing surface registration methods often face a trade-off between efficiency and robustness. Local point matching methods are computationally efficient, but vulnerable to noise and initialisation. Methods designed for global point set alignment tend to incur a high computational cost. To address the challenge, here we present a fast surface registration method, which formulates surface meshes as probability measures and surface registration as a distributional optimisation problem. The discrepancy between two meshes is measured using an efficient sliced Wasserstein distance with log-linear computational complexity. We propose a novel optimisation method, AdamFlow, which generalises the well-known Adam optimisation method from the Euclidean space to the probability space for minimising the sliced Wasserstein distance. We theoretically analyse the asymptotic convergence of AdamFlow and empirically demonstrate its superior performance in both affine and non-rigid surface registration across various anatomical structures.

Jun Li, Che Liu, Wenjia Bai et al.

In this work, we address the problem of grounding abnormalities in medical images, where the goal is to localize clinical findings based on textual descriptions. While generalist Vision-Language Models (VLMs) excel in natural grounding tasks, they often struggle in the medical domain due to rare, compositional, and domain-specific terms that are poorly aligned with visual patterns. Specialized medical VLMs address this challenge via large-scale domain pretraining, but at the cost of substantial annotation and computational resources. To overcome these limitations, we propose \textbf{Knowledge to Sight (K2Sight)}, a framework that introduces structured semantic supervision by decomposing clinical concepts into interpretable visual attributes, such as shape, density, and anatomical location. These attributes are distilled from domain ontologies and encoded into concise instruction-style prompts, which guide region-text alignment during training. Unlike conventional report-level supervision, our approach explicitly bridges domain knowledge and spatial structure, enabling data-efficient training of compact models. We train compact models with 0.23B and 2B parameters using only 1.5\% of the data required by state-of-the-art medical VLMs. Despite their small size and limited training data, these models achieve performance on par with or better than 7B+ medical VLMs, with up to 9.82\% improvement in $mAP_{50}$. Code and models: \href{https://lijunrio.github.io/K2Sight/}{\textcolor{SOTAPink}{https://lijunrio.github.io/K2Sight/}}.

Weitong Zhang, Mengyun Qiao, Chengqi Zang et al.

Identifying associations between imaging phenotypes, disease risk factors, and clinical outcomes is essential for understanding disease mechanisms. However, traditional approaches rely on human-driven hypothesis testing and selection of association factors, often overlooking complex, non-linear dependencies among imaging phenotypes and other multi-modal data. To address this, we introduce Multi-agent Exploratory Synergy for the Heart (MESHAgents): a framework that leverages large language models as agents to dynamically elicit, surface, and decide confounders and phenotypes in association studies. Specifically, we orchestrate a multi-disciplinary team of AI agents, which spontaneously generate and converge on insights through iterative, self-organizing reasoning. The framework dynamically synthesizes statistical correlations with multi-expert consensus, providing an automated pipeline for phenome-wide association studies (PheWAS). We demonstrate the system's capabilities through a population-based study of imaging phenotypes of the heart and aorta. MESHAgents autonomously uncovered correlations between imaging phenotypes and a wide range of non-imaging factors, identifying additional confounder variables beyond standard demographic factors. Validation on diagnosis tasks reveals that MESHAgents-discovered phenotypes achieve performance comparable to expert-selected phenotypes, with mean AUC differences as small as $-0.004_{\pm0.010}$ on disease classification tasks. Notably, the recall score improves for 6 out of 9 disease types. Our framework provides clinically relevant imaging phenotypes with transparent reasoning, offering a scalable alternative to expert-driven methods.

Berke Doga Basaran, Paul M. Matthews, Wenjia Bai

Assessing lesions and tracking their progression over time in brain magnetic resonance (MR) images is essential for diagnosing and monitoring multiple sclerosis (MS). Machine learning models have shown promise in automating the segmentation of MS lesions. However, training these models typically requires large, well-annotated datasets. Unfortunately, MS imaging datasets are often limited in size, spread across multiple hospital sites, and exhibit different formats (such as cross-sectional or longitudinal) and annotation styles. This data diversity presents a significant obstacle to developing a unified model for MS lesion segmentation. To address this issue, we introduce SegHeD+, a novel segmentation model that can handle multiple datasets and tasks, accommodating heterogeneous input data and performing segmentation for all lesions, new lesions, and vanishing lesions. We integrate domain knowledge about MS lesions by incorporating longitudinal, anatomical, and volumetric constraints into the segmentation model. Additionally, we perform lesion-level data augmentation to enlarge the training set and further improve segmentation performance. SegHeD+ is evaluated on five MS datasets and demonstrates superior performance in segmenting all, new, and vanishing lesions, surpassing several state-of-the-art methods in the field.

Zi Wang, Fanwen Wang, Chen Qin et al.

Cardiac magnetic resonance imaging (MRI) has emerged as a clinically gold-standard technique for diagnosing cardiac diseases, thanks to its ability to provide diverse information with multiple modalities and anatomical views. Accelerated cardiac MRI is highly expected to achieve time-efficient and patient-friendly imaging, and then advanced image reconstruction approaches are required to recover high-quality, clinically interpretable images from undersampled measurements. However, the lack of publicly available cardiac MRI k-space dataset in terms of both quantity and diversity has severely hindered substantial technological progress, particularly for data-driven artificial intelligence. Here, we provide a standardized, diverse, and high-quality CMRxRecon2024 dataset to facilitate the technical development, fair evaluation, and clinical transfer of cardiac MRI reconstruction approaches, towards promoting the universal frameworks that enable fast and robust reconstructions across different cardiac MRI protocols in clinical practice. To the best of our knowledge, the CMRxRecon2024 dataset is the largest and most protocal-diverse publicly available cardiac k-space dataset. It is acquired from 330 healthy volunteers, covering commonly used modalities, anatomical views, and acquisition trajectories in clinical cardiac MRI workflows. Besides, an open platform with tutorials, benchmarks, and data processing tools is provided to facilitate data usage, advanced method development, and fair performance evaluation.

Cheng Ouyang, Chen Chen, Surui Li et al.

Deep learning models usually suffer from domain shift issues, where models trained on one source domain do not generalize well to other unseen domains. In this work, we investigate the single-source domain generalization problem: training a deep network that is robust to unseen domains, under the condition that training data is only available from one source domain, which is common in medical imaging applications. We tackle this problem in the context of cross-domain medical image segmentation. Under this scenario, domain shifts are mainly caused by different acquisition processes. We propose a simple causality-inspired data augmentation approach to expose a segmentation model to synthesized domain-shifted training examples. Specifically, 1) to make the deep model robust to discrepancies in image intensities and textures, we employ a family of randomly-weighted shallow networks. They augment training images using diverse appearance transformations. 2) Further we show that spurious correlations among objects in an image are detrimental to domain robustness. These correlations might be taken by the network as domain-specific clues for making predictions, and they may break on unseen domains. We remove these spurious correlations via causal intervention. This is achieved by resampling the appearances of potentially correlated objects independently. The proposed approach is validated on three cross-domain segmentation tasks: cross-modality (CT-MRI) abdominal image segmentation, cross-sequence (bSSFP-LGE) cardiac MRI segmentation, and cross-center prostate MRI segmentation. The proposed approach yields consistent performance gains compared with competitive methods when tested on unseen domains.

Turkay Kart, Wenjia Bai, Ben Glocker et al.

In recent years, the research landscape of machine learning in medical imaging has changed drastically from supervised to semi-, weakly- or unsupervised methods. This is mainly due to the fact that ground-truth labels are time-consuming and expensive to obtain manually. Generating labels from patient metadata might be feasible but it suffers from user-originated errors which introduce biases. In this work, we propose an unsupervised approach for automatically clustering and categorizing large-scale medical image datasets, with a focus on cardiac MR images, and without using any labels. We investigated the end-to-end training using both class-balanced and imbalanced large-scale datasets. Our method was able to create clusters with high purity and achieved over 0.99 cluster purity on these datasets. The results demonstrate the potential of the proposed method for categorizing unstructured large medical databases, such as organizing clinical PACS systems in hospitals.

Chen Chen, Chen Qin, Cheng Ouyang et al.

The success of neural networks on medical image segmentation tasks typically relies on large labeled datasets for model training. However, acquiring and manually labeling a large medical image set is resource-intensive, expensive, and sometimes impractical due to data sharing and privacy issues. To address this challenge, we propose AdvChain, a generic adversarial data augmentation framework, aiming at improving both the diversity and effectiveness of training data for medical image segmentation tasks. AdvChain augments data with dynamic data augmentation, generating randomly chained photo-metric and geometric transformations to resemble realistic yet challenging imaging variations to expand training data. By jointly optimizing the data augmentation model and a segmentation network during training, challenging examples are generated to enhance network generalizability for the downstream task. The proposed adversarial data augmentation does not rely on generative networks and can be used as a plug-in module in general segmentation networks. It is computationally efficient and applicable for both low-shot supervised and semi-supervised learning. We analyze and evaluate the method on two MR image segmentation tasks: cardiac segmentation and prostate segmentation with limited labeled data. Results show that the proposed approach can alleviate the need for labeled data while improving model generalization ability, indicating its practical value in medical imaging applications.

Nicolo Savioli, Antonio de Marvao, Wenjia Bai et al.

Optimising the analysis of cardiac structure and function requires accurate 3D representations of shape and motion. However, techniques such as cardiac magnetic resonance imaging are conventionally limited to acquiring contiguous cross-sectional slices with low through-plane resolution and potential inter-slice spatial misalignment. Super-resolution in medical imaging aims to increase the resolution of images but is conventionally trained on features from low resolution datasets and does not super-resolve corresponding segmentations. Here we propose a semi-supervised multi-task generative adversarial network (Gemini-GAN) that performs joint super-resolution of the images and their labels using a ground truth of high resolution 3D cines and segmentations, while an unsupervised variational adversarial mixture autoencoder (V-AMA) is used for continuous domain adaptation. Our proposed approach is extensively evaluated on two transnational multi-ethnic populations of 1,331 and 205 adults respectively, delivering an improvement on state of the art methods in terms of Dice index, peak signal to noise ratio, and structural similarity index measure. This framework also exceeds the performance of state of the art generative domain adaptation models on external validation (Dice index 0.81 vs 0.74 for the left ventricle). This demonstrates how joint super-resolution and segmentation, trained on 3D ground-truth data with cross-domain generalization, enables robust precision phenotyping in diverse populations.

Shuo Wang, Chen Qin, Nicolo Savioli et al.

In cardiac magnetic resonance (CMR) imaging, a 3D high-resolution segmentation of the heart is essential for detailed description of its anatomical structures. However, due to the limit of acquisition duration and respiratory/cardiac motion, stacks of multi-slice 2D images are acquired in clinical routine. The segmentation of these images provides a low-resolution representation of cardiac anatomy, which may contain artefacts caused by motion. Here we propose a novel latent optimisation framework that jointly performs motion correction and super resolution for cardiac image segmentations. Given a low-resolution segmentation as input, the framework accounts for inter-slice motion in cardiac MR imaging and super-resolves the input into a high-resolution segmentation consistent with input. A multi-view loss is incorporated to leverage information from both short-axis view and long-axis view of cardiac imaging. To solve the inverse problem, iterative optimisation is performed in a latent space, which ensures the anatomical plausibility. This alleviates the need of paired low-resolution and high-resolution images for supervised learning. Experiments on two cardiac MR datasets show that the proposed framework achieves high performance, comparable to state-of-the-art super-resolution approaches and with better cross-domain generalisability and anatomical plausibility.