Kuang Gong

Se-In Jang, Tinsu Pan, Ye Li et al.

Position emission tomography (PET) is widely used in clinics and research due to its quantitative merits and high sensitivity, but suffers from low signal-to-noise ratio (SNR). Recently convolutional neural networks (CNNs) have been widely used to improve PET image quality. Though successful and efficient in local feature extraction, CNN cannot capture long-range dependencies well due to its limited receptive field. Global multi-head self-attention (MSA) is a popular approach to capture long-range information. However, the calculation of global MSA for 3D images has high computational costs. In this work, we proposed an efficient spatial and channel-wise encoder-decoder transformer, Spach Transformer, that can leverage spatial and channel information based on local and global MSAs. Experiments based on datasets of different PET tracers, i.e., $^{18}$F-FDG, $^{18}$F-ACBC, $^{18}$F-DCFPyL, and $^{68}$Ga-DOTATATE, were conducted to evaluate the proposed framework. Quantitative results show that the proposed Spach Transformer framework outperforms state-of-the-art deep learning architectures. Our codes are available at https://github.com/sijang/SpachTransformer

Kuang Gong, Keith A. Johnson, Georges El Fakhri et al.

Due to various physical degradation factors and limited counts received, PET image quality needs further improvements. The denoising diffusion probabilistic models (DDPM) are distribution learning-based models, which try to transform a normal distribution into a specific data distribution based on iterative refinements. In this work, we proposed and evaluated different DDPM-based methods for PET image denoising. Under the DDPM framework, one way to perform PET image denoising is to provide the PET image and/or the prior image as the network input. Another way is to supply the prior image as the input with the PET image included in the refinement steps, which can fit for scenarios of different noise levels. 120 18F-FDG datasets and 140 18F-MK-6240 datasets were utilized to evaluate the proposed DDPM-based methods. Quantification show that the DDPM-based frameworks with PET information included can generate better results than the nonlocal mean and Unet-based denoising methods. Adding additional MR prior in the model can help achieve better performance and further reduce the uncertainty during image denoising. Solely relying on MR prior while ignoring the PET information can result in large bias. Regional and surface quantification shows that employing MR prior as the network input while embedding PET image as a data-consistency constraint during inference can achieve the best performance. In summary, DDPM-based PET image denoising is a flexible framework, which can efficiently utilize prior information and achieve better performance than the nonlocal mean and Unet-based denoising methods.

Gary Y. Li, Junyu Chen, Se-In Jang et al.

Radiotherapy (RT) combined with cetuximab is the standard treatment for patients with inoperable head and neck cancers. Segmentation of head and neck (H&N) tumors is a prerequisite for radiotherapy planning but a time-consuming process. In recent years, deep convolutional neural networks have become the de facto standard for automated image segmentation. However, due to the expensive computational cost associated with enlarging the field of view in DCNNs, their ability to model long-range dependency is still limited, and this can result in sub-optimal segmentation performance for objects with background context spanning over long distances. On the other hand, Transformer models have demonstrated excellent capabilities in capturing such long-range information in several semantic segmentation tasks performed on medical images. Inspired by the recent success of Vision Transformers and advances in multi-modal image analysis, we propose a novel segmentation model, debuted, Cross-Modal Swin Transformer (SwinCross), with cross-modal attention (CMA) module to incorporate cross-modal feature extraction at multiple resolutions.To validate the effectiveness of the proposed method, we performed experiments on the HECKTOR 2021 challenge dataset and compared it with the nnU-Net (the backbone of the top-5 methods in HECKTOR 2021) and other state-of-the-art transformer-based methods such as UNETR, and Swin UNETR. The proposed method is experimentally shown to outperform these comparing methods thanks to the ability of the CMA module to capture better inter-modality complimentary feature representations between PET and CT, for the task of head-and-neck tumor segmentation.

Ye Li, Jianan Cui, Junyu Chen et al.

In PET, the amount of relative (signal-dependent) noise present in different body regions can be significantly different and is inherently related to the number of counts present in that region. The number of counts in a region depends, in principle and among other factors, on the total administered activity, scanner sensitivity, image acquisition duration, radiopharmaceutical tracer uptake in the region, and patient local body morphometry surrounding the region. In theory, less amount of denoising operations is needed to denoise a high-count (low relative noise) image than images a low-count (high relative noise) image, and vice versa. The current deep-learning-based methods for PET image denoising are predominantly trained on image appearance only and have no special treatment for images of different noise levels. Our hypothesis is that by explicitly providing the local relative noise level of the input image to a deep convolutional neural network (DCNN), the DCNN can outperform itself trained on image appearance only. To this end, we propose a noise-level-aware framework denoising framework that allows embedding of local noise level into a DCNN. The proposed is trained and tested on 30 and 15 patient PET images acquired on a GE Discovery MI PET/CT system. Our experiments showed that the increases in both PSNR and SSIM from our backbone network with relative noise level embedding (NLE) versus the same network without NLE were statistically significant with p<0.001, and the proposed method significantly outperformed a strong baseline method by a large margin.

Se-In Jang, Cristina Lois, Emma Thibault et al.

In this work, we developed a novel text-guided image synthesis technique which could generate realistic tau PET images from textual descriptions and the subject's MR image. The generated tau PET images have the potential to be used in examining relations between different measures and also increasing the public availability of tau PET datasets. The method was based on latent diffusion models. Both textual descriptions and the subject's MR prior image were utilized as conditions during image generation. The subject's MR image can provide anatomical details, while the text descriptions, such as gender, scan time, cognitive test scores, and amyloid status, can provide further guidance regarding where the tau neurofibrillary tangles might be deposited. Preliminary experimental results based on clinical [18F]MK-6240 datasets demonstrate the feasibility of the proposed method in generating realistic tau PET images at different clinical stages.

Yu Xin, Gorkem Can Ates, Jun Ma et al.

Text guided 3D medical image segmentation offers a flexible alternative to class based and spatial prompt based models by allowing users to specify regions of interest directly in natural language. This paradigm avoids reliance on predefined label sets, reduces ambiguous outputs, and aligns more naturally with clinical workflows. However, existing text guided frameworks are often computationally expensive, exhibit weak text volume feature alignment, and fail to capture fine anatomical details. We propose ESICA, a lightweight and scalable framework that addresses these challenges through three innovations: (1) a similarity matrix based mask prediction formulation that enhances semantic alignment, (2) an efficient decomposed decoder with adapter modules for accurate volumetric decoding, and (3) a two pass refinement strategy that sharpens boundaries and resolves uncertain regions. To improve training stability and generalization, ESICA adopts a two stage scheme consisting of positive only pretraining followed by balanced fine tuning. On the CVPR BiomedSegFM benchmark spanning five imaging modalities (CT, MRI, PET, ultrasound, and microscopy), ESICA achieves state of the art segmentation accuracy, while the compact ESICA4 Lite variant attains similar segmentation performance with substantially fewer parameters, yielding a superior efficiency accuracy trade off. Our framework advances text guided segmentation toward efficient, scalable, and clinically deployable systems. Code will be made publicly available at https://github.com/mirthAI/ESICA.

Ye Li, Junyu Chen, Se-in Jang et al.

Inspired by the recent success of Transformers for Natural Language Processing and vision Transformer for Computer Vision, many researchers in the medical imaging community have flocked to Transformer-based networks for various main stream medical tasks such as classification, segmentation, and estimation. In this study, we analyze, two recently published Transformer-based network architectures for the task of multimodal head-and-tumor segmentation and compare their performance to the de facto standard 3D segmentation network - the nnU-Net. Our results showed that modeling long-range dependencies may be helpful in cases where large structures are present and/or large field of view is needed. However, for small structures such as head-and-neck tumor, the convolution-based U-Net architecture seemed to perform well, especially when training dataset is small and computational resource is limited.

Hongxu Jiang, Fei Li, Boxiao Yu et al.

Three-dimensional (3D) medical image enhancement, including denoising and super-resolution, is critical for clinical diagnosis in CT, PET, and MRI. Although diffusion models have shown remarkable success in 2D medical imaging, scaling them to high-resolution 3D volumes remains computationally prohibitive due to lengthy diffusion trajectories over high-dimensional volumetric data. We observe that in conditional enhancement, strong anatomical priors in the degraded input render dense noise schedules largely redundant. Leveraging this insight, we propose a sparse voxel-space diffusion framework that trains and samples on a compact set of uniformly subsampled timesteps. The network predicts clean data directly on the data manifold, supervised in velocity space for stable gradient scaling. A lightweight Structure-aware Trajectory Modulation (STM) module recalibrates time embeddings at each network block based on local anatomical content, enabling structure-adaptive denoising over the shared sparse schedule. Operating directly in voxel space, our framework preserves fine anatomical detail without lossy compression while achieving up to $10\times$ training acceleration. Experiments on four datasets spanning CT, PET, and MRI demonstrate state-of-the-art performance on both denoising and super-resolution tasks. Our code is publicly available at: https://github.com/mirthAI/sparse-3d-diffusion.

Renjie Liang, Yiling Ma, Yang Xing et al.

Automated radiology report generation from 3D CT volumes often suffers from incomplete pathology coverage. We provide empirical evidence that this limitation stems from a representational bottleneck: contrastive 3D CT embeddings encode discriminative pathology signals, yet exhibit severe dimensional concentration, with as few as 2 effective dimensions out of 512. Corroborating this, scaling the language model yields no measurable improvement, suggesting that the bottleneck lies in the visual representation rather than the generator. This bottleneck limits both generation and retrieval; naive static retrieval fails to improve clinical efficacy and can even degrade performance. We propose \textbf{AdaRAG-CT}, an adaptive augmentation framework that compensates for this visual bottleneck by introducing supplementary textual information through controlled retrieval and selectively integrating it during generation. On the CT-RATE benchmark, AdaRAG-CT achieves state-of-the-art clinical efficacy, improving Clinical F1 from 0.420 (CT-Agent) to 0.480 (+6 points); ablation studies confirm that both the retrieval and generation components contribute to the improvement. Code is available at https://github.com/renjie-liang/Adaptive-RAG-for-3DCT-Report-Generation.

Hongxu Jiang, Muhammad Imran, Teng Zhang et al.

Denoising diffusion probabilistic models (DDPMs) have achieved unprecedented success in computer vision. However, they remain underutilized in medical imaging, a field crucial for disease diagnosis and treatment planning. This is primarily due to the high computational cost associated with (1) the use of large number of time steps (e.g., 1,000) in diffusion processes and (2) the increased dimensionality of medical images, which are often 3D or 4D. Training a diffusion model on medical images typically takes days to weeks, while sampling each image volume takes minutes to hours. To address this challenge, we introduce Fast-DDPM, a simple yet effective approach capable of improving training speed, sampling speed, and generation quality simultaneously. Unlike DDPM, which trains the image denoiser across 1,000 time steps, Fast-DDPM trains and samples using only 10 time steps. The key to our method lies in aligning the training and sampling procedures to optimize time-step utilization. Specifically, we introduced two efficient noise schedulers with 10 time steps: one with uniform time step sampling and another with non-uniform sampling. We evaluated Fast-DDPM across three medical image-to-image generation tasks: multi-image super-resolution, image denoising, and image-to-image translation. Fast-DDPM outperformed DDPM and current state-of-the-art methods based on convolutional networks and generative adversarial networks in all tasks. Additionally, Fast-DDPM reduced the training time to 0.2x and the sampling time to 0.01x compared to DDPM. Our code is publicly available at: https://github.com/mirthAI/Fast-DDPM.

Yu Xin, Gorkem Can Ates, Kuang Gong et al.

Vision-language models (VLMs) have shown promise in 2D medical image analysis, but extending them to 3D remains challenging due to the high computational demands of volumetric data and the difficulty of aligning 3D spatial features with clinical text. We present Med3DVLM, a 3D VLM designed to address these challenges through three key innovations: (1) DCFormer, an efficient encoder that uses decomposed 3D convolutions to capture fine-grained spatial features at scale; (2) SigLIP, a contrastive learning strategy with pairwise sigmoid loss that improves image-text alignment without relying on large negative batches; and (3) a dual-stream MLP-Mixer projector that fuses low- and high-level image features with text embeddings for richer multi-modal representations. We evaluate our model on the M3D dataset, which includes radiology reports and VQA data for 120,084 3D medical images. Results show that Med3DVLM achieves superior performance across multiple benchmarks. For image-text retrieval, it reaches 61.00% R@1 on 2,000 samples, significantly outperforming the current state-of-the-art M3D model (19.10%). For report generation, it achieves a METEOR score of 36.42% (vs. 14.38%). In open-ended visual question answering (VQA), it scores 36.76% METEOR (vs. 33.58%), and in closed-ended VQA, it achieves 79.95% accuracy (vs. 75.78%). These results highlight Med3DVLM's ability to bridge the gap between 3D imaging and language, enabling scalable, multi-task reasoning across clinical applications. Our code is publicly available at https://github.com/mirthAI/Med3DVLM.

Gorkem Can Ates, Yu Xin, Kuang Gong et al.

Vision-language models (VLMs) have been widely applied to 2D medical image analysis due to their ability to align visual and textual representations. However, extending VLMs to 3D imaging remains computationally challenging. Existing 3D VLMs often rely on Vision Transformers (ViTs), which are computationally expensive due to the quadratic complexity of self-attention, or on 3D convolutions, which require large numbers of parameters and FLOPs as kernel size increases. We introduce DCFormer, an efficient 3D image encoder that factorizes 3D convolutions into three parallel 1D convolutions along the depth, height, and width dimensions. This design preserves spatial information while significantly reducing computational cost. Integrated into a CLIP-based vision-language framework, DCFormer is trained and evaluated on CT-RATE, a dataset of 50,188 paired 3D chest CT volumes and radiology reports. In zero-shot and fine-tuned detection of 18 pathologies, as well as in image-text retrieval tasks, DCFormer consistently outperforms state-of-the-art 3D vision encoders, including CT-ViT, ViT, ConvNeXt, PoolFormer, and TransUNet. These results highlight DCFormer's potential for scalable, clinically deployable 3D medical VLMs. Our code is available at: https://github.com/mirthAI/DCFormer.

Jiong Wu, Kuang Gong

Deformable image registration plays an essential role in various medical image tasks. Existing deep learning-based deformable registration frameworks primarily utilize convolutional neural networks (CNNs) or Transformers to learn features to predict the deformations. However, the lack of semantic information in the learned features limits the registration performance. Furthermore, the similarity metric of the loss function is often evaluated only in the pixel space, which ignores the matching of high-level anatomical features and can lead to deformation folding. To address these issues, in this work, we proposed LDM-Morph, an unsupervised deformable registration algorithm for medical image registration. LDM-Morph integrated features extracted from the latent diffusion model (LDM) to enrich the semantic information. Additionally, a latent and global feature-based cross-attention module (LGCA) was designed to enhance the interaction of semantic information from LDM and global information from multi-head self-attention operations. Finally, a hierarchical metric was proposed to evaluate the similarity of image pairs in both the original pixel space and latent-feature space, enhancing topology preservation while improving registration accuracy. Extensive experiments on four public 2D cardiac image datasets show that the proposed LDM-Morph framework outperformed existing state-of-the-art CNNs- and Transformers-based registration methods regarding accuracy and topology preservation with comparable computational efficiency. Our code is publicly available at https://github.com/wujiong-hub/LDM-Morph.

Ziqian Huang, Boxiao Yu, Siqi Li et al.

Dynamic PET enables the quantitative estimation of physiology-related parameters and is widely utilized in research and increasingly adopted in clinical settings. Parametric imaging in dynamic PET requires kinetic modeling to estimate voxel-wise physiological parameters based on specific kinetic models. However, parametric images estimated through kinetic model fitting often suffer from low image quality due to the inherently ill-posed nature of the fitting process and the limited counts resulting from non-continuous data acquisition across multiple bed positions in whole-body PET. In this work, we proposed a diffusion model-based kinetic modeling framework for parametric image estimation, using the Patlak model as an example. The score function of the diffusion model was pre-trained on static total-body PET images and served as a prior for both Patlak slope and intercept images by leveraging their patch-wise similarity. During inference, the kinetic model was incorporated as a data-consistency constraint to guide the parametric image estimation. The proposed framework was evaluated on total-body dynamic PET datasets with different dose levels, demonstrating the feasibility and promising performance of the proposed framework in improving parametric image quality.

Yang Xing, Jiong Wu, Yuheng Bu et al.

Although new vision foundation models such as Segment Anything Model 2 (SAM2) have significantly enhanced zero-shot image segmentation capabilities, reliance on human-provided prompts poses significant challenges in adapting SAM2 to medical image segmentation tasks. Moreover, SAM2's performance in medical image segmentation was limited by the domain shift issue, since it was originally trained on natural images and videos. To address these challenges, we proposed SAM2 with support-set guided prompting (SAM2-SGP), a framework that eliminated the need for manual prompts. The proposed model leveraged the memory mechanism of SAM2 to generate pseudo-masks using image-mask pairs from a support set via a Pseudo-mask Generation (PMG) module. We further introduced a novel Pseudo-mask Attention (PMA) module, which used these pseudo-masks to automatically generate bounding boxes and enhance localized feature extraction by guiding attention to relevant areas. Furthermore, a low-rank adaptation (LoRA) strategy was adopted to mitigate the domain shift issue. The proposed framework was evaluated on both 2D and 3D datasets across multiple medical imaging modalities, including fundus photography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. The results demonstrated a significant performance improvement over state-of-the-art models, such as nnUNet and SwinUNet, as well as foundation models, such as SAM2 and MedSAM2, underscoring the effectiveness of the proposed approach. Our code is publicly available at https://github.com/astlian9/SAM_Support.

Teng Zhang, Hongxu Jiang, Kuang Gong et al.

Diffusion models generate data by learning to reverse a forward process, where samples are progressively perturbed with Gaussian noise according to a predefined noise schedule. From a geometric perspective, each noise schedule corresponds to a unique trajectory in probability space from the data distribution to a Gaussian prior. However, prior diffusion models rely on empirically chosen schedules that may not be optimal. This inefficiency necessitates many intermediate time steps, resulting in high computational costs during both training and sampling. To address this, we derive a family of geodesic noise schedules corresponding to the shortest paths in probability space under the Fisher-Rao metric. Based on these schedules, we propose Geodesic Diffusion Models (GDMs), which significantly improve training and sampling efficiency by minimizing the energy required to transform between probability distributions. This efficiency further enables sampling to start from an intermediate distribution in conditional image generation, achieving state-of-the-art results with as few as 6 steps. We evaluated GDM on two medical image enhancement tasks: CT image denoising and MRI image super-resolution. Experimental results show that GDM achieved state-of-the-art performance while reducing training time by 20- to 30-fold compared to Denoising Diffusion Probabilistic Models (DDPMs) and 4- to 6-fold compared to Fast-DDPM, and accelerating sampling by 160- to 170-fold and 1.6-fold, respectively. These gains support the use of GDM for efficient model development and real-time clinical applications. Our code is publicly available at: https://github.com/mirthAI/GDM-VE.

Seowung Leem, Lin Gu, Chenyu You et al.

The retina provides a unique, noninvasive window into Alzheimer's disease (AD) and dementia, capturing early structural changes through morphometric features, while systemic and lifestyle risk factors reflect well-established contributors to disease susceptibility long before clinical symptom onset. However, current retinal analysis frameworks typically model imaging and risk factors separately, limiting their ability to capture joint multimodal patterns critical for early risk prediction. Moreover, existing methods rarely incorporate mechanisms to organize or align patients with similar retinal and clinical characteristics, constraining the learning of coherent cross-modal associations. To address these limitations, we introduce REVEAL (REtinal-risk Vision-Language Early Alzheimer's Learning), a framework that aligns color fundus photographs with individualized disease-specific risk profiles for predicting incident AD and dementia, on average 8 years before diagnosis (range: 1-11 years). Because real-world risk factors are structured questionnaire data, we translate them into clinically interpretable narratives compatible with pretrained vision-language models (VLMs). We further propose a group-aware contrastive learning (GACL) strategy that clusters patients with similar retinal morphometry and risk factors as positive pairs, strengthening multimodal alignment. This unified representation learning framework substantially outperforms state-of-the-art retinal imaging models paired with clinical text encoders, as well as general-purpose VLMs, demonstrating the value of jointly modeling retinal biomarkers and clinical risk factors. By providing a generalizable and noninvasive approach for early AD and dementia risk stratification, REVEAL has the potential to enable earlier intervention and improve preventive care at the population level.

Jiong Wu, Yang Xing, Boxiao Yu et al.

Most publicly available medical segmentation datasets are only partially labeled, with annotations provided for a subset of anatomical structures. When multiple datasets are combined for training, this incomplete annotation poses challenges, as it limits the model's ability to learn shared anatomical representations among datasets. Furthermore, vision-only frameworks often fail to capture complex anatomical relationships and task-specific distinctions, leading to reduced segmentation accuracy and poor generalizability to unseen datasets. In this study, we proposed a novel CLIP-DINO Prompt-Driven Segmentation Network (CDPDNet), which combined a self-supervised vision transformer with CLIP-based text embedding and introduced task-specific text prompts to tackle these challenges. Specifically, the framework was constructed upon a convolutional neural network (CNN) and incorporated DINOv2 to extract both fine-grained and global visual features, which were then fused using a multi-head cross-attention module to overcome the limited long-range modeling capability of CNNs. In addition, CLIP-derived text embeddings were projected into the visual space to help model complex relationships among organs and tumors. To further address the partial label challenge and enhance inter-task discriminative capability, a Text-based Task Prompt Generation (TTPG) module that generated task-specific prompts was designed to guide the segmentation. Extensive experiments on multiple medical imaging datasets demonstrated that CDPDNet consistently outperformed existing state-of-the-art segmentation methods. Code and pretrained model are available at: https://github.com/wujiong-hub/CDPDNet.git.

Yafei Dong, Kuang Gong

Head and neck (H&N) cancers are among the most prevalent types of cancer worldwide, and [18F]F-FDG PET/CT is widely used for H&N cancer management. Recently, the diffusion model has demonstrated remarkable performance in various image-generation tasks. In this work, we proposed a 3D diffusion model to accurately perform H&N tumor segmentation from 3D PET and CT volumes. The 3D diffusion model was developed considering the 3D nature of PET and CT images acquired. During the reverse process, the model utilized a 3D UNet structure and took the concatenation of PET, CT, and Gaussian noise volumes as the network input to generate the tumor mask. Experiments based on the HECKTOR challenge dataset were conducted to evaluate the effectiveness of the proposed diffusion model. Several state-of-the-art techniques based on U-Net and Transformer structures were adopted as the reference methods. Benefits of employing both PET and CT as the network input as well as further extending the diffusion model from 2D to 3D were investigated based on various quantitative metrics and the uncertainty maps generated. Results showed that the proposed 3D diffusion model could generate more accurate segmentation results compared with other methods. Compared to the diffusion model in 2D format, the proposed 3D model yielded superior results. Our experiments also highlighted the advantage of utilizing dual-modality PET and CT data over only single-modality data for H&N tumor segmentation.

Boxiao Yu, Kuang Gong

Positron Emission Tomography (PET) is a vital imaging modality widely used in clinical diagnosis and preclinical research but faces limitations in image resolution and signal-to-noise ratio due to inherent physical degradation factors. Current deep learning-based denoising methods face challenges in adapting to the variability of clinical settings, influenced by factors such as scanner types, tracer choices, dose levels, and acquisition times. In this work, we proposed a novel 3D ControlNet-based denoising method for whole-body PET imaging. We first pre-trained a 3D Denoising Diffusion Probabilistic Model (DDPM) using a large dataset of high-quality normal-dose PET images. Following this, we fine-tuned the model on a smaller set of paired low- and normal-dose PET images, integrating low-dose inputs through a 3D ControlNet architecture, thereby making the model adaptable to denoising tasks in diverse clinical settings. Experimental results based on clinical PET datasets show that the proposed framework outperformed other state-of-the-art PET image denoising methods both in visual quality and quantitative metrics. This plug-and-play approach allows large diffusion models to be fine-tuned and adapted to PET images from diverse acquisition protocols.

Fumio Hashimoto, Kuang Gong

Diffusion models have shown great promise in medical image denoising and reconstruction, but their application to Positron Emission Tomography (PET) imaging remains limited by tracer-specific contrast variability and high computational demands. In this work, we proposed an anatomical prior-guided PET image reconstruction method based on diffusion models, inspired by the deep diffusion image prior (DDIP) framework. The proposed method alternated between diffusion sampling and model fine-tuning guided by the PET sinogram, enabling the reconstruction of high-quality images from various PET tracers using a score function pretrained on a dataset of another tracer. To improve computational efficiency, the half-quadratic splitting (HQS) algorithm was adopted to decouple network optimization from iterative PET reconstruction. The proposed method was evaluated using one simulation and two clinical datasets. For the simulation study, a model pretrained on [$^{18}$F]FDG data was tested on amyloid-negative PET data to assess out-of-distribution (OOD) performance. For the clinical-data validation, ten low-dose [$^{18}$F]FDG datasets and one [$^{18}$F]Florbetapir dataset were tested on a model pretrained on data from another tracer. Experiment results show that the proposed PET reconstruction method can generalize robustly across tracer distributions and scanner types, providing an efficient and versatile reconstruction framework for low-dose PET imaging.

Yang Xing, Jiong Wu, Savas Ozdemir et al.

Recent progress in medical vision-language models (VLMs) has achieved strong performance on image-level text-centric tasks such as report generation and visual question answering (VQA). However, achieving fine-grained visual grounding and volumetric spatial reasoning in 3D medical VLMs remains challenging, particularly when aiming to unify these capabilities within a single, generalizable framework. To address this challenge, we proposed MedVL-SAM2, a unified 3D medical multimodal model that concurrently supports report generation, VQA, and multi-paradigm segmentation, including semantic, referring, and interactive segmentation. MedVL-SAM2 integrates image-level reasoning and pixel-level perception through a cohesive architecture tailored for 3D medical imaging, and incorporates a SAM2-based volumetric segmentation module to enable precise multi-granular spatial reasoning. The model is trained in a multi-stage pipeline: it is first pre-trained on a large-scale corpus of 3D CT image-text pairs to align volumetric visual features with radiology-language embeddings. It is then jointly optimized with both language-understanding and segmentation objectives using a comprehensive 3D CT segmentation dataset. This joint training enables flexible interaction via language, point, or box prompts, thereby unifying high-level visual reasoning with spatially precise localization. Our unified architecture delivers state-of-the-art performance across report generation, VQA, and multiple 3D segmentation tasks. Extensive analyses further show that the model provides reliable 3D visual grounding, controllable interactive segmentation, and robust cross-modal reasoning, demonstrating that high-level semantic reasoning and precise 3D localization can be jointly achieved within a unified 3D medical VLM.

Yuxin Gong, Se-in Jang, Wei Shao et al.

Accurate quantification of tau pathology via tau positron emission tomography (PET) scan is crucial for diagnosing and monitoring Alzheimer's disease (AD). However, the high cost and limited availability of tau PET restrict its widespread use. In contrast, structural magnetic resonance imaging (MRI) and plasma-based biomarkers provide non-invasive and widely available complementary information related to brain anatomy and disease progression. In this work, we propose a text-guided 3D diffusion model for 3D tau PET image synthesis, leveraging multimodal conditions from both structural MRI and plasma measurement. Specifically, the textual prompt is from the plasma p-tau217 measurement, which is a key indicator of AD progression, while MRI provides anatomical structure constraints. The proposed framework is trained and evaluated using clinical AV1451 tau PET data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Experimental results demonstrate that our approach can generate realistic, clinically meaningful 3D tau PET across a range of disease stages. The proposed framework can help perform tau PET data augmentation under different settings, provide a non-invasive, cost-effective alternative for visualizing tau pathology, and support the simulation of disease progression under varying plasma biomarker levels and cognitive conditions.

Siqi Li, Kuang Gong, Ramsey D. Badawi et al.

Image reconstruction of low-count positron emission tomography (PET) data is challenging. Kernel methods address the challenge by incorporating image prior information in the forward model of iterative PET image reconstruction. The kernelized expectation-maximization (KEM) algorithm has been developed and demonstrated to be effective and easy to implement. A common approach for a further improvement of the kernel method would be adding an explicit regularization, which however leads to a complex optimization problem. In this paper, we propose an implicit regularization for the kernel method by using a deep coefficient prior, which represents the kernel coefficient image in the PET forward model using a convolutional neural-network. To solve the maximum-likelihood neural network-based reconstruction problem, we apply the principle of optimization transfer to derive a neural KEM algorithm. Each iteration of the algorithm consists of two separate steps: a KEM step for image update from the projection data and a deep-learning step in the image domain for updating the kernel coefficient image using the neural network. This optimization algorithm is guaranteed to monotonically increase the data likelihood. The results from computer simulations and real patient data have demonstrated that the neural KEM can outperform existing KEM and deep image prior methods.

Kuang Gong, Ciprian Catana, Jinyi Qi et al.

Direct reconstruction methods have been developed to estimate parametric images directly from the measured PET sinograms by combining the PET imaging model and tracer kinetics in an integrated framework. Due to limited counts received, signal-to-noise-ratio (SNR) and resolution of parametric images produced by direct reconstruction frameworks are still limited. Recently supervised deep learning methods have been successfully applied to medical imaging denoising/reconstruction when large number of high-quality training labels are available. For static PET imaging, high-quality training labels can be acquired by extending the scanning time. However, this is not feasible for dynamic PET imaging, where the scanning time is already long enough. In this work, we proposed an unsupervised deep learning framework for direct parametric reconstruction from dynamic PET, which was tested on the Patlak model and the relative equilibrium Logan model. The patient's anatomical prior image, which is readily available from PET/CT or PET/MR scans, was supplied as the network input to provide a manifold constraint, and also utilized to construct a kernel layer to perform non-local feature denoising. The linear kinetic model was embedded in the network structure as a 1x1 convolution layer. The training objective function was based on the PET statistical model. Evaluations based on dynamic datasets of 18F-FDG and 11C-PiB tracers show that the proposed framework can outperform the traditional and the kernel method-based direct reconstruction methods.

Jianan Cui, Kuang Gong, Paul Han et al.

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is a powerful imaging technology that can measure cerebral blood flow (CBF) quantitatively. However, since only a small portion of blood is labeled compared to the whole tissue volume, conventional ASL suffers from low signal-to-noise ratio (SNR), poor spatial resolution, and long acquisition time. In this paper, we proposed a super-resolution method based on a multi-scale generative adversarial network (GAN) through unsupervised training. The network only needs the low-resolution (LR) ASL image itself for training and the T1-weighted image as the anatomical prior. No training pairs or pre-training are needed. A low-pass filter guided item was added as an additional loss to suppress the noise interference from the LR ASL image. After the network was trained, the super-resolution (SR) image was generated by supplying the upsampled LR ASL image and corresponding T1-weighted image to the generator of the last layer. Performance of the proposed method was evaluated by comparing the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) using normal-resolution (NR) ASL image (5.5 min acquisition) and high-resolution (HR) ASL image (44 min acquisition) as the ground truth. Compared to the nearest, linear, and spline interpolation methods, the proposed method recovers more detailed structure information, reduces the image noise visually, and achieves the highest PSNR and SSIM when using HR ASL image as the ground-truth.

Nuobei Xie, Kuang Gong, Ning Guo et al.

Patlak model is widely used in 18F-FDG dynamic positron emission tomography (PET) imaging, where the estimated parametric images reveal important biochemical and physiology information. Because of better noise modeling and more information extracted from raw sinogram, direct Patlak reconstruction gains its popularity over the indirect approach which utilizes reconstructed dynamic PET images alone. As the prerequisite of direct Patlak methods, raw data from dynamic PET are rarely stored in clinics and difficult to obtain. In addition, the direct reconstruction is time-consuming due to the bottleneck of multiple-frame reconstruction. All of these impede the clinical adoption of direct Patlak reconstruction.In this work, we proposed a data-driven framework which maps the dynamic PET images to the high-quality motion-corrected direct Patlak images through a convolutional neural network. For the patient motion during the long period of dynamic PET scan, we combined the correction with the backward/forward projection in direct reconstruction to better fit the statistical model. Results based on fifteen clinical 18F-FDG dynamic brain PET datasets demonstrates the superiority of the proposed framework over Gaussian, nonlocal mean and BM4D denoising, regarding the image bias and contrast-to-noise ratio.

Nuobei Xie, Kuang Gong, Ning Guo et al.

Positron emission tomography (PET) is widely used for clinical diagnosis. As PET suffers from low resolution and high noise, numerous efforts try to incorporate anatomical priors into PET image reconstruction, especially with the development of hybrid PET/CT and PET/MRI systems. In this work, we proposed a novel 3D structural convolutional sparse coding (CSC) concept for penalized-likelihood PET image reconstruction, named 3D PET-CSC. The proposed 3D PET-CSC takes advantage of the convolutional operation and manages to incorporate anatomical priors without the need of registration or supervised training. As 3D PET-CSC codes the whole 3D PET image, instead of patches, it alleviates the staircase artifacts commonly presented in traditional patch-based sparse coding methods. Moreover, we developed the residual-image and order-subset mechanisms to further reduce the computational cost and accelerate the convergence for the proposed 3D PET-CSC method. Experiments based on computer simulations and clinical datasets demonstrate the superiority of 3D PET-CSC compared with other reference methods.

Dufan Wu, Kuang Gong, Kyungsang Kim et al.

Deep neural networks have been proved efficient for medical image denoising. Current training methods require both noisy and clean images. However, clean images cannot be acquired for many practical medical applications due to naturally noisy signal, such as dynamic imaging, spectral computed tomography, arterial spin labeling magnetic resonance imaging, etc. In this paper we proposed a training method which learned denoising neural networks from noisy training samples only. Training data in the acquisition domain was split to two subsets and the network was trained to map one noisy set to the other. A consensus loss function was further proposed to efficiently combine the outputs from both subsets. A mathematical proof was provided that the proposed training scheme was equivalent to training with noisy and clean samples when the noise in the two subsets was uncorrelated and zero-mean. The method was validated on Low-dose CT Challenge dataset and NYU MRI dataset and achieved improved performance compared to existing unsupervised methods.

Kuang Gong, Kyungsang Kim, Jianan Cui et al.

Recently deep neural networks have been widely and successfully applied in computer vision tasks and attracted growing interests in medical imaging. One barrier for the application of deep neural networks to medical imaging is the need of large amounts of prior training pairs, which is not always feasible in clinical practice. In this work we propose a personalized representation learning framework where no prior training pairs are needed, but only the patient's own prior images. The representation is expressed using a deep neural network with the patient's prior images as network input. We then applied this novel image representation to inverse problems in medical imaging in which the original inverse problem was formulated as a constraint optimization problem and solved using the alternating direction method of multipliers (ADMM) algorithm. Anatomically guided brain positron emission tomography (PET) image reconstruction and image denoising were employed as examples to demonstrate the effectiveness of the proposed framework. Quantification results based on simulation and real datasets show that the proposed personalized representation framework outperform other widely adopted methods.

Kuang Gong, Jaewon Yang, Kyungsang Kim et al.

Positron Emission Tomography (PET) is a functional imaging modality widely used in neuroscience studies. To obtain meaningful quantitative results from PET images, attenuation correction is necessary during image reconstruction. For PET/MR hybrid systems, PET attenuation is challenging as Magnetic Resonance (MR) images do not reflect attenuation coefficients directly. To address this issue, we present deep neural network methods to derive the continuous attenuation coefficients for brain PET imaging from MR images. With only Dixon MR images as the network input, the existing U-net structure was adopted and analysis using forty patient data sets shows it is superior than other Dixon based methods. When both Dixon and zero echo time (ZTE) images are available, we have proposed a modified U-net structure, named GroupU-net, to efficiently make use of both Dixon and ZTE information through group convolution modules when the network goes deeper. Quantitative analysis based on fourteen real patient data sets demonstrates that both network approaches can perform better than the standard methods, and the proposed network structure can further reduce the PET quantification error compared to the U-net structure.

Kuang Gong, Jiahui Guan, Kyungsang Kim et al.

PET image reconstruction is challenging due to the ill-poseness of the inverse problem and limited number of detected photons. Recently deep neural networks have been widely and successfully used in computer vision tasks and attracted growing interests in medical imaging. In this work, we trained a deep residual convolutional neural network to improve PET image quality by using the existing inter-patient information. An innovative feature of the proposed method is that we embed the neural network in the iterative reconstruction framework for image representation, rather than using it as a post-processing tool. We formulate the objective function as a constraint optimization problem and solve it using the alternating direction method of multipliers (ADMM) algorithm. Both simulation data and hybrid real data are used to evaluate the proposed method. Quantification results show that our proposed iterative neural network method can outperform the neural network denoising and conventional penalized maximum likelihood methods.