Yitian Zhao

Hongrun Zhang, Yanda Meng, Yitian Zhao et al.

Multiple instance learning (MIL) has been increasingly used in the classification of histopathology whole slide images (WSIs). However, MIL approaches for this specific classification problem still face unique challenges, particularly those related to small sample cohorts. In these, there are limited number of WSI slides (bags), while the resolution of a single WSI is huge, which leads to a large number of patches (instances) cropped from this slide. To address this issue, we propose to virtually enlarge the number of bags by introducing the concept of pseudo-bags, on which a double-tier MIL framework is built to effectively use the intrinsic features. Besides, we also contribute to deriving the instance probability under the framework of attention-based MIL, and utilize the derivation to help construct and analyze the proposed framework. The proposed method outperforms other latest methods on the CAMELYON-16 by substantially large margins, and is also better in performance on the TCGA lung cancer dataset. The proposed framework is ready to be extended for wider MIL applications. The code is available at: https://github.com/hrzhang1123/DTFD-MIL

Heng Li, Haofeng Liu, Huazhu Fu et al.

Fundus photography is a routine examination in clinics to diagnose and monitor ocular diseases. However, for cataract patients, the fundus image always suffers quality degradation caused by the clouding lens. The degradation prevents reliable diagnosis by ophthalmologists or computer-aided systems. To improve the certainty in clinical diagnosis, restoration algorithms have been proposed to enhance the quality of fundus images. Unfortunately, challenges remain in the deployment of these algorithms, such as collecting sufficient training data and preserving retinal structures. In this paper, to circumvent the strict deployment requirement, a structure-consistent restoration network (SCR-Net) for cataract fundus images is developed from synthesized data that shares an identical structure. A cataract simulation model is firstly designed to collect synthesized cataract sets (SCS) formed by cataract fundus images sharing identical structures. Then high-frequency components (HFCs) are extracted from the SCS to constrain structure consistency such that the structure preservation in SCR-Net is enforced. The experiments demonstrate the effectiveness of SCR-Net in the comparison with state-of-the-art methods and the follow-up clinical applications. The code is available at https://github.com/liamheng/ArcNet-Medical-Image-Enhancement.

Jinkui Hao, Ting Shen, Xueli Zhu et al.

Automated detection of retinal structures, such as retinal vessels (RV), the foveal avascular zone (FAZ), and retinal vascular junctions (RVJ), are of great importance for understanding diseases of the eye and clinical decision-making. In this paper, we propose a novel Voting-based Adaptive Feature Fusion multi-task network (VAFF-Net) for joint segmentation, detection, and classification of RV, FAZ, and RVJ in optical coherence tomography angiography (OCTA). A task-specific voting gate module is proposed to adaptively extract and fuse different features for specific tasks at two levels: features at different spatial positions from a single encoder, and features from multiple encoders. In particular, since the complexity of the microvasculature in OCTA images makes simultaneous precise localization and classification of retinal vascular junctions into bifurcation/crossing a challenging task, we specifically design a task head by combining the heatmap regression and grid classification. We take advantage of three different \textit{en face} angiograms from various retinal layers, rather than following existing methods that use only a single \textit{en face}. To facilitate further research, part of these datasets with the source code and evaluation benchmark have been released for public access:https://github.com/iMED-Lab/VAFF-Net.

Yanda Meng, Joshua Bridge, Meng Wei et al.

This paper proposes an adaptive auxiliary task learning based approach for object counting problems. Unlike existing auxiliary task learning based methods, we develop an attention-enhanced adaptively shared backbone network to enable both task-shared and task-tailored features learning in an end-to-end manner. The network seamlessly combines standard Convolution Neural Network (CNN) and Graph Convolution Network (GCN) for feature extraction and feature reasoning among different domains of tasks. Our approach gains enriched contextual information by iteratively and hierarchically fusing the features across different task branches of the adaptive CNN backbone. The whole framework pays special attention to the objects' spatial locations and varied density levels, informed by object (or crowd) segmentation and density level segmentation auxiliary tasks. In particular, thanks to the proposed dilated contrastive density loss function, our network benefits from individual and regional context supervision in terms of pixel-independent and pixel-dependent feature learning mechanisms, along with strengthened robustness. Experiments on seven challenging multi-domain datasets demonstrate that our method achieves superior performance to the state-of-the-art auxiliary task learning based counting methods. Our code is made publicly available at: https://github.com/smallmax00/Counting_With_Adaptive_Auxiliary

Heng Li, Haofeng Liu, Yan Hu et al.

Cataracts are the leading cause of vision loss worldwide. Restoration algorithms are developed to improve the readability of cataract fundus images in order to increase the certainty in diagnosis and treatment for cataract patients. Unfortunately, the requirement of annotation limits the application of these algorithms in clinics. This paper proposes a network to annotation-freely restore cataractous fundus images (ArcNet) so as to boost the clinical practicability of restoration. Annotations are unnecessary in ArcNet, where the high-frequency component is extracted from fundus images to replace segmentation in the preservation of retinal structures. The restoration model is learned from the synthesized images and adapted to real cataract images. Extensive experiments are implemented to verify the performance and effectiveness of ArcNet. Favorable performance is achieved using ArcNet against state-of-the-art algorithms, and the diagnosis of ocular fundus diseases in cataract patients is promoted by ArcNet. The capability of properly restoring cataractous images in the absence of annotated data promises the proposed algorithm outstanding clinical practicability.

Feixiang Zhou, Jianyang Xie, Zhuangzhi Gao et al.

The missing-modality problem poses a significant challenge in image-tabular multimodal learning across a wide range of multimedia applications, including product understanding, recommendation systems, and medical diagnosis. This challenge is particularly pronounced when the two modalities are highly heterogeneous, as images and tabular attributes differ substantially in their semantic granularity and data distributions. Existing methods learn modality-invariant representations through disentanglement and alignment over global token-averaged features, capturing only coarse cross-modal consistency and overlooking fine-grained semantic and distributional misalignment, which hampers the exploitation of complementary cues under missing modalities. To address this, we propose DFPL, a novel framework for fine-grained prototype learning. Specifically, Shared-Specific Prototype Modeling (SSPM) extracts compact and diverse shared and modality-specific prototypes, and further performs prototype-level disentanglement to suppress redundant intra-modality correlations. Additionally, we propose a Prototype-guided Fine-grained Alignment (PFA) module that jointly enforces prototype-level distribution matching and prototype-to-class semantic alignment within a unified prototype space, thereby preserving both fine-grained distributional and semantic consistency across modalities. We further introduce a Class-aware Multi-scale Aggregation (CMA) module to adaptively aggregate shared semantics and modality-specific characteristics from global and prototype levels for robust predictions. Extensive experiments on three diverse image-tabular benchmarks demonstrate the superiority of our method compared to the previous approaches under various missing-modality settings. Code will be made publicly available.

Qinkai Yu, Jianyang Xie, Anh Nguyen et al.

Diabetic retinopathy (DR) is a complication of diabetes and usually takes decades to reach sight-threatening levels. Accurate and robust detection of DR severity is critical for the timely management and treatment of diabetes. However, most current DR grading methods suffer from insufficient robustness to data variability (\textit{e.g.} colour fundus images), posing a significant difficulty for accurate and robust grading. In this work, we propose a novel DR grading framework CLIP-DR based on three observations: 1) Recent pre-trained visual language models, such as CLIP, showcase a notable capacity for generalisation across various downstream tasks, serving as effective baseline models. 2) The grading of image-text pairs for DR often adheres to a discernible natural sequence, yet most existing DR grading methods have primarily overlooked this aspect. 3) A long-tailed distribution among DR severity levels complicates the grading process. This work proposes a novel ranking-aware prompting strategy to help the CLIP model exploit the ordinal information. Specifically, we sequentially design learnable prompts between neighbouring text-image pairs in two different ranking directions. Additionally, we introduce a Similarity Matrix Smooth module into the structure of CLIP to balance the class distribution. Finally, we perform extensive comparisons with several state-of-the-art methods on the GDRBench benchmark, demonstrating our CLIP-DR's robustness and superior performance. The implementation code is available \footnote{\url{https://github.com/Qinkaiyu/CLIP-DR}

Qinkai Yu, Chong Zhang, Gaojie Jin et al.

Annotating medical data for training AI models is often costly and limited due to the shortage of specialists with relevant clinical expertise. This challenge is further compounded by privacy and ethical concerns associated with sensitive patient information. As a result, well-trained medical segmentation models on private datasets constitute valuable intellectual property requiring robust protection mechanisms. Existing model protection techniques primarily focus on classification and generative tasks, while segmentation models-crucial to medical image analysis-remain largely underexplored. In this paper, we propose a novel, stealthy, and harmless method, StealthMark, for verifying the ownership of medical segmentation models under black-box conditions. Our approach subtly modulates model uncertainty without altering the final segmentation outputs, thereby preserving the model's performance. To enable ownership verification, we incorporate model-agnostic explanation methods, e.g. LIME, to extract feature attributions from the model outputs. Under specific triggering conditions, these explanations reveal a distinct and verifiable watermark. We further design the watermark as a QR code to facilitate robust and recognizable ownership claims. We conducted extensive experiments across four medical imaging datasets and five mainstream segmentation models. The results demonstrate the effectiveness, stealthiness, and harmlessness of our method on the original model's segmentation performance. For example, when applied to the SAM model, StealthMark consistently achieved ASR above 95% across various datasets while maintaining less than a 1% drop in Dice and AUC scores, significantly outperforming backdoor-based watermarking methods and highlighting its strong potential for practical deployment. Our implementation code is made available at: https://github.com/Qinkaiyu/StealthMark.

Amrest Chinkamol, Vetit Kanjaras, Phattarapong Sawangjai et al.

While there have been increased researches using deep learning techniques for the extraction of vascular structure from the 2D en face OCTA, for such approach, it is known that the data annotation process on the curvilinear structure like the retinal vasculature is very costly and time consuming, albeit few tried to address the annotation problem. In this work, we propose the application of the scribble-base weakly-supervised learning method to automate the pixel-level annotation. The proposed method, called OCTAve, combines the weakly-supervised learning using scribble-annotated ground truth augmented with an adversarial and a novel self-supervised deep supervision. Our novel mechanism is designed to utilize the discriminative outputs from the discrimination layer of a UNet-like architecture where the Kullback-Liebler Divergence between the aggregate discriminative outputs and the segmentation map predicate is minimized during the training. This combined method leads to the better localization of the vascular structure as shown in our experiments. We validate our proposed method on the large public datasets i.e., ROSE, OCTA-500. The segmentation performance is compared against both state-of-the-art fully-supervised and scribble-based weakly-supervised approaches. The implementation of our work used in the experiments is located at [LINK].

Huaying Hao, Cong Xu, Dan Zhang et al.

Retinal Optical Coherence Tomography Angiography (OCTA) with high-resolution is important for the quantification and analysis of retinal vasculature. However, the resolution of OCTA images is inversely proportional to the field of view at the same sampling frequency, which is not conducive to clinicians for analyzing larger vascular areas. In this paper, we propose a novel Sparse-based domain Adaptation Super-Resolution network (SASR) for the reconstruction of realistic 6x6 mm2/low-resolution (LR) OCTA images to high-resolution (HR) representations. To be more specific, we first perform a simple degradation of the 3x3 mm2/high-resolution (HR) image to obtain the synthetic LR image. An efficient registration method is then employed to register the synthetic LR with its corresponding 3x3 mm2 image region within the 6x6 mm2 image to obtain the cropped realistic LR image. We then propose a multi-level super-resolution model for the fully-supervised reconstruction of the synthetic data, guiding the reconstruction of the realistic LR images through a generative-adversarial strategy that allows the synthetic and realistic LR images to be unified in the feature domain. Finally, a novel sparse edge-aware loss is designed to dynamically optimize the vessel edge structure. Extensive experiments on two OCTA sets have shown that our method performs better than state-of-the-art super-resolution reconstruction methods. In addition, we have investigated the performance of the reconstruction results on retina structure segmentations, which further validate the effectiveness of our approach.

Yanda Meng, Xu Chen, Dongxu Gao et al.

In this paper, we propose a novel multi-level aggregation network to regress the coordinates of the vertices of a 3D face from a single 2D image in an end-to-end manner. This is achieved by seamlessly combining standard convolutional neural networks (CNNs) with Graph Convolution Networks (GCNs). By iteratively and hierarchically fusing the features across different layers and stages of the CNNs and GCNs, our approach can provide a dense face alignment and 3D face reconstruction simultaneously for the benefit of direct feature learning of 3D face mesh. Experiments on several challenging datasets demonstrate that our method outperforms state-of-the-art approaches on both 2D and 3D face alignment tasks.

Shouyue Liu, Jinkui Hao, Yanwu Xu et al.

Optical Coherence Tomography Angiography (OCTA) is a promising tool for detecting Alzheimer's disease (AD) by imaging the retinal microvasculature. Ophthalmologists commonly use region-based analysis, such as the ETDRS grid, to study OCTA image biomarkers and understand the correlation with AD. However, existing studies have used general deep computer vision methods, which present challenges in providing interpretable results and leveraging clinical prior knowledge. To address these challenges, we propose a novel deep-learning framework called Polar-Net. Our approach involves mapping OCTA images from Cartesian coordinates to polar coordinates, which allows for the use of approximate sector convolution and enables the implementation of the ETDRS grid-based regional analysis method commonly used in clinical practice. Furthermore, Polar-Net incorporates clinical prior information of each sector region into the training process, which further enhances its performance. Additionally, our framework adapts to acquire the importance of the corresponding retinal region, which helps researchers and clinicians understand the model's decision-making process in detecting AD and assess its conformity to clinical observations. Through evaluations on private and public datasets, we have demonstrated that Polar-Net outperforms existing state-of-the-art methods and provides more valuable pathological evidence for the association between retinal vascular changes and AD. In addition, we also show that the two innovative modules introduced in our framework have a significant impact on improving overall performance.

Chengtai Li, Yuting He, Jianfeng Ren et al.

While visual reasoning for simple analogies has received significant attention, compositional visual relations (CVR) remain relatively unexplored due to their greater complexity. To solve CVR tasks, we propose Predictive Reasoning with Augmented Anomaly Contrastive Learning (PR-A$^2$CL), \ie, to identify an outlier image given three other images that follow the same compositional rules. To address the challenge of modelling abundant compositional rules, an Augmented Anomaly Contrastive Learning is designed to distil discriminative and generalizable features by maximizing similarity among normal instances while minimizing similarity between normal and anomalous outliers. More importantly, a predict-and-verify paradigm is introduced for rule-based reasoning, in which a series of Predictive Anomaly Reasoning Blocks (PARBs) iteratively leverage features from three out of the four images to predict those of the remaining one. Throughout the subsequent verification stage, the PARBs progressively pinpoint the specific discrepancies attributable to the underlying rules. Experimental results on SVRT, CVR and MC$^2$R datasets show that PR-A$^2$CL significantly outperforms state-of-the-art reasoning models.

Shouyue Liu, Ziyi Zhang, Yuanyuan Gu et al.

Early detection of dementia, such as Alzheimer's disease (AD) or mild cognitive impairment (MCI), is essential to enable timely intervention and potential treatment. Accurate detection of AD/MCI is challenging due to the high complexity, cost, and often invasive nature of current diagnostic techniques, which limit their suitability for large-scale population screening. Given the shared embryological origins and physiological characteristics of the retina and brain, retinal imaging is emerging as a potentially rapid and cost-effective alternative for the identification of individuals with or at high risk of AD. In this paper, we present a novel PolarNet+ that uses retinal optical coherence tomography angiography (OCTA) to discriminate early-onset AD (EOAD) and MCI subjects from controls. Our method first maps OCTA images from Cartesian coordinates to polar coordinates, allowing approximate sub-region calculation to implement the clinician-friendly early treatment of diabetic retinopathy study (ETDRS) grid analysis. We then introduce a multi-view module to serialize and analyze the images along three dimensions for comprehensive, clinically useful information extraction. Finally, we abstract the sequence embedding into a graph, transforming the detection task into a general graph classification problem. A regional relationship module is applied after the multi-view module to excavate the relationship between the sub-regions. Such regional relationship analyses validate known eye-brain links and reveal new discriminative patterns.

Yepeng Liu, Zhichao Sun, Baosheng Yu et al.

Many keypoint detection and description methods have been proposed for image matching or registration. While these methods demonstrate promising performance for single-modality image matching, they often struggle with multimodal data because the descriptors trained on single-modality data tend to lack robustness against the non-linear variations present in multimodal data. Extending such methods to multimodal image matching often requires well-aligned multimodal data to learn modality-invariant descriptors. However, acquiring such data is often costly and impractical in many real-world scenarios. To address this challenge, we propose a modality-invariant feature learning network (MIFNet) to compute modality-invariant features for keypoint descriptions in multimodal image matching using only single-modality training data. Specifically, we propose a novel latent feature aggregation module and a cumulative hybrid aggregation module to enhance the base keypoint descriptors trained on single-modality data by leveraging pre-trained features from Stable Diffusion models. %, our approach generates robust and invariant features across diverse and unknown modalities. We validate our method with recent keypoint detection and description methods in three multimodal retinal image datasets (CF-FA, CF-OCT, EMA-OCTA) and two remote sensing datasets (Optical-SAR and Optical-NIR). Extensive experiments demonstrate that the proposed MIFNet is able to learn modality-invariant feature for multimodal image matching without accessing the targeted modality and has good zero-shot generalization ability. The code will be released at https://github.com/lyp-deeplearning/MIFNet.

Qinkai Yu, Wei Zhou, Hantao Liu et al.

As a long-term complication of diabetes, diabetic retinopathy (DR) progresses slowly, potentially taking years to threaten vision. An accurate and robust evaluation of its severity is vital to ensure prompt management and care. Ordinal regression leverages the underlying inherent order between categories to achieve superior performance beyond traditional classification. However, there exist challenges leading to lower DR classification performance: 1) The uneven distribution of DR severity levels, characterized by a long-tailed pattern, adds complexity to the grading process. 2)The ambiguity in defining category boundaries introduces additional challenges, making the classification process more complex and prone to inconsistencies. This work proposes a novel autoregressive ordinal regression method called AOR-DR to address the above challenges by leveraging the clinical knowledge of inherent ordinal information in DR grading dataset settings. Specifically, we decompose the DR grading task into a series of ordered steps by fusing the prediction of the previous steps with extracted image features as conditions for the current prediction step. Additionally, we exploit the diffusion process to facilitate conditional probability modeling, enabling the direct use of continuous global image features for autoregression without relearning contextual information from patch-level features. This ensures the effectiveness of the autoregressive process and leverages the capabilities of pre-trained large-scale foundation models. Extensive experiments were conducted on four large-scale publicly available color fundus datasets, demonstrating our model's effectiveness and superior performance over six recent state-of-the-art ordinal regression methods. The implementation code is available at https://github.com/Qinkaiyu/AOR-DR.

Jianyang Xie, Yitian Zhao, Yanda Meng et al.

Spatial-temporal graph convolutional networks (ST-GCNs) showcase impressive performance in skeleton-based human action recognition (HAR). However, despite the development of numerous models, their recognition performance does not differ significantly after aligning the input settings. With this observation, we hypothesize that ST-GCNs are over-parameterized for HAR, a conjecture subsequently confirmed through experiments employing the lottery ticket hypothesis. Additionally, a novel sparse ST-GCNs generator is proposed, which trains a sparse architecture from a randomly initialized dense network while maintaining comparable performance levels to the dense components. Moreover, we generate multi-level sparsity ST-GCNs by integrating sparse structures at various sparsity levels and demonstrate that the assembled model yields a significant enhancement in HAR performance. Thorough experiments on four datasets, including NTU-RGB+D 60(120), Kinetics-400, and FineGYM, demonstrate that the proposed sparse ST-GCNs can achieve comparable performance to their dense components. Even with 95% fewer parameters, the sparse ST-GCNs exhibit a degradation of <1% in top-1 accuracy. Meanwhile, the multi-level sparsity ST-GCNs, which require only 66% of the parameters of the dense ST-GCNs, demonstrate an improvement of >1% in top-1 accuracy. The code is available at https://github.com/davelailai/Sparse-ST-GCN.

Feixiang Zhou, Zhuangzhi Gao, He Zhao et al.

Accurate segmentation of tubular structures, such as vascular networks, plays a critical role in various medical domains. A remaining significant challenge in this task is structural fragmentation, which can adversely impact downstream applications. Existing methods primarily focus on designing various loss functions to constrain global topological structures. However, they often overlook local discontinuity regions, leading to suboptimal segmentation results. To overcome this limitation, we propose a novel Global-to-Local Connectivity Preservation (GLCP) framework that can simultaneously perceive global and local structural characteristics of tubular networks. Specifically, we propose an Interactive Multi-head Segmentation (IMS) module to jointly learn global segmentation, skeleton maps, and local discontinuity maps, respectively. This enables our model to explicitly target local discontinuity regions while maintaining global topological integrity. In addition, we design a lightweight Dual-Attention-based Refinement (DAR) module to further improve segmentation quality by refining the resulting segmentation maps. Extensive experiments on both 2D and 3D datasets demonstrate that our GLCP achieves superior accuracy and continuity in tubular structure segmentation compared to several state-of-the-art approaches. The source codes will be available at https://github.com/FeixiangZhou/GLCP.

Qinkai Yu, Jianyang Xie, Yitian Zhao et al.

Multimodal ophthalmic imaging-based diagnosis integrates color fundus image with optical coherence tomography (OCT) to provide a comprehensive view of ocular pathologies. However, the uneven global distribution of healthcare resources often results in real-world clinical scenarios encountering incomplete multimodal data, which significantly compromises diagnostic accuracy. Existing commonly used pipelines, such as modality imputation and distillation methods, face notable limitations: 1)Imputation methods struggle with accurately reconstructing key lesion features, since OCT lesions are localized, while fundus images vary in style. 2)distillation methods rely heavily on fully paired multimodal training data. To address these challenges, we propose a novel multimodal alignment and fusion framework capable of robustly handling missing modalities in the task of ophthalmic diagnostics. By considering the distinctive feature characteristics of OCT and fundus images, we emphasize the alignment of semantic features within the same category and explicitly learn soft matching between modalities, allowing the missing modality to utilize existing modality information, achieving robust cross-modal feature alignment under the missing modality. Specifically, we leverage the Optimal Transport for multi-scale modality feature alignment: class-wise alignment through predicted class prototypes and feature-wise alignment via cross-modal shared feature transport. Furthermore, we propose an asymmetric fusion strategy that effectively exploits the distinct characteristics of OCT and fundus modalities. Extensive evaluations on three large ophthalmic multimodal datasets demonstrate our model's superior performance under various modality-incomplete scenarios, achieving Sota performance in both complete modality and inter-modality incompleteness conditions. Code is available at https://github.com/Qinkaiyu/RIMA

Xu Chen, Xiangde Luo, Yitian Zhao et al.

Image segmentation is a fundamental topic in image processing and has been studied for many decades. Deep learning-based supervised segmentation models have achieved state-of-the-art performance but most of them are limited by using pixel-wise loss functions for training without geometrical constraints. Inspired by Euler's Elastica model and recent active contour models introduced into the field of deep learning, we propose a novel active contour with elastica (ACE) loss function incorporating Elastica (curvature and length) and region information as geometrically-natural constraints for the image segmentation tasks. We introduce the mean curvature i.e. the average of all principal curvatures, as a more effective image prior to representing curvature in our ACE loss function. Furthermore, based on the definition of the mean curvature, we propose a fast solution to approximate the ACE loss in three-dimensional (3D) by using Laplace operators for 3D image segmentation. We evaluate our ACE loss function on four 2D and 3D natural and biomedical image datasets. Our results show that the proposed loss function outperforms other mainstream loss functions on different segmentation networks. Our source code is available at https://github.com/HiLab-git/ACELoss.

Meng Wang, Tian Lin, Qingshan Hou et al.

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We introduce GlobeReady, a clinician-friendly AI platform that enables fundus disease diagnosis that operates without retraining, fine-tuning, or the needs for technical expertise. GlobeReady demonstrates high accuracy across imaging modalities: 93.9-98.5% for 11 fundus diseases using color fundus photographs (CPFs) and 87.2-92.7% for 15 fundus diseases using optic coherence tomography (OCT) scans. By leveraging training-free local feature augmentation, GlobeReady platform effectively mitigates domain shifts across centers and populations, achieving accuracies of 88.9-97.4% across five centers on average in China, 86.3-96.9% in Vietnam, and 73.4-91.0% in Singapore, and 90.2-98.9% in the UK. Incorporating a bulit-in confidence-quantifiable diagnostic mechanism further enhances the platform's accuracy to 94.9-99.4% with CFPs and 88.2-96.2% with OCT, while enabling identification of out-of-distribution cases with 86.3% accuracy across 49 common and rare fundus diseases using CFPs, and 90.6% accuracy across 13 diseases using OCT. Clinicians from countries rated GlobeReady highly for usability and clinical relevance (average score 4.6/5). These findings demonstrate GlobeReady's robustness, generalizability and potential to support global ophthalmic care without technical barriers.

Zhuangzhi Gao, Feixiang Zhou, He Zhao et al.

Segmenting curvilinear structures in medical images is essential for analyzing morphological patterns in clinical applications. Integrating topological properties, such as connectivity, improves segmentation accuracy and consistency. However, extracting and embedding such properties - especially from Persistence Diagrams (PD) - is challenging due to their non-differentiability and computational cost. Existing approaches mostly encode topology through handcrafted loss functions, which generalize poorly across tasks. In this paper, we propose PIs-Regressor, a simple yet effective module that learns persistence image (PI) - finite, differentiable representations of topological features - directly from data. Together with Topology SegNet, which fuses these features in both downsampling and upsampling stages, our framework integrates topology into the network architecture itself rather than auxiliary losses. Unlike existing methods that depend heavily on handcrafted loss functions, our approach directly incorporates topological information into the network structure, leading to more robust segmentation. Our design is flexible and can be seamlessly combined with other topology-based methods to further enhance segmentation performance. Experimental results show that integrating topological features enhances model robustness, effectively handling challenges like overexposure and blurring in medical imaging. Our approach on three curvilinear benchmarks demonstrate state-of-the-art performance in both pixel-level accuracy and topological fidelity.

Weicheng Liao, Zan Chen, Jianyang Xie et al.

Ultra-Wide-Field (UWF) retinal imaging has revolutionized retinal diagnostics by providing a comprehensive view of the retina. However, it often suffers from quality-degrading factors such as blurring and uneven illumination, which obscure fine details and mask pathological information. While numerous retinal image enhancement methods have been proposed for other fundus imageries, they often fail to address the unique requirements in UWF, particularly the need to preserve pathological details. In this paper, we propose a novel frequency-aware self-supervised learning method for UWF image enhancement. It incorporates frequency-decoupled image deblurring and Retinex-guided illumination compensation modules. An asymmetric channel integration operation is introduced in the former module, so as to combine global and local views by leveraging high- and low-frequency information, ensuring the preservation of fine and broader structural details. In addition, a color preservation unit is proposed in the latter Retinex-based module, to provide multi-scale spatial and frequency information, enabling accurate illumination estimation and correction. Experimental results demonstrate that the proposed work not only enhances visualization quality but also improves disease diagnosis performance by restoring and correcting fine local details and uneven intensity. To the best of our knowledge, this work is the first attempt for UWF image enhancement, offering a robust and clinically valuable tool for improving retinal disease management.

Tao Chen, Dan Zhang, Da Chen et al.

Choroidal neovascularization (CNV), a primary characteristic of wet age-related macular degeneration (wet AMD), represents a leading cause of blindness worldwide. In clinical practice, optical coherence tomography angiography (OCTA) is commonly used for studying CNV-related pathological changes, due to its micron-level resolution and non-invasive nature. Thus, accurate segmentation of CNV regions and vessels in OCTA images is crucial for clinical assessment of wet AMD. However, challenges existed due to irregular CNV shapes and imaging limitations like projection artifacts, noises and boundary blurring. Moreover, the lack of publicly available datasets constraints the CNV analysis. To address these challenges, this paper constructs the first publicly accessible CNV dataset (CNVSeg), and proposes a novel multilateral graph convolutional interaction-enhanced CNV segmentation network (MTG-Net). This network integrates both region and vessel morphological information, exploring semantic and geometric duality constraints within the graph domain. Specifically, MTG-Net consists of a multi-task framework and two graph-based cross-task modules: Multilateral Interaction Graph Reasoning (MIGR) and Multilateral Reinforcement Graph Reasoning (MRGR). The multi-task framework encodes rich geometric features of lesion shapes and surfaces, decoupling the image into three task-specific feature maps. MIGR and MRGR iteratively reason about higher-order relationships across tasks through a graph mechanism, enabling complementary optimization for task-specific objectives. Additionally, an uncertainty-weighted loss is proposed to mitigate the impact of artifacts and noise on segmentation accuracy. Experimental results demonstrate that MTG-Net outperforms existing methods, achieving a Dice socre of 87.21\% for region segmentation and 88.12\% for vessel segmentation.

Jiong Zhang, Qihang Xie, Lei Mou et al.

Cerebrovascular diseases (CVDs) remain a leading cause of global disability and mortality. Digital Subtraction Angiography (DSA) sequences, recognized as the gold standard for diagnosing CVDs, can clearly visualize the dynamic flow and reveal pathological conditions within the cerebrovasculature. Therefore, precise segmentation of cerebral arteries (CAs) and classification between their main trunks and branches are crucial for physicians to accurately quantify diseases. However, achieving accurate CA segmentation in DSA sequences remains a challenging task due to small vessels with low contrast, and ambiguity between vessels and residual skull structures. Moreover, the lack of publicly available datasets limits exploration in the field. In this paper, we introduce a DSA Sequence-based Cerebral Artery segmentation dataset (DSCA), the publicly accessible dataset designed specifically for pixel-level semantic segmentation of CAs. Additionally, we propose DSANet, a spatio-temporal network for CA segmentation in DSA sequences. Unlike existing DSA segmentation methods that focus only on a single frame, the proposed DSANet introduces a separate temporal encoding branch to capture dynamic vessel details across multiple frames. To enhance small vessel segmentation and improve vessel connectivity, we design a novel TemporalFormer module to capture global context and correlations among sequential frames. Furthermore, we develop a Spatio-Temporal Fusion (STF) module to effectively integrate spatial and temporal features from the encoder. Extensive experiments demonstrate that DSANet outperforms other state-of-the-art methods in CA segmentation, achieving a Dice of 0.9033.

Jialu Zhang, Qian Zhang, Jianfeng Ren et al.

Multi-label image classification is a fundamental but challenging task in computer vision. Over the past few decades, solutions exploring relationships between semantic labels have made great progress. However, the underlying spatial-contextual information of labels is under-exploited. To tackle this problem, a spatial-context-aware deep neural network is proposed to predict labels taking into account both semantic and spatial information. This proposed framework is evaluated on Microsoft COCO and PASCAL VOC, two widely used benchmark datasets for image multi-labelling. The results show that the proposed approach is superior to the state-of-the-art solutions on dealing with the multi-label image classification problem.

Yanda Meng, Hongrun Zhang, Dongxu Gao et al.

Segmentation is an essential operation of image processing. The convolution operation suffers from a limited receptive field, while global modelling is fundamental to segmentation tasks. In this paper, we apply graph convolution into the segmentation task and propose an improved \textit{Laplacian}. Different from existing methods, our \textit{Laplacian} is data-dependent, and we introduce two attention diagonal matrices to learn a better vertex relationship. In addition, it takes advantage of both region and boundary information when performing graph-based information propagation. Specifically, we model and reason about the boundary-aware region-wise correlations of different classes through learning graph representations, which is capable of manipulating long range semantic reasoning across various regions with the spatial enhancement along the object's boundary. Our model is well-suited to obtain global semantic region information while also accommodates local spatial boundary characteristics simultaneously. Experiments on two types of challenging datasets demonstrate that our method outperforms the state-of-the-art approaches on the segmentation of polyps in colonoscopy images and of the optic disc and optic cup in colour fundus images.

Yanda Meng, Hongrun Zhang, Yitian Zhao et al.

Semi-supervised approaches for crowd counting attract attention, as the fully supervised paradigm is expensive and laborious due to its request for a large number of images of dense crowd scenarios and their annotations. This paper proposes a spatial uncertainty-aware semi-supervised approach via regularized surrogate task (binary segmentation) for crowd counting problems. Different from existing semi-supervised learning-based crowd counting methods, to exploit the unlabeled data, our proposed spatial uncertainty-aware teacher-student framework focuses on high confident regions' information while addressing the noisy supervision from the unlabeled data in an end-to-end manner. Specifically, we estimate the spatial uncertainty maps from the teacher model's surrogate task to guide the feature learning of the main task (density regression) and the surrogate task of the student model at the same time. Besides, we introduce a simple yet effective differential transformation layer to enforce the inherent spatial consistency regularization between the main task and the surrogate task in the student model, which helps the surrogate task to yield more reliable predictions and generates high-quality uncertainty maps. Thus, our model can also address the task-level perturbation problems that occur spatial inconsistency between the primary and surrogate tasks in the student model. Experimental results on four challenging crowd counting datasets demonstrate that our method achieves superior performance to the state-of-the-art semi-supervised methods.

Yuhao Niu, Lin Gu, Yitian Zhao et al.

Though deep learning has shown successful performance in classifying the label and severity stage of certain diseases, most of them give few explanations on how to make predictions. Inspired by Koch's Postulates, the foundation in evidence-based medicine (EBM) to identify the pathogen, we propose to exploit the interpretability of deep learning application in medical diagnosis. By determining and isolating the neuron activation patterns on which diabetic retinopathy (DR) detector relies to make decisions, we demonstrate the direct relation between the isolated neuron activation and lesions for a pathological explanation. To be specific, we first define novel pathological descriptors using activated neurons of the DR detector to encode both spatial and appearance information of lesions. Then, to visualize the symptom encoded in the descriptor, we propose Patho-GAN, a new network to synthesize medically plausible retinal images. By manipulating these descriptors, we could even arbitrarily control the position, quantity, and categories of generated lesions. We also show that our synthesized images carry the symptoms directly related to diabetic retinopathy diagnosis. Our generated images are both qualitatively and quantitatively superior to the ones by previous methods. Besides, compared to existing methods that take hours to generate an image, our second level speed endows the potential to be an effective solution for data augmentation.

Jiansheng Fang, Yanwu Xu, Yitian Zhao et al.

Chest X-rays are the most commonly available and affordable radiological examination for screening thoracic diseases. According to the domain knowledge of screening chest X-rays, the pathological information usually lay on the lung and heart regions. However, it is costly to acquire region-level annotation in practice, and model training mainly relies on image-level class labels in a weakly supervised manner, which is highly challenging for computer-aided chest X-ray screening. To address this issue, some methods have been proposed recently to identify local regions containing pathological information, which is vital for thoracic disease classification. Inspired by this, we propose a novel deep learning framework to explore discriminative information from lung and heart regions. We design a feature extractor equipped with a multi-scale attention module to learn global attention maps from global images. To exploit disease-specific cues effectively, we locate lung and heart regions containing pathological information by a well-trained pixel-wise segmentation model to generate binarization masks. By introducing element-wise logical AND operator on the learned global attention maps and the binarization masks, we obtain local attention maps in which pixels are $1$ for lung and heart region and $0$ for other regions. By zeroing features of non-lung and heart regions in attention maps, we can effectively exploit their disease-specific cues in lung and heart regions. Compared to existing methods fusing global and local features, we adopt feature weighting to avoid weakening visual cues unique to lung and heart regions. Evaluated by the benchmark split on the publicly available chest X-ray14 dataset, the comprehensive experiments show that our method achieves superior performance compared to the state-of-the-art methods.

Shuai Yu, Jianyang Xie, Jinkui Hao et al.

Optical Coherence Tomography Angiography (OCTA) has been increasingly used in the management of eye and systemic diseases in recent years. Manual or automatic analysis of blood vessel in 2D OCTA images (en face angiograms) is commonly used in clinical practice, however it may lose rich 3D spatial distribution information of blood vessels or capillaries that are useful for clinical decision-making. In this paper, we introduce a novel 3D vessel reconstruction framework based on the estimation of vessel depth maps from OCTA images. First, we design a network with structural constraints to predict the depth of blood vessels in OCTA images. In order to promote the accuracy of the predicted depth map at both the overall structure- and pixel- level, we combine MSE and SSIM loss as the training loss function. Finally, the 3D vessel reconstruction is achieved by utilizing the estimated depth map and 2D vessel segmentation results. Experimental results demonstrate that our method is effective in the depth prediction and 3D vessel reconstruction for OCTA images.% results may be used to guide subsequent vascular analysis

Lei Mou, Yitian Zhao, Huazhu Fu et al.

Automated detection of curvilinear structures, e.g., blood vessels or nerve fibres, from medical and biomedical images is a crucial early step in automatic image interpretation associated to the management of many diseases. Precise measurement of the morphological changes of these curvilinear organ structures informs clinicians for understanding the mechanism, diagnosis, and treatment of e.g. cardiovascular, kidney, eye, lung, and neurological conditions. In this work, we propose a generic and unified convolution neural network for the segmentation of curvilinear structures and illustrate in several 2D/3D medical imaging modalities. We introduce a new curvilinear structure segmentation network (CS2-Net), which includes a self-attention mechanism in the encoder and decoder to learn rich hierarchical representations of curvilinear structures. Two types of attention modules - spatial attention and channel attention - are utilized to enhance the inter-class discrimination and intra-class responsiveness, to further integrate local features with their global dependencies and normalization, adaptively. Furthermore, to facilitate the segmentation of curvilinear structures in medical images, we employ a 1x3 and a 3x1 convolutional kernel to capture boundary features. ...

Yuhui Ma, Huaying Hao, Huazhu Fu et al.

Optical Coherence Tomography Angiography (OCT-A) is a non-invasive imaging technique, and has been increasingly used to image the retinal vasculature at capillary level resolution. However, automated segmentation of retinal vessels in OCT-A has been under-studied due to various challenges such as low capillary visibility and high vessel complexity, despite its significance in understanding many eye-related diseases. In addition, there is no publicly available OCT-A dataset with manually graded vessels for training and validation. To address these issues, for the first time in the field of retinal image analysis we construct a dedicated Retinal OCT-A SEgmentation dataset (ROSE), which consists of 229 OCT-A images with vessel annotations at either centerline-level or pixel level. This dataset has been released for public access to assist researchers in the community in undertaking research in related topics. Secondly, we propose a novel Split-based Coarse-to-Fine vessel segmentation network (SCF-Net), with the ability to detect thick and thin vessels separately. In the SCF-Net, a split-based coarse segmentation (SCS) module is first introduced to produce a preliminary confidence map of vessels, and a split-based refinement (SRN) module is then used to optimize the shape/contour of the retinal microvasculature. Thirdly, we perform a thorough evaluation of the state-of-the-art vessel segmentation models and our SCF-Net on the proposed ROSE dataset. The experimental results demonstrate that our SCF-Net yields better vessel segmentation performance in OCT-A than both traditional methods and other deep learning methods.

Huaying Hao, Huazhu Fu, Yanwu Xu et al.

Anterior chamber angle (ACA) classification is a key step in the diagnosis of angle-closure glaucoma in Anterior Segment Optical Coherence Tomography (AS-OCT). Existing automated analysis methods focus on a binary classification system (i.e., open angle or angle-closure) in a 2D AS-OCT slice. However, clinical diagnosis requires a more discriminating ACA three-class system (i.e., open, narrow, or synechiae angles) for the benefit of clinicians who seek better to understand the progression of the spectrum of angle-closure glaucoma types. To address this, we propose a novel sequence multi-scale aggregation deep network (SMA-Net) for open-narrow-synechiae ACA classification based on an AS-OCT sequence. In our method, a Multi-Scale Discriminative Aggregation (MSDA) block is utilized to learn the multi-scale representations at slice level, while a ConvLSTM is introduced to study the temporal dynamics of these representations at sequence level. Finally, a multi-level loss function is used to combine the slice-based and sequence-based losses. The proposed method is evaluated across two AS-OCT datasets. The experimental results show that the proposed method outperforms existing state-of-the-art methods in applicability, effectiveness, and accuracy. We believe this work to be the first attempt to classify ACAs into open, narrow, or synechia types grading using AS-OCT sequences.

Jinkui Hao, Huazhu Fu, Yanwu Xu et al.

Precise characterization and analysis of iris shape from Anterior Segment OCT (AS-OCT) are of great importance in facilitating diagnosis of angle-closure-related diseases. Existing methods focus solely on analyzing structural properties identified from the 2D slice, while accurate characterization of morphological changes of iris shape in 3D AS-OCT may be able to reveal in addition the risk of disease progression. In this paper, we propose a novel framework for reconstruction and quantification of 3D iris surface from AS-OCT imagery. We consider it to be the first work to detect angle-closure glaucoma by means of 3D representation. An iris segmentation network with wavelet refinement block (WRB) is first proposed to generate the initial shape of the iris from single AS-OCT slice. The 3D iris surface is then reconstructed using a guided optimization method with Poisson-disk sampling. Finally, a set of surface-based features are extracted, which are used in detecting of angle-closure glaucoma. Experimental results demonstrate that our method is highly effective in iris segmentation and surface reconstruction. Moreover, we show that 3D-based representation achieves better performance in angle-closure glaucoma detection than does 2D-based feature.

Kang Zhou, Shenghua Gao, Jun Cheng et al.

With the development of convolutional neural network, deep learning has shown its success for retinal disease detection from optical coherence tomography (OCT) images. However, deep learning often relies on large scale labelled data for training, which is oftentimes challenging especially for disease with low occurrence. Moreover, a deep learning system trained from data-set with one or a few diseases is unable to detect other unseen diseases, which limits the practical usage of the system in disease screening. To address the limitation, we propose a novel anomaly detection framework termed Sparsity-constrained Generative Adversarial Network (Sparse-GAN) for disease screening where only healthy data are available in the training set. The contributions of Sparse-GAN are two-folds: 1) The proposed Sparse-GAN predicts the anomalies in latent space rather than image-level; 2) Sparse-GAN is constrained by a novel Sparsity Regularization Net. Furthermore, in light of the role of lesions for disease screening, we present to leverage on an anomaly activation map to show the heatmap of lesions. We evaluate our proposed Sparse-GAN on a publicly available dataset, and the results show that the proposed method outperforms the state-of-the-art methods.

Lei Mou, Li Chen, Jun Cheng et al.

The detection of retinal vessel is of great importance in the diagnosis and treatment of many ocular diseases. Many methods have been proposed for vessel detection. However, most of the algorithms neglect the connectivity of the vessels, which plays an important role in the diagnosis. In this paper, we propose a novel method for retinal vessel detection. The proposed method includes a dense dilated network to get an initial detection of the vessels and a probability regularized walk algorithm to address the fracture issue in the initial detection. The dense dilated network integrates newly proposed dense dilated feature extraction blocks into an encoder-decoder structure to extract and accumulate features at different scales. A multiscale Dice loss function is adopted to train the network. To improve the connectivity of the segmented vessels, we also introduce a probability regularized walk algorithm to connect the broken vessels. The proposed method has been applied on three public data sets: DRIVE, STARE and CHASE_DB1. The results show that the proposed method outperforms the state-of-the-art methods in accuracy, sensitivity, specificity and also are under receiver operating characteristic curve.

Hao Qiu, Zaiwang Gu, Lei Mou et al.

The optic disc segmentation is an important step for retinal image-based disease diagnosis such as glaucoma. The inner limiting membrane (ILM) is the first boundary in the OCT, which can help to extract the retinal pigment epithelium (RPE) through gradient edge information to locate the boundary of the optic disc. Thus, the ILM layer segmentation is of great importance for optic disc localization. In this paper, we build a new optic disc centered dataset from 20 volunteers and manually annotated the ILM boundary in each OCT scan as ground-truth. We also propose a channel attention based context encoder network modified from the CE-Net to segment the optic disc. It mainly contains three phases: the encoder module, the channel attention based context encoder module, and the decoder module. Finally, we demonstrate that our proposed method achieves state-of-the-art disc segmentation performance on our dataset mentioned above.

Tianyang Zhang, Huazhu Fu, Yitian Zhao et al.

Generative Adversarial Networks (GANs) have the capability of synthesizing images, which have been successfully applied to medical image synthesis tasks. However, most of existing methods merely consider the global contextual information and ignore the fine foreground structures, e.g., vessel, skeleton, which may contain diagnostic indicators for medical image analysis. Inspired by human painting procedure, which is composed of stroking and color rendering steps, we propose a Sketching-rendering Unconditional Generative Adversarial Network (SkrGAN) to introduce a sketch prior constraint to guide the medical image generation. In our SkrGAN, a sketch guidance module is utilized to generate a high quality structural sketch from random noise, then a color render mapping is used to embed the sketch-based representations and resemble the background appearances. Experimental results show that the proposed SkrGAN achieves the state-of-the-art results in synthesizing images for various image modalities, including retinal color fundus, X-Ray, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). In addition, we also show that the performances of medical image segmentation method have been improved by using our synthesized images as data augmentation.

Xingjun Ma, Yuhao Niu, Lin Gu et al.

Deep neural networks (DNNs) have become popular for medical image analysis tasks like cancer diagnosis and lesion detection. However, a recent study demonstrates that medical deep learning systems can be compromised by carefully-engineered adversarial examples/attacks with small imperceptible perturbations. This raises safety concerns about the deployment of these systems in clinical settings. In this paper, we provide a deeper understanding of adversarial examples in the context of medical images. We find that medical DNN models can be more vulnerable to adversarial attacks compared to models for natural images, according to two different viewpoints. Surprisingly, we also find that medical adversarial attacks can be easily detected, i.e., simple detectors can achieve over 98% detection AUC against state-of-the-art attacks, due to fundamental feature differences compared to normal examples. We believe these findings may be a useful basis to approach the design of more explainable and secure medical deep learning systems.

Zaiwang Gu, Jun Cheng, Huazhu Fu et al.

Medical image segmentation is an important step in medical image analysis. With the rapid development of convolutional neural network in image processing, deep learning has been used for medical image segmentation, such as optic disc segmentation, blood vessel detection, lung segmentation, cell segmentation, etc. Previously, U-net based approaches have been proposed. However, the consecutive pooling and strided convolutional operations lead to the loss of some spatial information. In this paper, we propose a context encoder network (referred to as CE-Net) to capture more high-level information and preserve spatial information for 2D medical image segmentation. CE-Net mainly contains three major components: a feature encoder module, a context extractor and a feature decoder module. We use pretrained ResNet block as the fixed feature extractor. The context extractor module is formed by a newly proposed dense atrous convolution (DAC) block and residual multi-kernel pooling (RMP) block. We applied the proposed CE-Net to different 2D medical image segmentation tasks. Comprehensive results show that the proposed method outperforms the original U-Net method and other state-of-the-art methods for optic disc segmentation, vessel detection, lung segmentation, cell contour segmentation and retinal optical coherence tomography layer segmentation.