Yuhui Tao

Ahjol Senbi, Tianyu Huang, Fei Lyu et al.

We explore the feasibility and potential of building a ground-truth-free evaluation model to assess the quality of segmentations generated by the Segment Anything Model (SAM) and its variants in medical imaging. This evaluation model estimates segmentation quality scores by analyzing the coherence and consistency between the input images and their corresponding segmentation predictions. Based on prior research, we frame the task of training this model as a regression problem within a supervised learning framework, using Dice scores (and optionally other metrics) along with mean squared error to compute the training loss. The model is trained utilizing a large collection of public datasets of medical images with segmentation predictions from SAM and its variants. We name this model EvanySeg (Evaluation of Any Segmentation in Medical Images). Our exploration of convolution-based models (e.g., ResNet) and transformer-based models (e.g., ViT) suggested that ViT yields better performance for this task. EvanySeg can be employed for various tasks, including: (1) identifying poorly segmented samples by detecting low-percentile segmentation quality scores; (2) benchmarking segmentation models without ground truth by averaging quality scores across test samples; (3) alerting human experts to poor-quality segmentation predictions during human-AI collaboration by applying a threshold within the score space; and (4) selecting the best segmentation prediction for each test sample at test time when multiple segmentation models are available, by choosing the prediction with the highest quality score. Models and code will be made available at https://github.com/ahjolsenbics/EvanySeg.

Ziqing Yu, Yuhui Tao, Jiayu Huo et al.

Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

Xiao Ma, Yuhui Tao, Zetian Zhang et al.

Medical image segmentation is critical for clinical diagnosis, treatment planning, and monitoring, yet segmentation models often struggle with uncertainties stemming from occlusions, ambiguous boundaries, and variations in imaging devices. Traditional test-time augmentation (TTA) techniques typically rely on predefined geometric and photometric transformations, limiting their adaptability and effectiveness in complex medical scenarios. In this study, we introduced Test-Time Generative Augmentation (TTGA), a novel augmentation strategy specifically tailored for medical image segmentation at inference time. Different from conventional augmentation strategies that suffer from excessive randomness or limited flexibility, TTGA leverages a domain-fine-tuned generative model to produce contextually relevant and diverse augmentations tailored to the characteristics of each test image. Built upon diffusion model inversion, a masked null-text inversion method is proposed to enable region-specific augmentations during sampling. Furthermore, a dual denoising pathway is designed to balance precise identity preservation with controlled variability. We demonstrate the efficacy of our TTGA through extensive experiments across three distinct segmentation tasks spanning nine datasets. Our results consistently demonstrate that TTGA not only improves segmentation accuracy (with DSC gains ranging from 0.1% to 2.3% over the baseline) but also offers pixel-wise error estimation (with DSC gains ranging from 1.1% to 29.0% over the baseline). The source code and demonstration are available at: https://github.com/maxiao0234/TTGA.

Yuhui Tao, Yizhe Zhang, Qiang Chen

The development of artificial intelligence models for macular edema (ME) analy-sis always relies on expert-annotated pixel-level image datasets which are expen-sive to collect prospectively. While anomaly-detection-based weakly-supervised methods have shown promise in edema area (EA) segmentation task, their per-formance still lags behind fully-supervised approaches. In this paper, we leverage the strong correlation between EA and retinal layers in spectral-domain optical coherence tomography (SD-OCT) images, along with the update characteristics of weakly-supervised learning, to enhance an off-the-shelf adversarial framework for EA segmentation with a novel layer-structure-guided post-processing step and a test-time-adaptation (TTA) strategy. By incorporating additional retinal lay-er information, our framework reframes the dense EA prediction task as one of confirming intersection points between the EA contour and retinal layers, result-ing in predictions that better align with the shape prior of EA. Besides, the TTA framework further helps address discrepancies in the manifestations and presen-tations of EA between training and test sets. Extensive experiments on two pub-licly available datasets demonstrate that these two proposed ingredients can im-prove the accuracy and robustness of EA segmentation, bridging the gap between weakly-supervised and fully-supervised models.

Yuhui Tao, Zhongwei Zhao, Zilong Wang et al.

The non-invasive assessment of increasingly incidentally discovered renal masses is a critical challenge in urologic oncology, where diagnostic uncertainty frequently leads to the overtreatment of benign or indolent tumors. In this study, we developed and validated RenalCLIP using a dataset of 27,866 CT scans from 8,809 patients across nine Chinese medical centers and the public TCIA cohort, a visual-language foundation model for characterization, diagnosis and prognosis of renal mass. The model was developed via a two-stage pre-training strategy that first enhances the image and text encoders with domain-specific knowledge before aligning them through a contrastive learning objective, to create robust representations for superior generalization and diagnostic precision. RenalCLIP achieved better performance and superior generalizability across 10 core tasks spanning the full clinical workflow of kidney cancer, including anatomical assessment, diagnostic classification, and survival prediction, compared with other state-of-the-art general-purpose CT foundation models. Especially, for complicated task like recurrence-free survival prediction in the TCIA cohort, RenalCLIP achieved a C-index of 0.726, representing a substantial improvement of approximately 20% over the leading baselines. Furthermore, RenalCLIP's pre-training imparted remarkable data efficiency; in the diagnostic classification task, it only needs 20% training data to achieve the peak performance of all baseline models even after they were fully fine-tuned on 100% of the data. Additionally, it achieved superior performance in report generation, image-text retrieval and zero-shot diagnosis tasks. Our findings establish that RenalCLIP provides a robust tool with the potential to enhance diagnostic accuracy, refine prognostic stratification, and personalize the management of patients with kidney cancer.