Libin Lan

Pengzhou Cai, Lu Jiang, Yanxin Li et al.

In this paper, we propose a method, named BRAU-Net, to solve the pubic symphysis-fetal head segmentation task. The method adopts a U-Net-like pure Transformer architecture with bi-level routing attention and skip connections, which effectively learns local-global semantic information. The proposed BRAU-Net was evaluated on transperineal Ultrasound images dataset from the pubic symphysis-fetal head segmentation and angle of progression (FH-PS-AOP) challenge. The results demonstrate that the proposed BRAU-Net achieves comparable a final score. The codes will be available at https://github.com/Caipengzhou/BRAU-Net.

Jieyun Bai, Zihao Zhou, Zhanhong Ou et al.

Segmentation of the fetal and maternal structures, particularly intrapartum ultrasound imaging as advocated by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for monitoring labor progression, is a crucial first step for quantitative diagnosis and clinical decision-making. This requires specialized analysis by obstetrics professionals, in a task that i) is highly time- and cost-consuming and ii) often yields inconsistent results. The utility of automatic segmentation algorithms for biometry has been proven, though existing results remain suboptimal. To push forward advancements in this area, the Grand Challenge on Pubic Symphysis-Fetal Head Segmentation (PSFHS) was held alongside the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to enhance the development of automatic segmentation algorithms at an international scale, providing the largest dataset to date with 5,101 intrapartum ultrasound images collected from two ultrasound machines across three hospitals from two institutions. The scientific community's enthusiastic participation led to the selection of the top 8 out of 179 entries from 193 registrants in the initial phase to proceed to the competition's second stage. These algorithms have elevated the state-of-the-art in automatic PSFHS from intrapartum ultrasound images. A thorough analysis of the results pinpointed ongoing challenges in the field and outlined recommendations for future work. The top solutions and the complete dataset remain publicly available, fostering further advancements in automatic segmentation and biometry for intrapartum ultrasound imaging.

Pengzhou Cai, Xueyuan Zhang, Libin Lan et al.

In recent years, significant progress has been made in tumor segmentation within the field of digital pathology. However, variations in organs, tissue preparation methods, and image acquisition processes can lead to domain discrepancies among digital pathology images. To address this problem, in this paper, we use Rein, a fine-tuning method, to parametrically and efficiently fine-tune various vision foundation models (VFMs) for MICCAI 2024 Cross-Organ and Cross-Scanner Adenocarcinoma Segmentation (COSAS2024). The core of Rein consists of a set of learnable tokens, which are directly linked to instances, improving functionality at the instance level in each layer. In the data environment of the COSAS2024 Challenge, extensive experiments demonstrate that Rein fine-tuned the VFMs to achieve satisfactory results. Specifically, we used Rein to fine-tune ConvNeXt and DINOv2. Our team used the former to achieve scores of 0.7719 and 0.7557 on the preliminary test phase and final test phase in task1, respectively, while the latter achieved scores of 0.8848 and 0.8192 on the preliminary test phase and final test phase in task2. Code is available at GitHub.

Jieyun Bai, Zihao Zhou, Yitong Tang et al.

A substantial proportion (45\%) of maternal deaths, neonatal deaths, and stillbirths occur during the intrapartum phase, with a particularly high burden in low- and middle-income countries. Intrapartum biometry plays a critical role in monitoring labor progression; however, the routine use of ultrasound in resource-limited settings is hindered by a shortage of trained sonographers. To address this challenge, the Intrapartum Ultrasound Grand Challenge (IUGC), co-hosted with MICCAI 2024, was launched. The IUGC introduces a clinically oriented multi-task automatic measurement framework that integrates standard plane classification, fetal head-pubic symphysis segmentation, and biometry, enabling algorithms to exploit complementary task information for more accurate estimation. Furthermore, the challenge releases the largest multi-center intrapartum ultrasound video dataset to date, comprising 774 videos (68,106 frames) collected from three hospitals, providing a robust foundation for model training and evaluation. In this study, we present a comprehensive overview of the challenge design, review the submissions from eight participating teams, and analyze their methods from five perspectives: preprocessing, data augmentation, learning strategy, model architecture, and post-processing. In addition, we perform a systematic analysis of the benchmark results to identify key bottlenecks, explore potential solutions, and highlight open challenges for future research. Although encouraging performance has been achieved, our findings indicate that the field remains at an early stage, and further in-depth investigation is required before large-scale clinical deployment. All benchmark solutions and the complete dataset have been publicly released to facilitate reproducible research and promote continued advances in automatic intrapartum ultrasound biometry.

Pengzhou Cai, Lu Jiang, Yanxin Li et al.

Pubic symphysis-fetal head segmentation in transperineal ultrasound images plays a critical role for the assessment of fetal head descent and progression. Existing transformer segmentation methods based on sparse attention mechanism use handcrafted static patterns, which leads to great differences in terms of segmentation performance on specific datasets. To address this issue, we introduce a dynamic, query-aware sparse attention mechanism for ultrasound image segmentation. Specifically, we propose a novel method, named BRAU-Net to solve the pubic symphysis-fetal head segmentation task in this paper. The method adopts a U-Net-like encoder-decoder architecture with bi-level routing attention and skip connections, which effectively learns local-global semantic information. In addition, we propose an inverted bottleneck patch expanding (IBPE) module to reduce information loss while performing up-sampling operations. The proposed BRAU-Net is evaluated on FH-PS-AoP and HC18 datasets. The results demonstrate that our method could achieve excellent segmentation results. The code is available on GitHub.

Libin Lan, Yanxin Li, Xiaojuan Liu et al.

Both CNN-based and Transformer-based methods have achieved remarkable success in medical image segmentation tasks. However, CNN-based methods struggle to effectively capture global contextual information due to the inherent limitations of convolution operations. Meanwhile, Transformer-based methods suffer from insufficient local feature modeling and face challenges related to the high computational complexity caused by the self-attention mechanism. To address these limitations, we propose a novel hybrid CNN-Transformer architecture, named MSLAU-Net, which integrates the strengths of both paradigms. The proposed MSLAU-Net incorporates two key ideas. First, it introduces Multi-Scale Linear Attention, designed to efficiently extract multi-scale features from medical images while modeling long-range dependencies with low computational complexity. Second, it adopts a top-down feature aggregation mechanism, which performs multi-level feature aggregation and restores spatial resolution using a lightweight structure. Extensive experiments conducted on benchmark datasets covering three imaging modalities demonstrate that the proposed MSLAU-Net outperforms other state-of-the-art methods on nearly all evaluation metrics, validating the superiority, effectiveness, and robustness of our approach. Our code is available at https://github.com/Monsoon49/MSLAU-Net.

Libin Lan, Hongxing Li, Zunhui Xia et al.

Incomplete multi-modal medical image segmentation faces critical challenges from modality imbalance, including imbalanced modality missing rates and heterogeneous modality contributions. Due to their reliance on idealized assumptions of complete modality availability, existing methods fail to dynamically balance contributions and neglect the structural relationships between modalities, resulting in suboptimal performance in real-world clinical scenarios. To address these limitations, we propose a novel model, named Dynamic Modality-Aware Fusion Network (DMAF-Net). The DMAF-Net adopts three key ideas. First, it introduces a Dynamic Modality-Aware Fusion (DMAF) module to suppress missing-modality interference by combining transformer attention with adaptive masking and weight modality contributions dynamically through attention maps. Second, it designs a synergistic Relation Distillation and Prototype Distillation framework to enforce global-local feature alignment via covariance consistency and masked graph attention, while ensuring semantic consistency through cross-modal class-specific prototype alignment. Third, it presents a Dynamic Training Monitoring (DTM) strategy to stabilize optimization under imbalanced missing rates by tracking distillation gaps in real-time, and to balance convergence speeds across modalities by adaptively reweighting losses and scaling gradients. Extensive experiments on BraTS2020 and MyoPS2020 demonstrate that DMAF-Net outperforms existing methods for incomplete multi-modal medical image segmentation. Extensive experiments on BraTS2020 and MyoPS2020 demonstrate that DMAF-Net outperforms existing methods for incomplete multi-modal medical image segmentation. Our code is available at https://github.com/violet-42/DMAF-Net.

Zunhui Xia, Hongxing Li, Libin Lan

In the childbirth process, traditional methods involve invasive vaginal examinations, but research has shown that these methods are both subjective and inaccurate. Ultrasound-assisted diagnosis offers an objective yet effective way to assess fetal head position via two key parameters: Angle of Progression (AoP) and Head-Symphysis Distance (HSD), calculated by segmenting the fetal head (FH) and pubic symphysis (PS), which aids clinicians in ensuring a smooth delivery process. Therefore, accurate segmentation of FH and PS is crucial. In this work, we propose a sparse self-attention network architecture with good performance and high computational efficiency, named DSSAU-Net, for the segmentation of FH and PS. Specifically, we stack varying numbers of Dual Sparse Selection Attention (DSSA) blocks at each stage to form a symmetric U-shaped encoder-decoder network architecture. For a given query, DSSA is designed to explicitly perform one sparse token selection at both the region and pixel levels, respectively, which is beneficial for further reducing computational complexity while extracting the most relevant features. To compensate for the information loss during the upsampling process, skip connections with convolutions are designed. Additionally, multiscale feature fusion is employed to enrich the model's global and local information. The performance of DSSAU-Net has been validated using the Intrapartum Ultrasound Grand Challenge (IUGC) 2024 \textit{test set} provided by the organizer in the MICCAI IUGC 2024 competition\footnote{\href{https://codalab.lisn.upsaclay.fr/competitions/18413\#learn\_the\_details}{https://codalab.lisn.upsaclay.fr/competitions/18413\#learn\_the\_details}}, where we win the fourth place on the tasks of classification and segmentation, demonstrating its effectiveness. The codes will be available at https://github.com/XiaZunhui/DSSAU-Net.

Libin Lan, Pengzhou Cai, Lu Jiang et al.

Accurate medical image segmentation is essential for clinical quantification, disease diagnosis, treatment planning and many other applications. Both convolution-based and transformer-based u-shaped architectures have made significant success in various medical image segmentation tasks. The former can efficiently learn local information of images while requiring much more image-specific inductive biases inherent to convolution operation. The latter can effectively capture long-range dependency at different feature scales using self-attention, whereas it typically encounters the challenges of quadratic compute and memory requirements with sequence length increasing. To address this problem, through integrating the merits of these two paradigms in a well-designed u-shaped architecture, we propose a hybrid yet effective CNN-Transformer network, named BRAU-Net++, for an accurate medical image segmentation task. Specifically, BRAU-Net++ uses bi-level routing attention as the core building block to design our u-shaped encoder-decoder structure, in which both encoder and decoder are hierarchically constructed, so as to learn global semantic information while reducing computational complexity. Furthermore, this network restructures skip connection by incorporating channel-spatial attention which adopts convolution operations, aiming to minimize local spatial information loss and amplify global dimension-interaction of multi-scale features. Extensive experiments on three public benchmark datasets demonstrate that our proposed approach surpasses other state-of-the-art methods including its baseline: BRAU-Net under almost all evaluation metrics. We achieve the average Dice-Similarity Coefficient (DSC) of 82.47, 90.10, and 92.94 on Synapse multi-organ segmentation, ISIC-2018 Challenge, and CVC-ClinicDB, as well as the mIoU of 84.01 and 88.17 on ISIC-2018 Challenge and CVC-ClinicDB, respectively.

Yanxin Li, Hui Wan, Libin Lan

Accurate medical image segmentation requires effective modeling of both long-range dependencies and fine-grained boundary details. While transformers mitigate the issue of insufficient semantic information arising from the limited receptive field inherent in convolutional neural networks, they introduce new challenges: standard self-attention incurs quadratic computational complexity and often assigns non-negligible attention weights to irrelevant regions, diluting focus on discriminative structures and ultimately compromising segmentation accuracy. Existing attention variants, although effective in reducing computational complexity, fail to suppress redundant computation and inadvertently impair global context modeling. Furthermore, conventional fusion strategies in encoder-decoder architectures, typically based on simple concatenation or summation, can not adaptively integrate high-level semantic information with low-level spatial details. To address these limitations, we propose DCAU-Net, a novel yet efficient segmentation framework with two key ideas. First, a new Differential Cross Attention (DCA) is designed to compute the difference between two independent softmax attention maps to adaptively highlight discriminative structures. By replacing pixel-wise key and value tokens with window-level summary tokens, DCA dramatically reduces computational complexity without sacrificing precision. Second, a Channel-Spatial Feature Fusion (CSFF) strategy is introduced to adaptively recalibrate features from skip connections and up-sampling paths through using sequential channel and spatial attention, effectively suppressing redundant information and amplifying salient cues. Experiments on two public benchmarks demonstrate that DCAU-Net achieves competitive performance with enhanced segmentation accuracy and robustness.

Ruining Deng, Tianyuan Yao, Yucheng Tang et al.

Chronic kidney disease (CKD) is a major global health issue, affecting over 10% of the population and causing significant mortality. While kidney biopsy remains the gold standard for CKD diagnosis and treatment, the lack of comprehensive benchmarks for kidney pathology segmentation hinders progress in the field. To address this, we organized the Kidney Pathology Image Segmentation (KPIs) Challenge, introducing a dataset that incorporates preclinical rodent models of CKD with over 10,000 annotated glomeruli from 60+ Periodic Acid Schiff (PAS)-stained whole slide images. The challenge includes two tasks, patch-level segmentation and whole slide image segmentation and detection, evaluated using the Dice Similarity Coefficient (DSC) and F1-score. By encouraging innovative segmentation methods that adapt to diverse CKD models and tissue conditions, the KPIs Challenge aims to advance kidney pathology analysis, establish new benchmarks, and enable precise, large-scale quantification for disease research and diagnosis.

Libin Lan, Lu Jiang, Tianshu Yu et al.

Video summarization aims to generate a compact, informative, and representative synopsis of raw videos, which is crucial for browsing, analyzing, and understanding video content. Dominant approaches in video summarization primarily rely on recurrent or convolutional neural networks, and more recently on encoder-only transformer architectures. However, these methods typically suffer from several limitations in parallelism, modeling long-range dependencies, and providing explicit generative capabilities. To address these issues, we propose a transformer-like architecture named FullTransNet with two-fold ideas. First, it uses a full transformer with an encoder-decoder structure as an alternative architecture for video summarization. As the full transformer is specifically designed for sequence transduction tasks, its direct application to video summarization is both intuitive and effective. Second, it replaces the standard full attention mechanism with a combination of local and global sparse attention, enabling the model to capture long-range dependencies while significantly reducing computational costs. This local-global sparse attention is applied exclusively at the encoder side, where the majority of computations occur, further enhancing efficiency. Extensive experiments on two widely used benchmark datasets, SumMe and TVSum, demonstrate that our model achieves F-scores of 54.4% and 63.9%, respectively, while maintaining relatively low computational and memory requirements. These results surpass the second-best performing methods by 0.1% and 0.3%, respectively, verifying the effectiveness and efficiency of FullTransNet.

Zunhui Xia, Hongxing Li, Libin Lan

Medical image recognition serves as a key way to aid in clinical diagnosis, enabling more accurate and timely identification of diseases and abnormalities. Vision transformer-based approaches have proven effective in handling various medical recognition tasks. However, these methods encounter two primary challenges. First, they are often task-specific and architecture-tailored, limiting their general applicability. Second, they usually either adopt full attention to model long-range dependencies, resulting in high computational costs, or rely on handcrafted sparse attention, potentially leading to suboptimal performance. To tackle these issues, we present MedFormer, an efficient medical vision transformer with two key ideas. First, it employs a pyramid scaling structure as a versatile backbone for various medical image recognition tasks, including image classification and dense prediction tasks such as semantic segmentation and lesion detection. This structure facilitates hierarchical feature representation while reducing the computation load of feature maps, highly beneficial for boosting performance. Second, it introduces a novel Dual Sparse Selection Attention (DSSA) with content awareness to improve computational efficiency and robustness against noise while maintaining high performance. As the core building technique of MedFormer, DSSA is designed to explicitly attend to the most relevant content. Theoretical analysis demonstrates that MedFormer outperforms existing medical vision transformers in terms of generality and efficiency. Extensive experiments across various imaging modality datasets show that MedFormer consistently enhances performance in all three medical image recognition tasks mentioned above. MedFormer provides an efficient and versatile solution for medical image recognition, with strong potential for clinical application.

Zunhui Xia, Hongxing Li, Libin Lan

In recent years, transformer-based methods have achieved remarkable progress in medical image segmentation due to their superior ability to capture long-range dependencies. However, these methods typically suffer from two major limitations. First, their computational complexity scales quadratically with the input sequences. Second, the feed-forward network (FFN) modules in vanilla Transformers typically rely on fully connected layers, which limits models' ability to capture local contextual information and multiscale features critical for precise semantic segmentation. To address these issues, we propose an efficient medical image segmentation network, named TCSAFormer. The proposed TCSAFormer adopts two key ideas. First, it incorporates a Compressed Attention (CA) module, which combines token compression and pixel-level sparse attention to dynamically focus on the most relevant key-value pairs for each query. This is achieved by pruning globally irrelevant tokens and merging redundant ones, significantly reducing computational complexity while enhancing the model's ability to capture relationships between tokens. Second, it introduces a Dual-Branch Feed-Forward Network (DBFFN) module as a replacement for the standard FFN to capture local contextual features and multiscale information, thereby strengthening the model's feature representation capability. We conduct extensive experiments on three publicly available medical image segmentation datasets: ISIC-2018, CVC-ClinicDB, and Synapse, to evaluate the segmentation performance of TCSAFormer. Experimental results demonstrate that TCSAFormer achieves superior performance compared to existing state-of-the-art (SOTA) methods, while maintaining lower computational overhead, thus achieving an optimal trade-off between efficiency and accuracy.

Libin Lan, Hongxing Li, Zunhui Xia et al.

Learning medical visual representations directly from paired images and reports through multimodal self-supervised learning has emerged as a novel and efficient approach to digital diagnosis in recent years. However, existing models suffer from several severe limitations. 1) neglecting the selection of negative samples, resulting in the scarcity of hard negatives and the inclusion of false negatives; 2) focusing on global feature extraction, but overlooking the fine-grained local details that are crucial for medical image recognition tasks; and 3) contrastive learning primarily targets high-level features but ignoring low-level details which are essential for accurate medical analysis. Motivated by these critical issues, this paper presents a Cross-Modal Cluster-Guided Negative Sampling (CM-CGNS) method with two-fold ideas. First, it extends the k-means clustering used for local text features in the single-modal domain to the multimodal domain through cross-modal attention. This improvement increases the number of negative samples and boosts the model representation capability. Second, it introduces a Cross-Modal Masked Image Reconstruction (CM-MIR) module that leverages local text-to-image features obtained via cross-modal attention to reconstruct masked local image regions. This module significantly strengthens the model's cross-modal information interaction capabilities and retains low-level image features essential for downstream tasks. By well handling the aforementioned limitations, the proposed CM-CGNS can learn effective and robust medical visual representations suitable for various recognition tasks. Extensive experimental results on classification, detection, and segmentation tasks across five downstream datasets show that our method outperforms state-of-the-art approaches on multiple metrics, verifying its superior performance.