Zhenxi Zhang

Heng Zhou, Chunna Tian, Zhenxi Zhang et al.

RGB-Thermal salient object detection (SOD) combines two spectra to segment visually conspicuous regions in images. Most existing methods use boundary maps to learn the sharp boundary. These methods ignore the interactions between isolated boundary pixels and other confident pixels, leading to sub-optimal performance. To address this problem,we propose a position-aware relation learning network (PRLNet) for RGB-T SOD based on swin transformer. PRLNet explores the distance and direction relationships between pixels to strengthen intra-class compactness and inter-class separation, generating salient object masks with clear boundaries and homogeneous regions. Specifically, we develop a novel signed distance map auxiliary module (SDMAM) to improve encoder feature representation, which takes into account the distance relation of different pixels in boundary neighborhoods. Then, we design a feature refinement approach with directional field (FRDF), which rectifies features of boundary neighborhood by exploiting the features inside salient objects. FRDF utilizes the directional information between object pixels to effectively enhance the intra-class compactness of salient regions. In addition, we constitute a pure transformer encoder-decoder network to enhance multispectral feature representation for RGB-T SOD. Finally, we conduct quantitative and qualitative experiments on three public benchmark datasets.The results demonstrate that our proposed method outperforms the state-of-the-art methods.

Heng Zhou, Xiaoxiong Liu, Zhenxi Zhang et al.

Remote sensing images (RSIs) are frequently degraded by haze, fog, and thin clouds, which obscure surface reflectance and hinder downstream applications. This study presents the first systematic and unified survey of RSIs dehazing, integrating methodological evolution, benchmark assessment, and physical consistency analysis. We categorize existing approaches into a three-stage progression: from handcrafted physical priors, to data-driven deep restoration, and finally to hybrid physical-intelligent generation, and summarize more than 30 representative methods across CNNs, GANs, Transformers, and diffusion models. To provide a reliable empirical reference, we conduct large-scale quantitative experiments on five public datasets using 12 metrics, including PSNR, SSIM, CIEDE, LPIPS, FID, SAM, ERGAS, UIQI, QNR, NIQE, and HIST. Cross-domain comparison reveals that recent Transformer- and diffusion-based models improve SSIM by 12%~18% and reduce perceptual errors by 20%~35% on average, while hybrid physics-guided designs achieve higher radiometric stability. A dedicated physical radiometric consistency experiment further demonstrates that models with explicit transmission or airlight constraints reduce color bias by up to 27%. Based on these findings, we summarize open challenges: dynamic atmospheric modeling, multimodal fusion, lightweight deployment, data scarcity, and joint degradations, and outline promising research directions for future development of trustworthy, controllable, and efficient (TCE) dehazing systems. All reviewed resources, including source code, benchmark datasets, evaluation metrics, and reproduction configurations are publicly available at https://github.com/VisionVerse/RemoteSensing-Restoration-Survey.

Heng Zhou, Chunna Tian, Zhenxi Zhang et al.

A key challenge of infrared small target segmentation (ISTS) is to balance false negative pixels (FNs) and false positive pixels (FPs). Traditional methods combine FNs and FPs into a single objective by weighted sum, and the optimization process is decided by one actor. Minimizing FNs and FPs with the same strategy leads to antagonistic decisions. To address this problem, we propose a competitive game framework (pixelGame) from a novel perspective for ISTS. In pixelGame, FNs and FPs are controlled by different player whose goal is to minimize their own utility function. FNs-player and FPs-player are designed with different strategies: One is to minimize FNs and the other is to minimize FPs. The utility function drives the evolution of the two participants in competition. We consider the Nash equilibrium of pixelGame as the optimal solution. In addition, we propose maximum information modulation (MIM) to highlight the tar-get information. MIM effectively focuses on the salient region including small targets. Extensive experiments on two standard public datasets prove the effectiveness of our method. Compared with other state-of-the-art methods, our method achieves better performance in terms of F1-measure (F1) and the intersection of union (IoU).

Zhenxi Zhang, Yitao Zhuang, Yao Pu et al.

Anatomical structure masks are widely adopted in radiotherapy dose prediction, as they provide explicit geometric constraints that facilitate structure-dose coupling. However, conventional manual delineation of these masks requires precise annotation of structure boundaries relevant to radiotherapy, which is time-consuming and labor-intensive. To address these limitations, we propose a scribble-guided dose prediction framework that relies solely on anatomical structures annotated with sparse scribbles. Specifically, we design a Scribble Completion Module (SCM) to generate dense anatomical masks by propagating sparse scribble labels to semantically similar voxels. During the propagation process, a supervoxel-based regularization is introduced to preserve geometric boundary consistency to ensure anatomical plausibility. Furthermore, we propose a Structure-Guided Dose Generation Module (SGDGM) to strengthen the correspondence between sparse structural cues and dose distribution. The completed dense masks derived from scribbles serve as structural guidance to condition dose prediction, forming a scribble-mask-dose learning pipeline under sparse annotation. Experiments on the GDP-HMM dataset demonstrate that ScribbleDose achieves competitive dose prediction performance using only sparse structural annotations. The source code and reannotated scribble annotations are publicly available at https://github.com/iCherishxixixi/ScribbleDose.

Zhenxi Zhang, Chunna Tian, Zhicheng Jiao

Semi-supervised learning methods have been explored in medical image segmentation tasks due to the scarcity of pixel-level annotation in the real scenario. Proto-type alignment based consistency constraint is an intuitional and plausible solu-tion to explore the useful information in the unlabeled data. In this paper, we propose a mutual- and self- prototype alignment (MSPA) framework to better utilize the unlabeled data. In specific, mutual-prototype alignment enhances the information interaction between labeled and unlabeled data. The mutual-prototype alignment imposes two consistency constraints in reverse directions between the unlabeled and labeled data, which enables the consistent embedding and model discriminability on unlabeled data. The proposed self-prototype alignment learns more stable region-wise features within unlabeled images, which optimizes the classification margin in semi-supervised segmentation by boosting the intra-class compactness and inter-class separation on the feature space. Extensive experimental results on three medical datasets demonstrate that with a small amount of labeled data, MSPA achieves large improvements by leveraging the unlabeled data. Our method also outperforms seven state-of-the-art semi-supervised segmentation methods on all three datasets.

Yanyu Ye, Zhenxi Zhang, Wei Wei et al.

Source-free test-time adaptation for medical image segmentation aims to enhance the adaptability of segmentation models to diverse and previously unseen test sets of the target domain, which contributes to the generalizability and robustness of medical image segmentation models without access to the source domain. Ensuring consistency between target edges and paired inputs is crucial for test-time adaptation. To improve the performance of test-time domain adaptation, we propose a multi task consistency guided source-free test-time domain adaptation medical image segmentation method which ensures the consistency of the local boundary predictions and the global prototype representation. Specifically, we introduce a local boundary consistency constraint method that explores the relationship between tissue region segmentation and tissue boundary localization tasks. Additionally, we propose a global feature consistency constraint toto enhance the intra-class compactness. We conduct extensive experiments on the segmentation of benchmark fundus images. Compared to prediction directly by the source domain model, the segmentation Dice score is improved by 6.27\% and 0.96\% in RIM-ONE-r3 and Drishti GS datasets, respectively. Additionally, the results of experiments demonstrate that our proposed method outperforms existing competitive domain adaptation segmentation algorithms.

Zhenxi Zhang, Fuchen Zheng, Adnan Iltaf et al.

Accurate segmentation of aortic vascular structures is critical for diagnosing and treating cardiovascular diseases.Traditional Transformer-based models have shown promise in this domain by capturing long-range dependencies between vascular features. However, their reliance on fixed-size rectangular patches often influences the integrity of complex vascular structures, leading to suboptimal segmentation accuracy. To address this challenge, we propose the adaptive Morph Patch Transformer (MPT), a novel architecture specifically designed for aortic vascular segmentation. Specifically, MPT introduces an adaptive patch partitioning strategy that dynamically generates morphology-aware patches aligned with complex vascular structures. This strategy can preserve semantic integrity of complex vascular structures within individual patches. Moreover, a Semantic Clustering Attention (SCA) method is proposed to dynamically aggregate features from various patches with similar semantic characteristics. This method enhances the model's capability to segment vessels of varying sizes, preserving the integrity of vascular structures. Extensive experiments on three open-source dataset(AVT, AortaSeg24 and TBAD) demonstrate that MPT achieves state-of-the-art performance, with improvements in segmenting intricate vascular structures.

Yifan Xiang, Zhenxi Zhang, Bin Li et al.

Recent advances in personalized MLLMs enable effective capture of user-specific concepts, supporting both recognition of personalized concepts and contextual captioning. However, humans typically explore and reason over relations among objects and individuals, transcending surface-level information to achieve more personalized and contextual understanding. To this end, existing methods may face three main limitations: Their training data lacks multi-object sets in which relations among objects are learnable. Building on the limited training data, their models overlook the relations between different personalized concepts and fail to reason over them. Their experiments mainly focus on a single personalized concept, where evaluations are limited to recognition and captioning tasks. To address the limitations, we present a new dataset named ReGraP, consisting of 120 sets of personalized knowledge. Each set includes images, KGs, and CoT QA pairs derived from the KGs, enabling more structured and sophisticated reasoning pathways. We propose ReGraP-LLaVA, an MLLM trained with the corresponding KGs and CoT QA pairs, where soft and hard graph prompting methods are designed to align KGs within the model's semantic space. We establish the ReGraP Benchmark, which contains diverse task types: multiple-choice, fill-in-the-blank, True/False, and descriptive questions in both open- and closed-ended settings. The proposed benchmark is designed to evaluate the relational reasoning and knowledge-connection capability of personalized MLLMs. We conduct experiments on the proposed ReGraP-LLaVA and other competitive MLLMs. Results show that the proposed model not only learns personalized knowledge but also performs relational reasoning in responses, achieving the SoTA performance compared with the competitive methods. All the codes and datasets are released at: https://github.com/xyfyyds/ReGraP.

Adnan Iltaf, Rayan Merghani Ahmed, Zhenxi Zhang et al.

Medical image segmentation is crucial for clinical diagnosis and treatment planning, especially when dealing with complex anatomical structures such as vessels. However, accurately segmenting vessels remains challenging due to their small size, intricate edge structures, and susceptibility to artifacts and imaging noise. In this work, we propose VesselSAM, an enhanced version of the Segment Anything Model (SAM), specifically tailored for aortic vessel segmentation. VesselSAM incorporates AtrousLoRA, a novel module integrating Atrous Attention and Low-Rank Adaptation (LoRA), to enhance segmentation performance. Atrous Attention enables the model to capture multi-scale contextual information, preserving both fine-grained local details and broader global context. Additionally, LoRA facilitates efficient fine-tuning of the frozen SAM image encoder, reducing the number of trainable parameters and thereby enhancing computational efficiency. We evaluate VesselSAM using two challenging datasets: the Aortic Vessel Tree (AVT) dataset and the Type-B Aortic Dissection (TBAD) dataset. VesselSAM achieves state-of-the-art performance, attaining DSC scores of 93.50\%, 93.25\%, 93.02\%, and 93.26\% across multi-center datasets. Our results demonstrate that VesselSAM delivers high segmentation accuracy while significantly reducing computational overhead compared to existing large-scale models. This development paves the way for enhanced AI-based aortic vessel segmentation in clinical environments. The code and models will be released at https://github.com/Adnan-CAS/AtrousLora.

Zhenxi Zhang, Yanyang Wang, Yao Wu et al.

Developmental Canal Stenosis (DCS) quantification is crucial in cervical spondylosis screening. Compared with quantifying DCS manually, a more efficient and time-saving manner is provided by deep keypoint localization networks, which can be implemented in either the coordinate or the image domain. However, the vertebral visualization features often lead to abnormal topological structures during keypoint localization, including keypoint distortion with edges and weakly connected structures, which cannot be fully suppressed in either the coordinate or image domain alone. To overcome this limitation, a keypoint-edge and a reparameterization modules are utilized to restrict these abnormal structures in a cross-domain manner. The keypoint-edge constraint module restricts the keypoints on the edges of vertebrae, which ensures that the distribution pattern of keypoint coordinates is consistent with those for DCS quantification. And the reparameterization module constrains the weakly connected structures in image-domain heatmaps with coordinates combined. Moreover, the cross-domain network improves spatial generalization by utilizing heatmaps and incorporating coordinates for accurate localization, which avoids the trade-off between these two properties in an individual domain. Comprehensive results of distinct quantification tasks show the superiority and generability of the proposed Topology-inspired Cross-domain Network (TCN) compared with other competing localization methods.

Zhenxi Zhang, Heng Zhou, Xiaoran Shi et al.

Semi-supervised segmentation presents a promising approach for large-scale medical image analysis, effectively reducing annotation burdens while achieving comparable performance. This methodology holds substantial potential for streamlining the segmentation process and enhancing its feasibility within clinical settings for translational investigations. While cross-supervised training, based on distinct co-training sub-networks, has become a prevalent paradigm for this task, addressing critical issues such as predication disagreement and label-noise suppression requires further attention and progress in cross-supervised training. In this paper, we introduce an Evidential Tri-Branch Consistency learning framework (ETC-Net) for semi-supervised medical image segmentation. ETC-Net employs three branches: an evidential conservative branch, an evidential progressive branch, and an evidential fusion branch. The first two branches exhibit complementary characteristics, allowing them to address prediction diversity and enhance training stability. We also integrate uncertainty estimation from the evidential learning into cross-supervised training, mitigating the negative impact of erroneous supervision signals. Additionally, the evidential fusion branch capitalizes on the complementary attributes of the first two branches and leverages an evidence-based Dempster-Shafer fusion strategy, supervised by more reliable and accurate pseudo-labels of unlabeled data. Extensive experiments conducted on LA, Pancreas-CT, and ACDC datasets demonstrate that ETC-Net surpasses other state-of-the-art methods for semi-supervised segmentation. The code will be made available in the near future at https://github.com/Medsemiseg.

Fuchen Zheng, Chengpei Xu, Long Ma et al.

Visual state-space models (SSMs) have shown strong potential for medical image segmentation, yet their effectiveness is often limited by two practical issues: axis-biased scan ordering weakens the modeling of oblique and curved structures, and naive multi-branch fusion tends to amplify redundant responses. We present TopoMamba, a topology-aware scan-and-fuse framework for segmenting heterogeneous medical visual media. The method combines a diagonal/anti-diagonal TopoA-Scan branch with the standard Cross-Scan branch to provide complementary structural priors, and introduces ScanCache, a device-aware caching mechanism that amortizes explicit scan-index construction across recurring resolutions. To fuse heterogeneous scan features efficiently, we further propose a lightweight HSIC Gate that regulates branch interaction using a dependence-aware scalar gating rule. We also instantiate a volumetric TopoMamba-3D for practical 3D clinical segmentation. Experiments on Synapse CT, ISIC 2017 dermoscopy, and CVC-ClinicDB endoscopy show that TopoMamba consistently improves segmentation quality over strong CNN, Transformer, and SSM baselines, with particularly clear gains on thin or curved targets such as the pancreas and gallbladder, while maintaining favorable deployment efficiency under dynamic input resolutions. These results suggest that topology-aware scan ordering and lightweight dependence-aware fusion form an effective and practical design for medical multimedia segmentation. The code will be made publicly available.

Yao Pu, Yiming Shi, Zhenxi Zhang et al.

Magnetic resonance imaging (MRI) is essential for nasopharyngeal carcinoma (NPC) radiotherapy (RT), but practical constraints, such as patient discomfort, long scan times, and high costs often lead to incomplete modalities in clinical practice, compromising RT planning accuracy. Traditional MRI synthesis methods are modality-specific, limited in anatomical adaptability, and lack clinical interpretability-failing to meet NPC's RT needs. Here, we developed a unified foundation model integrating contrastive visual representation learning and vision-language alignment (VLA) to enable any-to-all MRI synthesis. The model uses a contrastive encoder for modality-invariant representations and a CLIP-based text-informed decoder for semantically consistent synthesis, supporting any-to-all MRI synthesis via one unified foundation model. Trained on 40,825 images from 13 institutions, it achieves consistently high performance (average SSIM 0.90, PSNR 27) across 26 internal/external validation sites (15,748 images), with superior synthesis fidelity and robustness to noise and domain shifts. Meanwhile, its unified representation enhances downstream RT-relevant tasks (e.g., segmentation). This work advances digital medicine solutions for NPC care by leveraging foundation models to bridge technical synthesis and clinical utility.

Zhenxi Zhang, Ran Ran, Chunna Tian et al.

Semi-supervised medical image segmentation offers a promising solution for large-scale medical image analysis by significantly reducing the annotation burden while achieving comparable performance. Employing this method exhibits a high degree of potential for optimizing the segmentation process and increasing its feasibility in clinical settings during translational investigations. Recently, cross-supervised training based on different co-training sub-networks has become a standard paradigm for this task. Still, the critical issues of sub-network disagreement and label-noise suppression require further attention and progress in cross-supervised training. This paper proposes a cross-supervised learning framework based on dual classifiers (DC-Net), including an evidential classifier and a vanilla classifier. The two classifiers exhibit complementary characteristics, enabling them to handle disagreement effectively and generate more robust and accurate pseudo-labels for unlabeled data. We also incorporate the uncertainty estimation from the evidential classifier into cross-supervised training to alleviate the negative effect of the error supervision signal. The extensive experiments on LA and Pancreas-CT dataset illustrate that DC-Net outperforms other state-of-the-art methods for semi-supervised segmentation. The code will be released soon.

Zhenxi Zhang, Ran Ran, Chunna Tian et al.

Consistency learning plays a crucial role in semi-supervised medical image segmentation as it enables the effective utilization of limited annotated data while leveraging the abundance of unannotated data. The effectiveness and efficiency of consistency learning are challenged by prediction diversity and training stability, which are often overlooked by existing studies. Meanwhile, the limited quantity of labeled data for training often proves inadequate for formulating intra-class compactness and inter-class discrepancy of pseudo labels. To address these issues, we propose a self-aware and cross-sample prototypical learning method (SCP-Net) to enhance the diversity of prediction in consistency learning by utilizing a broader range of semantic information derived from multiple inputs. Furthermore, we introduce a self-aware consistency learning method that exploits unlabeled data to improve the compactness of pseudo labels within each class. Moreover, a dual loss re-weighting method is integrated into the cross-sample prototypical consistency learning method to improve the reliability and stability of our model. Extensive experiments on ACDC dataset and PROMISE12 dataset validate that SCP-Net outperforms other state-of-the-art semi-supervised segmentation methods and achieves significant performance gains compared to the limited supervised training. Our code will come soon.

Zhenxi Zhang, Chunna Tian, Jie Li et al.

Medical image segmentation is usually regarded as one of the most important intermediate steps in clinical situations and medical imaging research. Thus, accurately assessing the segmentation quality of the automatically generated predictions is essential for guaranteeing the reliability of the results of the computer-assisted diagnosis (CAD). Many researchers apply neural networks to train segmentation quality regression models to estimate the segmentation quality of a new data cohort without labeled ground truth. Recently, a novel idea is proposed that transforming the segmentation quality assessment (SQA) problem intothe pixel-wise error map prediction task in the form of segmentation. However, the simple application of vanilla segmentation structures in medical image fails to detect some small and thin error regions of the auto-generated masks with complex anatomical structures. In this paper, we propose collaborative boundaryaware context encoding networks called AEP-Net for error prediction task. Specifically, we propose a collaborative feature transformation branch for better feature fusion between images and masks, and precise localization of error regions. Further, we propose a context encoding module to utilize the global predictor from the error map to enhance the feature representation and regularize the networks. We perform experiments on IBSR v2.0 dataset and ACDC dataset. The AEP-Net achieves an average DSC of 0.8358, 0.8164 for error prediction task,and shows a high Pearson correlation coefficient of 0.9873 between the actual segmentation accuracy and the predicted accuracy inferred from the predicted error map on IBSR v2.0 dataset, which verifies the efficacy of our AEP-Net.

Zhenxi Zhang, Jie Li, Zhusi Zhong et al.

3D image segmentation is one of the most important and ubiquitous problems in medical image processing. It provides detailed quantitative analysis for accurate disease diagnosis, abnormal detection, and classification. Currently deep learning algorithms are widely used in medical image segmentation, most algorithms trained models with full annotated datasets. However, obtaining medical image datasets is very difficult and expensive, and full annotation of 3D medical image is a monotonous and time-consuming work. Partially labelling informative slices in 3D images will be a great relief of manual annotation. Sample selection strategies based on active learning have been proposed in the field of 2D image, but few strategies focus on 3D images. In this paper, we propose a sparse annotation strategy based on attention-guided active learning for 3D medical image segmentation. Attention mechanism is used to improve segmentation accuracy and estimate the segmentation accuracy of each slice. The comparative experiments with three different strategies using datasets from the developing human connectome project (dHCP) show that, our strategy only needs 15% to 20% annotated slices in brain extraction task and 30% to 35% annotated slices in tissue segmentation task to achieve comparative results as full annotation.

Zhusi Zhong, Jie Li, Zhenxi Zhang et al.

Cephalometric tracing method is usually used in orthodontic diagnosis and treatment planning. In this paper, we propose a deep learning based framework to automatically detect anatomical landmarks in cephalometric X-ray images. We train the deep encoder-decoder for landmark detection, and combine global landmark configuration with local high-resolution feature responses. The proposed frame-work is based on 2-stage u-net, regressing the multi-channel heatmaps for land-mark detection. In this framework, we embed attention mechanism with global stage heatmaps, guiding the local stage inferring, to regress the local heatmap patches in a high resolution. Besides, the Expansive Exploration strategy improves robustness while inferring, expanding the searching scope without increasing model complexity. We have evaluated our framework in the most widely-used public dataset of landmark detection in cephalometric X-ray images. With less computation and manually tuning, our framework achieves state-of-the-art results.