Minfeng Xu

Heng Guo, Jianfeng Zhang, Ke Yan et al.

Automatic parsing of human anatomies at the instance-level from 3D computed tomography (CT) is a prerequisite step for many clinical applications. The presence of pathologies, broken structures or limited field-of-view (FOV) can all make anatomy parsing algorithms vulnerable. In this work, we explore how to leverage and implement the successful detection-then-segmentation paradigm for 3D medical data, and propose a steerable, robust, and efficient computing framework for detection, identification, and segmentation of anatomies in CT scans. Considering the complicated shapes, sizes, and orientations of anatomies, without loss of generality, we present a nine degrees of freedom (9-DoF) pose estimation solution in full 3D space using a novel single-stage, non-hierarchical representation. Our whole framework is executed in a steerable manner where any anatomy of interest can be directly retrieved to further boost inference efficiency. We have validated our method on three medical imaging parsing tasks: ribs, spine, and abdominal organs. For rib parsing, CT scans have been annotated at the rib instance-level for quantitative evaluation, similarly for spine vertebrae and abdominal organs. Extensive experiments on 9-DoF box detection and rib instance segmentation demonstrate the high efficiency and effectiveness of our framework (with the identification rate of 97.0% and the segmentation Dice score of 90.9%), compared favorably against several strong baselines (e.g., CenterNet, FCOS, and nnU-Net). For spine parsing and abdominal multi-organ segmentation, our method achieves competitive results on par with state-of-the-art methods on the public CTSpine1K dataset and FLARE22 competition, respectively. Our annotations, code, and models are available at: https://github.com/alibaba-damo-academy/Med_Query.

Yankai Jiang, Mingze Sun, Heng Guo et al.

Self-supervised learning (SSL) has recently achieved promising performance for 3D medical image analysis tasks. Most current methods follow existing SSL paradigm originally designed for photographic or natural images, which cannot explicitly and thoroughly exploit the intrinsic similar anatomical structures across varying medical images. This may in fact degrade the quality of learned deep representations by maximizing the similarity among features containing spatial misalignment information and different anatomical semantics. In this work, we propose a new self-supervised learning framework, namely Alice, that explicitly fulfills Anatomical invariance modeling and semantic alignment via elaborately combining discriminative and generative objectives. Alice introduces a new contrastive learning strategy which encourages the similarity between views that are diversely mined but with consistent high-level semantics, in order to learn invariant anatomical features. Moreover, we design a conditional anatomical feature alignment module to complement corrupted embeddings with globally matched semantics and inter-patch topology information, conditioned by the distribution of local image content, which permits to create better contrastive pairs. Our extensive quantitative experiments on three 3D medical image analysis tasks demonstrate and validate the performance superiority of Alice, surpassing the previous best SSL counterpart methods and showing promising ability for united representation learning. Codes are available at https://github.com/alibaba-damo-academy/alice.

Jieneng Chen, Yingda Xia, Jiawen Yao et al.

Human readers or radiologists routinely perform full-body multi-organ multi-disease detection and diagnosis in clinical practice, while most medical AI systems are built to focus on single organs with a narrow list of a few diseases. This might severely limit AI's clinical adoption. A certain number of AI models need to be assembled non-trivially to match the diagnostic process of a human reading a CT scan. In this paper, we construct a Unified Tumor Transformer (CancerUniT) model to jointly detect tumor existence & location and diagnose tumor characteristics for eight major cancers in CT scans. CancerUniT is a query-based Mask Transformer model with the output of multi-tumor prediction. We decouple the object queries into organ queries, tumor detection queries and tumor diagnosis queries, and further establish hierarchical relationships among the three groups. This clinically-inspired architecture effectively assists inter- and intra-organ representation learning of tumors and facilitates the resolution of these complex, anatomically related multi-organ cancer image reading tasks. CancerUniT is trained end-to-end using a curated large-scale CT images of 10,042 patients including eight major types of cancers and occurring non-cancer tumors (all are pathology-confirmed with 3D tumor masks annotated by radiologists). On the test set of 631 patients, CancerUniT has demonstrated strong performance under a set of clinically relevant evaluation metrics, substantially outperforming both multi-disease methods and an assembly of eight single-organ expert models in tumor detection, segmentation, and diagnosis. This moves one step closer towards a universal high performance cancer screening tool.

Minfeng Xu, Heng Guo, Jianfeng Zhang et al.

Accurate and robust abdominal multi-organ segmentation from CT imaging of different modalities is a challenging task due to complex inter- and intra-organ shape and appearance variations among abdominal organs. In this paper, we propose a probabilistic multi-organ segmentation network with hierarchical spatial-wise feature modulation to capture flexible organ semantic variants and inject the learnt variants into different scales of feature maps for guiding segmentation. More specifically, we design an input decomposition module via a conditional variational auto-encoder to learn organ-specific distributions on the low dimensional latent space and model richer organ semantic variations that is conditioned on input images.Then by integrating these learned variations into the V-Net decoder hierarchically via spatial feature transformation, which has the ability to convert the variations into conditional Affine transformation parameters for spatial-wise feature maps modulating and guiding the fine-scale segmentation. The proposed method is trained on the publicly available AbdomenCT-1K dataset and evaluated on two other open datasets, i.e., 100 challenging/pathological testing patient cases from AbdomenCT-1K fully-supervised abdominal organ segmentation benchmark and 90 cases from TCIA+&BTCV dataset. Highly competitive or superior quantitative segmentation results have been achieved using these datasets for four abdominal organs of liver, kidney, spleen and pancreas with reported Dice scores improved by 7.3% for kidneys and 9.7% for pancreas, while being ~7 times faster than two strong baseline segmentation methods(nnUNet and CoTr).

Jianpeng Zhang, Xianghua Ye, Jianfeng Zhang et al.

Lung cancer is a leading cause of death worldwide and early screening is critical for improving survival outcomes. In clinical practice, the contextual structure of nodules and the accumulated experience of radiologists are the two core elements related to the accuracy of identification of benign and malignant nodules. Contextual information provides comprehensive information about nodules such as location, shape, and peripheral vessels, and experienced radiologists can search for clues from previous cases as a reference to enrich the basis of decision-making. In this paper, we propose a radiologist-inspired method to simulate the diagnostic process of radiologists, which is composed of context parsing and prototype recalling modules. The context parsing module first segments the context structure of nodules and then aggregates contextual information for a more comprehensive understanding of the nodule. The prototype recalling module utilizes prototype-based learning to condense previously learned cases as prototypes for comparative analysis, which is updated online in a momentum way during training. Building on the two modules, our method leverages both the intrinsic characteristics of the nodules and the external knowledge accumulated from other nodules to achieve a sound diagnosis. To meet the needs of both low-dose and noncontrast screening, we collect a large-scale dataset of 12,852 and 4,029 nodules from low-dose and noncontrast CTs respectively, each with pathology- or follow-up-confirmed labels. Experiments on several datasets demonstrate that our method achieves advanced screening performance on both low-dose and noncontrast scenarios.

Xiaoyu Bai, Fan Bai, Xiaofei Huo et al.

Radiotherapists require accurate registration of MR/CT images to effectively use information from both modalities. In a typical registration pipeline, rigid or affine transformations are applied to roughly align the fixed and moving images before proceeding with the deformation step. While recent learning-based methods have shown promising results in the rigid/affine step, these methods often require images with similar field-of-view (FOV) for successful alignment. As a result, aligning images with different FOVs remains a challenging task. Self-supervised landmark detection methods like self-supervised Anatomical eMbedding (SAM) have emerged as a useful tool for mapping and cropping images to similar FOVs. However, these methods are currently limited to intra-modality use only. To address this limitation and enable cross-modality matching, we propose a new approach called Cross-SAM. Our approach utilizes a novel iterative process that alternates between embedding learning and CT-MRI registration. We start by applying aggressive contrast augmentation on both CT and MRI images to train a SAM model. We then use this SAM to identify corresponding regions on paired images using robust grid-points matching, followed by a point-set based affine/rigid registration, and a deformable fine-tuning step to produce registered paired images. We use these registered pairs to enhance the matching ability of SAM, which is then processed iteratively. We use the final model for cross-modality matching tasks. We evaluated our approach on two CT-MRI affine registration datasets and found that Cross-SAM achieved robust affine registration on both datasets, significantly outperforming other methods and achieving state-of-the-art performance.

Zhanghexuan Ji, Dazhou Guo, Puyang Wang et al.

Deep learning empowers the mainstream medical image segmentation methods. Nevertheless current deep segmentation approaches are not capable of efficiently and effectively adapting and updating the trained models when new incremental segmentation classes (along with new training datasets or not) are required to be added. In real clinical environment, it can be preferred that segmentation models could be dynamically extended to segment new organs/tumors without the (re-)access to previous training datasets due to obstacles of patient privacy and data storage. This process can be viewed as a continual semantic segmentation (CSS) problem, being understudied for multi-organ segmentation. In this work, we propose a new architectural CSS learning framework to learn a single deep segmentation model for segmenting a total of 143 whole-body organs. Using the encoder/decoder network structure, we demonstrate that a continually-trained then frozen encoder coupled with incrementally-added decoders can extract and preserve sufficiently representative image features for new classes to be subsequently and validly segmented. To maintain a single network model complexity, we trim each decoder progressively using neural architecture search and teacher-student based knowledge distillation. To incorporate with both healthy and pathological organs appearing in different datasets, a novel anomaly-aware and confidence learning module is proposed to merge the overlapped organ predictions, originated from different decoders. Trained and validated on 3D CT scans of 2500+ patients from four datasets, our single network can segment total 143 whole-body organs with very high accuracy, closely reaching the upper bound performance level by training four separate segmentation models (i.e., one model per dataset/task).

Ke Yan, Dakai Jin, Dazhou Guo et al.

Finding abnormal lymph nodes in radiological images is highly important for various medical tasks such as cancer metastasis staging and radiotherapy planning. Lymph nodes (LNs) are small glands scattered throughout the body. They are grouped or defined to various LN stations according to their anatomical locations. The CT imaging appearance and context of LNs in different stations vary significantly, posing challenges for automated detection, especially for pathological LNs. Motivated by this observation, we propose a novel end-to-end framework to improve LN detection performance by leveraging their station information. We design a multi-head detector and make each head focus on differentiating the LN and non-LN structures of certain stations. Pseudo station labels are generated by an LN station classifier as a form of multi-task learning during training, so we do not need another explicit LN station prediction model during inference. Our algorithm is evaluated on 82 patients with lung cancer and 91 patients with esophageal cancer. The proposed implicit station stratification method improves the detection sensitivity of thoracic lymph nodes from 65.1% to 71.4% and from 80.3% to 85.5% at 2 false positives per patient on the two datasets, respectively, which significantly outperforms various existing state-of-the-art baseline techniques such as nnUNet, nnDetection and LENS.

Bokai Zhao, Yiyang Zhang, Yuanchi Zhu et al.

Pathology foundation models (PFMs) have emerged as a core approach for learning transferable representations from whole slide images (WSIs), and they are typically benchmarked through downstream clinical endpoints. While such task level evaluations are indispensable, they offer limited insight into what the representations themselves encode, particularly whether PFM embeddings can distinguish meaningful tissue regions and capture their spatial relationships. We present SpaPath-Bench, a representation level benchmark designed to diagnose spatial representation capability in PFMs. SpaPath-Bench formulates spatial domain identification (SDI) on paired whole slide image and spatial transcriptomics (ST) data as a diagnostic task. It curates 42 public paired WSI and ST slides, enables large scale evaluation across 19 encoders and seven SDI methods, and measures partition quality using three complementary criteria: unsupervised spatial coherence, transcriptomics referenced agreement, and expert referenced agreement. Across 83K runs, SpaPath-Bench reveals that different pretraining paradigms capture distinct aspects of tissue spatial architecture, and it provides practical guidance for building the next generation of spatially aware computational pathology models. Code and data pipelines are publicly available at https://bokai-zhao.github.io/SpaPath-benchboard/.

Chengyu Fang, Heng Guo, Zheng Jiang et al.

Multimodal large language models are promising for clinical visual question answering tasks, but scaling to 3D imaging is hindered by high computational costs. Prior methods often rely on 2D slices or fixed-length token compression, disrupting volumetric continuity and obscuring subtle findings. We present Photon, a framework that represents 3D medical volumes with token sequences of variable length. Photon introduces instruction-conditioned token scheduling and surrogate gradient propagation to adaptively reduce tokens during both training and inference, which lowers computational cost while mitigating the attention dilution caused by redundant tokens. It incorporates a custom backpropagation rule with gradient restoration to enable differentiable optimization despite discrete token drop. To stabilize token compression and ensure reliable use of visual evidence, Photon further applies regularization objectives that mitigate language-only bias and improve reliability. Experiments on diverse medical visual question answering tasks show that Photon achieves state-of-the-art accuracy while reducing resource usage and accelerating both training and inference.

Bizhe Bai, Yan-Jie Zhou, Yujian Hu et al.

Pulmonary embolism (PE) is a life-threatening condition where rapid and accurate diagnosis is imperative yet difficult due to predominantly atypical symptomatology. Computed tomography pulmonary angiography (CTPA) is acknowledged as the gold standard imaging tool in clinics, yet it can be contraindicated for emergency department (ED) patients and represents an onerous procedure, thus necessitating PE identification through non-contrast CT (NCT) scans. In this work, we explore the feasibility of applying a deep-learning approach to NCT scans for PE identification. We propose a novel Cross-Phase Mutual learNing framework (CPMN) that fosters knowledge transfer from CTPA to NCT, while concurrently conducting embolism segmentation and abnormality classification in a multi-task manner. The proposed CPMN leverages the Inter-Feature Alignment (IFA) strategy that enhances spatial contiguity and mutual learning between the dual-pathway network, while the Intra-Feature Discrepancy (IFD) strategy can facilitate precise segmentation of PE against complex backgrounds for single-pathway networks. For a comprehensive assessment of the proposed approach, a large-scale dual-phase dataset containing 334 PE patients and 1,105 normal subjects has been established. Experimental results demonstrate that CPMN achieves the leading identification performance, which is 95.4\% and 99.6\% in patient-level sensitivity and specificity on NCT scans, indicating the potential of our approach as an economical, accessible, and precise tool for PE identification in clinical practice.

Heng Guo, Jianfeng Zhang, Jiaxing Huang et al.

Segment anything model (SAM) demonstrates strong generalization ability on natural image segmentation. However, its direct adaptation in medical image segmentation tasks shows significant performance drops. It also requires an excessive number of prompt points to obtain a reasonable accuracy. Although quite a few studies explore adapting SAM into medical image volumes, the efficiency of 2D adaptation methods is unsatisfactory and 3D adaptation methods are only capable of segmenting specific organs/tumors. In this work, we propose a comprehensive and scalable 3D SAM model for whole-body CT segmentation, named CT-SAM3D. Instead of adapting SAM, we propose a 3D promptable segmentation model using a (nearly) fully labeled CT dataset. To train CT-SAM3D effectively, ensuring the model's accurate responses to higher-dimensional spatial prompts is crucial, and 3D patch-wise training is required due to GPU memory constraints. Therefore, we propose two key technical developments: 1) a progressively and spatially aligned prompt encoding method to effectively encode click prompts in local 3D space; and 2) a cross-patch prompt scheme to capture more 3D spatial context, which is beneficial for reducing the editing workloads when interactively prompting on large organs. CT-SAM3D is trained using a curated dataset of 1204 CT scans containing 107 whole-body anatomies and extensively validated using five datasets, achieving significantly better results against all previous SAM-derived models. Code, data, and our 3D interactive segmentation tool with quasi-real-time responses are available at https://github.com/alibaba-damo-academy/ct-sam3d.

Zijiang Yang, Hanqing Chao, Bokai Zhao et al.

Nucleus detection and classification (NDC) in histopathology analysis is a fundamental task that underpins a wide range of high-level pathology applications. However, existing methods heavily rely on labor-intensive nucleus-level annotations and struggle to fully exploit large-scale unlabeled data for learning discriminative nucleus representations. In this work, we propose MUSE (MUlti-scale denSE self-distillation), a novel self-supervised learning method tailored for NDC. At its core is NuLo (Nucleus-based Local self-distillation), a coordinate-guided mechanism that enables flexible local self-distillation based on predicted nucleus positions. By removing the need for strict spatial alignment between augmented views, NuLo allows critical cross-scale alignment, thus unlocking the capacity of models for fine-grained nucleus-level representation. To support MUSE, we design a simple yet effective encoder-decoder architecture and a large field-of-view semi-supervised fine-tuning strategy that together maximize the value of unlabeled pathology images. Extensive experiments on three widely used benchmarks demonstrate that MUSE effectively addresses the core challenges of histopathological NDC. The resulting models not only surpass state-of-the-art supervised baselines but also outperform generic pathology foundation models.

Yicheng Wu, Zongyuan Ge, Donghao Zhang et al.

In this paper, we propose a novel mutual consistency network (MC-Net+) to effectively exploit the unlabeled data for semi-supervised medical image segmentation. The MC-Net+ model is motivated by the observation that deep models trained with limited annotations are prone to output highly uncertain and easily mis-classified predictions in the ambiguous regions (e.g., adhesive edges or thin branches) for medical image segmentation. Leveraging these challenging samples can make the semi-supervised segmentation model training more effective. Therefore, our proposed MC-Net+ model consists of two new designs. First, the model contains one shared encoder and multiple slightly different decoders (i.e., using different up-sampling strategies). The statistical discrepancy of multiple decoders' outputs is computed to denote the model's uncertainty, which indicates the unlabeled hard regions. Second, we apply a novel mutual consistency constraint between one decoder's probability output and other decoders' soft pseudo labels. In this way, we minimize the discrepancy of multiple outputs (i.e., the model uncertainty) during training and force the model to generate invariant results in such challenging regions, aiming at regularizing the model training. We compared the segmentation results of our MC-Net+ model with five state-of-the-art semi-supervised approaches on three public medical datasets. Extension experiments with two standard semi-supervised settings demonstrate the superior performance of our model over other methods, which sets a new state of the art for semi-supervised medical image segmentation. Our code is released publicly at https://github.com/ycwu1997/MC-Net.

Wei Fang, Yuxing Tang, Heng Guo et al.

In the realm of medical 3D data, such as CT and MRI images, prevalent anisotropic resolution is characterized by high intra-slice but diminished inter-slice resolution. The lowered resolution between adjacent slices poses challenges, hindering optimal viewing experiences and impeding the development of robust downstream analysis algorithms. Various volumetric super-resolution algorithms aim to surmount these challenges, enhancing inter-slice resolution and overall 3D medical imaging quality. However, existing approaches confront inherent challenges: 1) often tailored to specific upsampling factors, lacking flexibility for diverse clinical scenarios; 2) newly generated slices frequently suffer from over-smoothing, degrading fine details, and leading to inter-slice inconsistency. In response, this study presents CycleINR, a novel enhanced Implicit Neural Representation model for 3D medical data volumetric super-resolution. Leveraging the continuity of the learned implicit function, the CycleINR model can achieve results with arbitrary up-sampling rates, eliminating the need for separate training. Additionally, we enhance the grid sampling in CycleINR with a local attention mechanism and mitigate over-smoothing by integrating cycle-consistent loss. We introduce a new metric, Slice-wise Noise Level Inconsistency (SNLI), to quantitatively assess inter-slice noise level inconsistency. The effectiveness of our approach is demonstrated through image quality evaluations on an in-house dataset and a downstream task analysis on the Medical Segmentation Decathlon liver tumor dataset.

Zheng Jiang, Heng Guo, Chengyu Fang et al.

Medical Vision-Language Models (VLMs) hold immense promise for complex clinical tasks, but their reasoning capabilities are often constrained by text-only paradigms that fail to ground inferences in visual evidence. This limitation not only curtails performance on tasks requiring fine-grained visual analysis but also introduces risks of visual hallucination in safety-critical applications. Thus, we introduce MedVR, a novel reinforcement learning framework that enables annotation-free visual reasoning for medical VLMs. Its core innovation lies in two synergistic mechanisms: Entropy-guided Visual Regrounding (EVR) uses model uncertainty to direct exploration, while Consensus-based Credit Assignment (CCA) distills pseudo-supervision from rollout agreement. Without any human annotations for intermediate steps, MedVR achieves state-of-the-art performance on diverse public medical VQA benchmarks, significantly outperforming existing models. By learning to reason directly with visual evidence, MedVR promotes the robustness and transparency essential for accelerating the clinical deployment of medical AI.

Ao Li, Wei Fang, Hongbo Zhao et al.

In applications of diffusion models, controllable generation is of practical significance, but is also challenging. Current methods for controllable generation primarily focus on modifying the score function of diffusion models, while Mean Reverting (MR) Diffusion directly modifies the structure of the stochastic differential equation (SDE), making the incorporation of image conditions simpler and more natural. However, current training-free fast samplers are not directly applicable to MR Diffusion. And thus MR Diffusion requires hundreds of NFEs (number of function evaluations) to obtain high-quality samples. In this paper, we propose a new algorithm named MaRS (MR Sampler) to reduce the sampling NFEs of MR Diffusion. We solve the reverse-time SDE and the probability flow ordinary differential equation (PF-ODE) associated with MR Diffusion, and derive semi-analytical solutions. The solutions consist of an analytical function and an integral parameterized by a neural network. Based on this solution, we can generate high-quality samples in fewer steps. Our approach does not require training and supports all mainstream parameterizations, including noise prediction, data prediction and velocity prediction. Extensive experiments demonstrate that MR Sampler maintains high sampling quality with a speedup of 10 to 20 times across ten different image restoration tasks. Our algorithm accelerates the sampling procedure of MR Diffusion, making it more practical in controllable generation.

Dazhou Guo, Zhanghexuan Ji, Yanzhou Su et al.

Precision medicine in the quantitative management of chronic diseases and oncology would be greatly improved if the Computed Tomography (CT) scan of any patient could be segmented, parsed and analyzed in a precise and detailed way. However, there is no such fully annotated CT dataset with all anatomies delineated for training because of the exceptionally high manual cost, the need for specialized clinical expertise, and the time required to finish the task. To this end, we proposed a novel continual learning-driven CT model that can segment complete anatomies presented using dozens of previously partially labeled datasets, dynamically expanding its capacity to segment new ones without compromising previously learned organ knowledge. Existing multi-dataset approaches are not able to dynamically segment new anatomies without catastrophic forgetting and would encounter optimization difficulty or infeasibility when segmenting hundreds of anatomies across the whole range of body regions. Our single unified CT segmentation model, CL-Net, can highly accurately segment a clinically comprehensive set of 235 fine-grained whole-body anatomies. Composed of a universal encoder, multiple optimized and pruned decoders, CL-Net is developed using 13,952 CT scans from 20 public and 16 private high-quality partially labeled CT datasets of various vendors, different contrast phases, and pathologies. Extensive evaluation demonstrates that CL-Net consistently outperforms the upper limit of an ensemble of 36 specialist nnUNets trained per dataset with the complexity of 5% model size and significantly surpasses the segmentation accuracy of recent leading Segment Anything-style medical image foundation models by large margins. Our continual learning-driven CL-Net model would lay a solid foundation to facilitate many downstream tasks of oncology and chronic diseases using the most widely adopted CT imaging.

Che Liu, Zheng Jiang, Chengyu Fang et al.

Medical image retrieval is essential for clinical decision-making and translational research, relying on discriminative visual representations. Yet, current methods remain fragmented, relying on separate architectures and training strategies for 2D, 3D, and video-based medical data. This modality-specific design hampers scalability and inhibits the development of unified representations. To enable unified learning, we curate a large-scale hybrid-modality dataset comprising 867,653 medical imaging samples, including 2D X-rays and ultrasounds, RGB endoscopy videos, and 3D CT scans. Leveraging this dataset, we train M3Ret, a unified visual encoder without any modality-specific customization. It successfully learns transferable representations using both generative (MAE) and contrastive (SimDINO) self-supervised learning (SSL) paradigms. Our approach sets a new state-of-the-art in zero-shot image-to-image retrieval across all individual modalities, surpassing strong baselines such as DINOv3 and the text-supervised BMC-CLIP. More remarkably, strong cross-modal alignment emerges without paired data, and the model generalizes to unseen MRI tasks, despite never observing MRI during pretraining, demonstrating the generalizability of purely visual self-supervision to unseen modalities. Comprehensive analyses further validate the scalability of our framework across model and data sizes. These findings deliver a promising signal to the medical imaging community, positioning M3Ret as a step toward foundation models for visual SSL in multimodal medical image understanding.

Runze Wang, Zeli Chen, Zhiyun Song et al.

To reduce radiation exposure and improve the diagnostic efficacy of low-dose computed tomography (LDCT), numerous deep learning-based denoising methods have been developed to mitigate noise and artifacts. However, most of these approaches ignore the anatomical semantics of human tissues, which may potentially result in suboptimal denoising outcomes. To address this problem, we propose ALDEN, an anatomy-aware LDCT denoising method that integrates semantic features of pretrained vision models (PVMs) with adversarial and contrastive learning. Specifically, we introduce an anatomy-aware discriminator that dynamically fuses hierarchical semantic features from reference normal-dose CT (NDCT) via cross-attention mechanisms, enabling tissue-specific realism evaluation in the discriminator. In addition, we propose a semantic-guided contrastive learning module that enforces anatomical consistency by contrasting PVM-derived features from LDCT, denoised CT and NDCT, preserving tissue-specific patterns through positive pairs and suppressing artifacts via dual negative pairs. Extensive experiments conducted on two LDCT denoising datasets reveal that ALDEN achieves the state-of-the-art performance, offering superior anatomy preservation and substantially reducing over-smoothing issue of previous work. Further validation on a downstream multi-organ segmentation task (encompassing 117 anatomical structures) affirms the model's ability to maintain anatomical awareness.

Jiaxing Huang, Heng Guo, Le Lu et al.

Osteoporosis, characterized by reduced bone mineral density (BMD) and compromised bone microstructure, increases fracture risk in aging populations. While dual-energy X-ray absorptiometry (DXA) is the clinical standard for BMD assessment, its limited accessibility hinders diagnosis in resource-limited regions. Opportunistic computed tomography (CT) analysis has emerged as a promising alternative for osteoporosis diagnosis using existing imaging data. Current approaches, however, face three limitations: (1) underutilization of unlabeled vertebral data, (2) systematic bias from device-specific DXA discrepancies, and (3) insufficient integration of clinical knowledge such as spatial BMD distribution patterns. To address these, we propose a unified deep learning framework with three innovations. First, a self-supervised learning method using radiomic representations to leverage unlabeled CT data and preserve bone texture. Second, a Mixture of Experts (MoE) architecture with learned gating mechanisms to enhance cross-device adaptability. Third, a multi-task learning framework integrating osteoporosis diagnosis, BMD regression, and vertebra location prediction. Validated across three clinical sites and an external hospital, our approach demonstrates superior generalizability and accuracy over existing methods for opportunistic osteoporosis screening and diagnosis.

Minfeng Xu, Chen-Chen Fan, Yan-Jie Zhou et al.

Cardiovascular diseases (CVD) remain a leading health concern and contribute significantly to global mortality rates. While clinical advancements have led to a decline in CVD mortality, accurately identifying individuals who could benefit from preventive interventions remains an unsolved challenge in preventive cardiology. Current CVD risk prediction models, recommended by guidelines, are based on limited traditional risk factors or use CT imaging to acquire quantitative biomarkers, and still have limitations in predictive accuracy and applicability. On the other hand, end-to-end trained CVD risk prediction methods leveraging deep learning on CT images often fail to provide transparent and explainable decision grounds for assisting physicians. In this work, we proposed a novel joint representation that integrates discrete quantitative biomarkers and continuous deep features extracted from chest CT scans. Our approach initiated with a deep CVD risk classification model by capturing comprehensive continuous deep learning features while jointly obtaining currently clinical-established quantitative biomarkers via segmentation models. In the feature joint representation stage, we use an instance-wise feature-gated mechanism to align the continuous and discrete features, followed by a soft instance-wise feature interaction mechanism fostering independent and effective feature interaction for the final CVD risk prediction. Our method substantially improves CVD risk predictive performance and offers individual contribution analysis of each biomarker, which is important in assisting physicians' decision-making processes. We validated our method on a public chest low-dose CT dataset and a private external chest standard-dose CT patient cohort of 17,207 CT volumes from 6,393 unique subjects, and demonstrated superior predictive performance, achieving AUCs of 0.875 and 0.843, respectively.

Yujian Hu, Yilang Xiang, Yan-Jie Zhou et al.

The accurate and timely diagnosis of acute aortic syndromes (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic CT angiography (CTA) is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo non-contrast CT as the initial imaging testing, and CTA is reserved for those at higher risk. In this work, we present an artificial intelligence-based warning system, iAorta, using non-contrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multi-center retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve (AUC) of 0.958 (95% CI 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various non-contrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway. For the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under non-contrast CT protocol in the emergency department (ED) and enabled the average diagnostic time of these 21 AAS positive patients to be 102.1 (75-133) mins. Last, the iAorta can help avoid delayed or missed diagnosis of AAS in settings where non-contrast CT remains the unavoidable the initial or only imaging test in resource-constrained regions and in patients who cannot or did not receive intravenous contrast.

Yicheng Wu, Minfeng Xu, Zongyuan Ge et al.

Semi-supervised learning has attracted great attention in the field of machine learning, especially for medical image segmentation tasks, since it alleviates the heavy burden of collecting abundant densely annotated data for training. However, most of existing methods underestimate the importance of challenging regions (e.g. small branches or blurred edges) during training. We believe that these unlabeled regions may contain more crucial information to minimize the uncertainty prediction for the model and should be emphasized in the training process. Therefore, in this paper, we propose a novel Mutual Consistency Network (MC-Net) for semi-supervised left atrium segmentation from 3D MR images. Particularly, our MC-Net consists of one encoder and two slightly different decoders, and the prediction discrepancies of two decoders are transformed as an unsupervised loss by our designed cycled pseudo label scheme to encourage mutual consistency. Such mutual consistency encourages the two decoders to have consistent and low-entropy predictions and enables the model to gradually capture generalized features from these unlabeled challenging regions. We evaluate our MC-Net on the public Left Atrium (LA) database and it obtains impressive performance gains by exploiting the unlabeled data effectively. Our MC-Net outperforms six recent semi-supervised methods for left atrium segmentation, and sets the new state-of-the-art performance on the LA database.