Jennifer Alvén

Xixi Liu, Jorge Lazo, Andreas Hallqvist et al.

Accurate prognostication and risk estimation are essential for guiding clinical decision-making and optimizing patient management. While radiologist-assessed features from CT scans provide valuable indicators of disease severity and outcomes, interpreting such images requires expert knowledge, and translating rich visual information into textual summaries inevitably leads to information loss. In this work, we propose a vision-language framework for 3D CT image understanding that leverages large-scale open-sourced CT images paired with radiology reports through visual instruction tuning. This pre-training enables the model to learn clinically meaningful visual-textual representations, which can then be adapted to downstream survival prediction tasks. By incorporating a survival prediction head on top of the pre-trained model, our approach improves survival prediction from CT images and clinical data while generating clinically meaningful language responses to predefined questions. Experimental results demonstrate that our method outperforms baseline methods in survival prediction, particularly, when clinical data alone is less predictive. The code will be released upon acceptance.

Sofie Allgöwer, Mikael Johansson, Andreas Hallqvist et al.

Accurate prognosis prediction is important for treatment planning in lung cancer, but deep learning-driven survival modelling is often limited by the scarcity of curated imaging cohorts with reliable outcome data. This study evaluates whether representations from a domain-specific foundation model can be used for multimodal survival prediction in data-constrained clinical settings. We assess the foundation model CT-CLIP as a feature extractor for pretreatment computed tomography images and clinical variables from 242 diagnosed lung cancer patients. The evaluation includes adaptation strategies based on frozen encoders, full fine-tuning, and low-rank adaptation, together with modality ablations and comparisons with clinical and multimodal baselines. The results show that a frozen CT-CLIP model combined with a trainable lightweight survival head outperforms the clinical baseline and achieves comparable or improved performance relative to other multimodal approaches, and separates patients into clinically meaningful high- and low-risk groups.

Victor Wåhlstrand, Jennifer Alvén, Ida Häggström

We present a framework to take advantage of existing labels at inference, called \textit{exemplars}, in order to improve the performance of object detection in medical images. The method, \textit{exemplar diffusion}, leverages existing diffusion methods for object detection to enable a training-free approach to adding information of known bounding boxes at test time. We demonstrate that for medical image datasets with clear spatial structure, the method yields an across-the-board increase in average precision and recall, and a robustness to exemplar quality, enabling non-expert annotation. Moreover, we demonstrate how our method may also be used to quantify predictive uncertainty in diffusion detection methods. Source code and data splits openly available online: https://github.com/waahlstrand/ExemplarDiffusion

Victor Wåhlstrand Skärström, Lisa Johansson, Jennifer Alvén et al.

We present a novel method for explainable vertebral fracture assessment (XVFA) in low-dose radiographs using deep neural networks, incorporating vertebra detection and keypoint localization with uncertainty estimates. We incorporate Genant's semi-quantitative criteria as a differentiable rule-based means of classifying both vertebra fracture grade and morphology. Unlike previous work, XVFA provides explainable classifications relatable to current clinical methodology, as well as uncertainty estimations, while at the same time surpassing state-of-the art methods with a vertebra-level sensitivity of 93% and end-to-end AUC of 97% in a challenging setting. Moreover, we compare intra-reader agreement with model uncertainty estimates, with model reliability on par with human annotators.

Richard Petersen, Fredrik Kahl, Jennifer Alvén

Dense annotations, such as segmentation masks, are expensive and time-consuming to obtain, especially for 3D medical images where expert voxel-wise labeling is required. Weakly supervised approaches aim to address this limitation, but often rely on attribution-based methods that struggle to accurately capture small structures such as lung nodules. In this paper, we propose a weakly-supervised segmentation method for lung nodules by combining pretrained state-of-the-art rectified flow and predictor models in a plug-and-play manner. Our approach uses training-free guidance of a 3D rectified flow model, requiring only fine-tuning of the predictor using image-level labels and no retraining of the generative model. The proposed method produces improved-quality segmentations for two separate predictors, consistently detecting lung nodules of varying size and shapes. Experiments on LUNA16 demonstrate improvements over baseline methods, highlighting the potential of generative foundation models as tools for weakly supervised 3D medical image segmentation.

Roman Naeem, Timo Niiniskorpi, Charlotte Sandström et al.

Long-term mortality rates after endovascular aneurysm repair (EVAR) remain elevated due to post-EVAR rupture caused by loss of seal in stent graft sealing zones. Structured CT review using centerline measurements improves detection, but current workflows require manual centerline editing and expert operators. We propose a transformer framework for automated, protocol-driven sealing zone assessment that combines 3D centerline tracking with embedding-based geometric prediction. Two state-of-the-art image-to-graph models are evaluated for aorto-iliac centerline extraction from follow-up CT and for measurement of stent position, vessel diameters, and seal lengths according to EVAR4C protocol. Across the full test set and a challenging no-contrast subset, the proposed fully automatic method outperforms the commercial semi-automatic workflow.

Roman Naeem, David Hagerman, Jennifer Alvén et al.

Tubular trees, such as blood vessels and lung airways, are essential for material transport within the human body. Accurately detecting their centerlines with correct tree topology is critical for clinical tasks such as diagnosis, treatment planning, and surgical navigation. In these applications, maintaining high recall is crucial, as missing small branches can result in fatal mistakes caused by incomplete assessments or undetected abnormalities. We present RefTr, a 3D image-to-graph model for centerline generation of vascular trees via recurrent refinement of confluent trajectories. RefTr uses a Producer-Refiner architecture based on a Transformer decoder, where the Producer proposes a set of initial confluent trajectories that are recurrently refined by the Refiner to produce final trajectories, which forms the centerline graph. The confluent trajectory representation enables refinement of complete trajectories while explicitly enforcing a valid tree topology. The recurrent refinement scheme improves precision and reuses the same Refiner block across multiple steps, yielding a 2.4x reduction in decoder parameters compared to previous SOTA. We also introduce an efficient non-maximum suppression algorithm for spatial tree graphs to merge duplicate branches and boost precision. Across multiple public centerline datasets, RefTr achieves superior recall and comparable precision to previous SOTA, while offering faster inference and substantially fewer parameters, demonstrating its potential as a new state-of-the-art framework for vascular tree analysis in 3D medical imaging.