Xiaokun Liang

Xuan Liu, Yaoqin Xie, Songhui Diao et al.

During the process of computed tomography (CT), metallic implants often cause disruptive artifacts in the reconstructed images, impeding accurate diagnosis. Several supervised deep learning-based approaches have been proposed for reducing metal artifacts (MAR). However, these methods heavily rely on training with simulated data, as obtaining paired metal artifact CT and clean CT data in clinical settings is challenging. This limitation can lead to decreased performance when applying these methods in clinical practice. Existing unsupervised MAR methods, whether based on learning or not, typically operate within a single domain, either in the image domain or the sinogram domain. In this paper, we propose an unsupervised MAR method based on the diffusion model, a generative model with a high capacity to represent data distributions. Specifically, we first train a diffusion model using CT images without metal artifacts. Subsequently, we iteratively utilize the priors embedded within the pre-trained diffusion model in both the sinogram and image domains to restore the degraded portions caused by metal artifacts. This dual-domain processing empowers our approach to outperform existing unsupervised MAR methods, including another MAR method based on the diffusion model, which we have qualitatively and quantitatively validated using synthetic datasets. Moreover, our method demonstrates superior visual results compared to both supervised and unsupervised methods on clinical datasets.

Shilong Yang, Chulong Zhang, Qi Zang et al.

Breast cancer is a significant global health issue, and the diagnosis of breast imaging has always been challenging. Mammography images typically have extremely high resolution, with lesions occupying only a very small area. Down-sampling in neural networks can easily lead to the loss of microcalcifications or subtle structures, making it difficult for traditional neural network architectures to address these issues. To tackle these challenges, we propose a Context Clustering Network with triple information fusion. Firstly, compared to CNNs or transformers, we find that Context clustering methods (1) are more computationally efficient and (2) can more easily associate structural or pathological features, making them suitable for the clinical tasks of mammography. Secondly, we propose a triple information fusion mechanism that integrates global information, feature-based local information, and patch-based local information. The proposed approach is rigorously evaluated on two public datasets, Vindr-Mammo and CBIS-DDSM, using five independent splits to ensure statistical robustness. Our method achieves an AUC of 0.828 on Vindr-Mammo and 0.805 on CBIS-DDSM, outperforming the next best method by 3.1% and 2.4%, respectively. These improvements are statistically significant (p<0.05), underscoring the benefits of Context Clustering Network with triple information fusion. Overall, our Context Clustering framework demonstrates strong potential as a scalable and cost-effective solution for large-scale mammography screening, enabling more efficient and accurate breast cancer detection. Access to our method is available at https://github.com/Sohyu1/Mammo_Clustering.

Chulong Zhang, Yuming Jiang, Na Li et al.

Pathologists need to combine information from differently stained pathology slices for accurate diagnosis. Deformable image registration is a necessary technique for fusing multi-modal pathology slices. This paper proposes a hybrid deep feature-based deformable image registration framework for stained pathology samples. We first extract dense feature points via the detector-based and detector-free deep learning feature networks and perform points matching. Then, to further reduce false matches, an outlier detection method combining the isolation forest statistical model and the local affine correction model is proposed. Finally, the interpolation method generates the deformable vector field for pathology image registration based on the above matching points. We evaluate our method on the dataset of the Non-rigid Histology Image Registration (ANHIR) challenge, which is co-organized with the IEEE ISBI 2019 conference. Our technique outperforms the traditional approaches by 17% with the Average-Average registration target error (rTRE) reaching 0.0034. The proposed method achieved state-of-the-art performance and ranked 1st in evaluating the test dataset. The proposed hybrid deep feature-based registration method can potentially become a reliable method for pathology image registration.

Qi Lai, JunYan Li, Qiang Cai et al.

Real-time instance segmentation for spinal endoscopy is important for identifying and protecting critical anatomy during surgery, but it is difficult because of the narrow field of view, specular highlights, smoke/bleeding, unclear boundaries, and large scale changes. Deployment is also constrained by limited surgical hardware, so the model must balance accuracy and speed and remain stable under small-batch (even batch-1) training. We propose LMSF-A, a lightweight multi-scale attention framework co-designed across backbone, neck, and head. The backbone uses a C2f-Pro module that combines RepViT-style re-parameterized convolution (RVB) with efficient multi-scale attention (EMA), enabling multi-branch training while collapsing into a single fast path for inference. The neck improves cross-scale consistency and boundary detail using Scale-Sequence Feature Fusion (SSFF) and Triple Feature Encoding (TFE), which strengthens high-resolution features. The head adopts a Lightweight Multi-task Shared Head (LMSH) with shared convolutions and GroupNorm to reduce parameters and support batch-1 stability. We also release the clinically reviewed PELD dataset (61 patients, 610 images) with instance masks for adipose tissue, bone, ligamentum flavum, and nerve. Experiments show that LMSF-A is highly competitive (or even better than) in all evaluation metrics and much lighter than most instance segmentation methods requiring only 1.8M parameters and 8.8 GFLOPs, and it generalizes well to a public teeth benchmark. Code and dataset: https://github.com/hhwmortal/PELD-Instance-segmentation.

Lin Liu, Xinxin Fan, Haoyang Liu et al.

Rigid pre-registration involving local-global matching or other large deformation scenarios is crucial. Current popular methods rely on unsupervised learning based on grayscale similarity, but under circumstances where different poses lead to varying tissue structures, or where image quality is poor, these methods tend to exhibit instability and inaccuracies. In this study, we propose a novel method for medical image registration based on arbitrary voxel point of interest matching, called query point quizzer (QUIZ). QUIZ focuses on the correspondence between local-global matching points, specifically employing CNN for feature extraction and utilizing the Transformer architecture for global point matching queries, followed by applying average displacement for local image rigid transformation. We have validated this approach on a large deformation dataset of cervical cancer patients, with results indicating substantially smaller deviations compared to state-of-the-art methods. Remarkably, even for cross-modality subjects, it achieves results surpassing the current state-of-the-art.

Lin Liu, Xinxin Fan, Chulong Zhang et al.

Multimodal medical image fusion plays an instrumental role in several areas of medical image processing, particularly in disease recognition and tumor detection. Traditional fusion methods tend to process each modality independently before combining the features and reconstructing the fusion image. However, this approach often neglects the fundamental commonalities and disparities between multimodal information. Furthermore, the prevailing methodologies are largely confined to fusing two-dimensional (2D) medical image slices, leading to a lack of contextual supervision in the fusion images and subsequently, a decreased information yield for physicians relative to three-dimensional (3D) images. In this study, we introduce an innovative unsupervised feature mutual learning fusion network designed to rectify these limitations. Our approach incorporates a Deformable Cross Feature Blend (DCFB) module that facilitates the dual modalities in discerning their respective similarities and differences. We have applied our model to the fusion of 3D MRI and PET images obtained from 660 patients in the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. Through the application of the DCFB module, our network generates high-quality MRI-PET fusion images. Experimental results demonstrate that our method surpasses traditional 2D image fusion methods in performance metrics such as Peak Signal to Noise Ratio (PSNR) and Structural Similarity Index Measure (SSIM). Importantly, the capacity of our method to fuse 3D images enhances the information available to physicians and researchers, thus marking a significant step forward in the field. The code will soon be available online.

Muhammad Imran, Jonathan R. Krebs, Vishal Balaji Sivaraman et al.

Multi-class segmentation of the aorta in computed tomography angiography (CTA) scans is essential for diagnosing and planning complex endovascular treatments for patients with aortic dissections. However, existing methods reduce aortic segmentation to a binary problem, limiting their ability to measure diameters across different branches and zones. Furthermore, no open-source dataset is currently available to support the development of multi-class aortic segmentation methods. To address this gap, we organized the AortaSeg24 MICCAI Challenge, introducing the first dataset of 100 CTA volumes annotated for 23 clinically relevant aortic branches and zones. This dataset was designed to facilitate both model development and validation. The challenge attracted 121 teams worldwide, with participants leveraging state-of-the-art frameworks such as nnU-Net and exploring novel techniques, including cascaded models, data augmentation strategies, and custom loss functions. We evaluated the submitted algorithms using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD), highlighting the approaches adopted by the top five performing teams. This paper presents the challenge design, dataset details, evaluation metrics, and an in-depth analysis of the top-performing algorithms. The annotated dataset, evaluation code, and implementations of the leading methods are publicly available to support further research. All resources can be accessed at https://aortaseg24.grand-challenge.org.

Xuan Liu, Yaoqin Xie, Jun Cheng et al.

Denoising low-dose computed tomography (CT) images is a critical task in medical image computing. Supervised deep learning-based approaches have made significant advancements in this area in recent years. However, these methods typically require pairs of low-dose and normal-dose CT images for training, which are challenging to obtain in clinical settings. Existing unsupervised deep learning-based methods often require training with a large number of low-dose CT images or rely on specially designed data acquisition processes to obtain training data. To address these limitations, we propose a novel unsupervised method that only utilizes normal-dose CT images during training, enabling zero-shot denoising of low-dose CT images. Our method leverages the diffusion model, a powerful generative model. We begin by training a cascaded unconditional diffusion model capable of generating high-quality normal-dose CT images from low-resolution to high-resolution. The cascaded architecture makes the training of high-resolution diffusion models more feasible. Subsequently, we introduce low-dose CT images into the reverse process of the diffusion model as likelihood, combined with the priors provided by the diffusion model and iteratively solve multiple maximum a posteriori (MAP) problems to achieve denoising. Additionally, we propose methods to adaptively adjust the coefficients that balance the likelihood and prior in MAP estimations, allowing for adaptation to different noise levels in low-dose CT images. We test our method on low-dose CT datasets of different regions with varying dose levels. The results demonstrate that our method outperforms the state-of-the-art unsupervised method and surpasses several supervised deep learning-based methods. Codes are available in https://github.com/DeepXuan/Dn-Dp.

Shaode Yu, Haobo Chen, Hang Yu et al.

Feature selection is important in data representation and intelligent diagnosis. Elastic net is one of the most widely used feature selectors. However, the features selected are dependant on the training data, and their weights dedicated for regularized regression are irrelevant to their importance if used for feature ranking, that degrades the model interpretability and extension. In this study, an intuitive idea is put at the end of multiple times of data splitting and elastic net based feature selection. It concerns the frequency of selected features and uses the frequency as an indicator of feature importance. After features are sorted according to their frequency, linear support vector machine performs the classification in an incremental manner. At last, a compact subset of discriminative features is selected by comparing the prediction performance. Experimental results on breast cancer data sets (BCDR-F03, WDBC, GSE 10810, and GSE 15852) suggest that the proposed framework achieves competitive or superior performance to elastic net and with consistent selection of fewer features. How to further enhance its consistency on high-dimension small-sample-size data sets should be paid more attention in our future work. The proposed framework is accessible online (https://github.com/NicoYuCN/elasticnetFR).

Shaode Yu, Zhicheng Zhang, Xiaokun Liang et al.

More attention is being paid for feature importance ranking (FIR), in particular when thousands of features can be extracted for intelligent diagnosis and personalized medicine. A large number of FIR approaches have been proposed, while few are integrated for comparison and real-life applications. In this study, a matlab toolbox is presented and a total of 30 algorithms are collected. Moreover, the toolbox is evaluated on a database of 163 ultrasound images. To each breast mass lesion, 15 features are extracted. To figure out the optimal subset of features for classification, all combinations of features are tested and linear support vector machine is used for the malignancy prediction of lesions annotated in ultrasound images. At last, the effectiveness of FIR is analyzed according to performance comparison. The toolbox is online (https://github.com/NicoYuCN/matFIR). In our future work, more FIR methods, feature selection methods and machine learning classifiers will be integrated.

Meritxell Riera-Marin, Sikha O K, Julia Rodriguez-Comas et al.

Deep learning (DL) has become the dominant approach for medical image segmentation, yet ensuring the reliability and clinical applicability of these models requires addressing key challenges such as annotation variability, calibration, and uncertainty estimation. This is why we created the Calibration and Uncertainty for multiRater Volume Assessment in multiorgan Segmentation (CURVAS), which highlights the critical role of multiple annotators in establishing a more comprehensive ground truth, emphasizing that segmentation is inherently subjective and that leveraging inter-annotator variability is essential for robust model evaluation. Seven teams participated in the challenge, submitting a variety of DL models evaluated using metrics such as Dice Similarity Coefficient (DSC), Expected Calibration Error (ECE), and Continuous Ranked Probability Score (CRPS). By incorporating consensus and dissensus ground truth, we assess how DL models handle uncertainty and whether their confidence estimates align with true segmentation performance. Our findings reinforce the importance of well-calibrated models, as better calibration is strongly correlated with the quality of the results. Furthermore, we demonstrate that segmentation models trained on diverse datasets and enriched with pre-trained knowledge exhibit greater robustness, particularly in cases deviating from standard anatomical structures. Notably, the best-performing models achieved high DSC and well-calibrated uncertainty estimates. This work underscores the need for multi-annotator ground truth, thorough calibration assessments, and uncertainty-aware evaluations to develop trustworthy and clinically reliable DL-based medical image segmentation models.

Yudi Sang, Yanzhen Liu, Sutuke Yibulayimu et al.

The segmentation of pelvic fracture fragments in CT and X-ray images is crucial for trauma diagnosis, surgical planning, and intraoperative guidance. However, accurately and efficiently delineating the bone fragments remains a significant challenge due to complex anatomy and imaging limitations. The PENGWIN challenge, organized as a MICCAI 2024 satellite event, aimed to advance automated fracture segmentation by benchmarking state-of-the-art algorithms on these complex tasks. A diverse dataset of 150 CT scans was collected from multiple clinical centers, and a large set of simulated X-ray images was generated using the DeepDRR method. Final submissions from 16 teams worldwide were evaluated under a rigorous multi-metric testing scheme. The top-performing CT algorithm achieved an average fragment-wise intersection over union (IoU) of 0.930, demonstrating satisfactory accuracy. However, in the X-ray task, the best algorithm attained an IoU of 0.774, highlighting the greater challenges posed by overlapping anatomical structures. Beyond the quantitative evaluation, the challenge revealed methodological diversity in algorithm design. Variations in instance representation, such as primary-secondary classification versus boundary-core separation, led to differing segmentation strategies. Despite promising results, the challenge also exposed inherent uncertainties in fragment definition, particularly in cases of incomplete fractures. These findings suggest that interactive segmentation approaches, integrating human decision-making with task-relevant information, may be essential for improving model reliability and clinical applicability.

Chulong Zhang, Lin Liu, Jingjing Dai et al.

Computed tomography (CT) scans offer a detailed, three-dimensional representation of patients' internal organs. However, conventional CT reconstruction techniques necessitate acquiring hundreds or thousands of x-ray projections through a complete rotational scan of the body, making navigation or positioning during surgery infeasible. In image-guided radiation therapy, a method that reconstructs ultra-sparse X-ray projections into CT images, we can exploit the substantially reduced radiation dose and minimize equipment burden for localization and navigation. In this study, we introduce a novel Transformer architecture, termed XTransCT, devised to facilitate real-time reconstruction of CT images from two-dimensional X-ray images. We assess our approach regarding image quality and structural reliability using a dataset of fifty patients, supplied by a hospital, as well as the larger public dataset LIDC-IDRI, which encompasses thousands of patients. Additionally, we validated our algorithm's generalizability on the LNDb dataset. Our findings indicate that our algorithm surpasses other methods in image quality, structural precision, and generalizability. Moreover, in comparison to previous 3D convolution-based approaches, we note a substantial speed increase of approximately 300 %, achieving 44 ms per 3D image reconstruction.

Charles Huang, Masoud Badiei, Hyunseok Seo et al.

Purpose: Segmentation of organs-at-risk (OARs) is a bottleneck in current radiation oncology pipelines and is often time consuming and labor intensive. In this paper, we propose an atlas-based semi-supervised registration algorithm to generate accurate segmentations of OARs for which there are ground truth contours and rough segmentations of all other OARs in the atlas. To the best of our knowledge, this is the first study to use learning-based registration methods for the segmentation of head and neck patients and demonstrate its utility in clinical applications. Methods: Our algorithm cascades rigid and deformable deformation blocks, and takes on an atlas image (M), set of atlas-space segmentations (S_A), and a patient image (F) as inputs, while outputting patient-space segmentations of all OARs defined on the atlas. We train our model on 475 CT images taken from public archives and Stanford RadOnc Clinic (SROC), validate on 5 CT images from SROC, and test our model on 20 CT images from SROC. Results: Our method outperforms current state of the art learning-based registration algorithms and achieves an overall dice score of 0.789 on our test set. Moreover, our method yields a performance comparable to manual segmentation and supervised segmentation, while solving a much more complex registration problem. Whereas supervised segmentation methods only automate the segmentation process for a select few number of OARs, we demonstrate that our methods can achieve similar performance for OARs of interest, while also providing segmentations for every other OAR on the provided atlas. Conclusions: Our proposed algorithm has significant clinical applications and could help reduce the bottleneck for segmentation of head and neck OARs. Further, our results demonstrate that semi-supervised diffeomorphic registration can be accurately applied to both registration and segmentation problems.