Shaohua Kevin Zhou

Rongsheng Wang, Fenghe Tang, Zihang Jiang et al.

Learning transferable and interpretable representations from medical volumetric scans remains challenging due to complex anatomical structures and weak, heterogeneous supervision provided by radiology reports. In this paper, we propose Anatomy-aware Semantically-Adaptive Pre-training (ASAP), a principled vision-language pre-training framework for fine-grained medical volumetric representation learning from large-scale chest CT scans and their corresponding radiology reports. ASAP integrates three key components: (1) an anatomy-aware knowledge injection module that incorporates organ-level structural priors via off-the-shelf segmentation tool to encourage anatomically coherent representations; (2) a semantically-adaptive selective alignment mechanism that dynamically associates sentence-level findings with localized volumetric regions; and (3) a semantically-adaptive fusion module for effective interaction between anatomically informed visual features and grounded textual cues under dual-modal masked modeling paradigm. Beyond methodological contributions, we establish a comprehensive benchmark for medical volumetric vision-language pre-training on chest CT, covering 15 datasets and 22 downstream tasks spanning abnormality classification, segmentation, disease prognosis prediction, report generation, vocabulary classification, cross-modal retrieval and visual question answering. This benchmark provides standardized evaluation protocols to systematically assess representation quality under diverse clinical settings and data regimes. Extensive experiments demonstrate that ASAP consistently achieves state-of-the-art performance across tasks and datasets, with particularly pronounced gains under limited supervision and distribution shift, validating its effectiveness in learning transferable and clinically meaningful volumetric representations.

Haoyun Chen, Fenghe Tang, Wenxin Ma et al.

Universal medical image segmentation seeks to use a single foundational model to handle diverse tasks across multiple imaging modalities. However, existing approaches often rely heavily on manual visual prompts or retrieved reference images, which limits their automation and robustness. In addition, naive joint training across modalities often fails to address large domain shifts. To address these limitations, we propose Concept-to-Pixel (C2P), a novel prompt-free universal segmentation framework. C2P explicitly separates anatomical knowledge into two components: Geometric and Semantic representations. It leverages Multimodal Large Language Models (MLLMs) to distill abstract, high-level medical concepts into learnable Semantic Tokens and introduces explicitly supervised Geometric Tokens to enforce universal physical and structural constraints. These disentangled tokens interact deeply with image features to generate input-specific dynamic kernels for precise mask prediction. Furthermore, we introduce a Geometry-Aware Inference Consensus mechanism, which utilizes the model's predicted geometric constraints to assess prediction reliability and suppress outliers. Extensive experiments and analysis on a unified benchmark comprising eight diverse datasets across seven modalities demonstrate the significant superiority of our jointly trained approach, compared to universe- or single-model approaches. Remarkably, our unified model demonstrates strong generalization, achieving impressive results not only on zero-shot tasks involving unseen cases but also in cross-modal transfers across similar tasks. Code is available at: https://github.com/Yundi218/Concept-to-Pixel

Yuhe Tian, Kun Zhang, Haoran Ma et al.

While large language models (LLMs) have advanced CT report generation, existing methods typically encode 3D volumes holistically, failing to distinguish informative cues from redundant anatomical background. Inspired by radiological cognitive subtraction, we propose Differential Visual Prompting (DiffVP), which conditions report generation on explicit, high-level semantic scan-to-reference differences rather than solely on absolute visual features. DiffVP employs a hierarchical difference extractor to capture complementary global and local semantic discrepancies into a shared latent space, along with a difference-to-prompt generator that transforms these signals into learnable visual prefix tokens for LLM conditioning. These difference prompts serve as structured conditioning signals that implicitly suppress invariant anatomy while amplifying diagnostically relevant visual evidence, thereby facilitating accurate report generation without explicit lesion localization. On two large-scale benchmarks, DiffVP consistently outperforms prior methods, improving the average BLEU-1-4 by +10.98 and +4.36, respectively, and further boosts clinical efficacy on RadGenome-ChestCT (F1 score 0.421). All codes will be released at https://github.com/ArielTYH/DiffVP/.

Bingkun Nian, Fenghe Tang, Jianrui Ding et al.

Dynamic convolution demonstrates outstanding representation capabilities, which are crucial for natural image segmentation. However, it fails when applied to medical image segmentation (MIS) and infrared small target segmentation (IRSTS) due to limited data and limited fitting capacity. In this paper, we propose a new type of dynamic convolution called dynamic parameter convolution (DPConv) which shows superior fitting capacity, and it can efficiently leverage features from deep layers of encoder in reconstruction tasks to generate DPConv kernels that adapt to input variations.Moreover, we observe that DPConv, built upon deep features derived from reconstruction tasks, significantly enhances downstream segmentation performance. We refer to the segmentation network integrated with DPConv generated from reconstruction network as the siamese reconstruction-segmentation network (SRS). We conduct extensive experiments on seven datasets including five medical datasets and two infrared datasets, and the experimental results demonstrate that our method can show superior performance over several recently proposed methods. Furthermore, the zero-shot segmentation under unseen modality demonstrates the generalization of DPConv. The code is available at: https://github.com/fidshu/SRSNet.

Zhengyang Xu, Han Li, Jingsong Liu et al.

Recent AI navigation approaches aim to improve Whole-Slide Image (WSI) diagnosis by modeling spatial exploration and selecting diagnostically relevant regions, yet most operate at a single fixed magnification or rely on predefined magnification traversal. In clinical practice, pathologists examine slides across multiple magnifications and selectively inspect only necessary scales, dynamically integrating global and cellular evidence in a sequential manner. This mismatch prevents existing methods from modeling cross-magnification interactions and adaptive magnification selection inherent to real diagnostic workflows. To these, we propose a clinically consistent Multi-Magnification WSI Navigation Agent (MMNavAgent) that explicitly models multi magnification interaction and adaptive magnification selection. Specifically, we introduce a Cross-Magnification navigation Tool (CMT) that aggregates contextual information from adjacent magnifications to enhance discriminative representations along the navigation path. We further introduce a Magnification Selection Tool (MST) that leverages memory-driven reasoning within the agent framework to enable interactive and adaptive magnification selection, mimicking the sequential decision process of pathologists. Extensive experiments on a public dataset demonstrate improved diagnostic performance, with 1.45% gain of AUC and 2.93% gain of BACC over a non-agent baseline. Code will be public upon acceptance.

Yifan Li, Fenghe Tang, Yingtai Li et al.

General-purpose large Vision-Language Models (VLMs) demonstrate strong capabilities in generating detailed descriptions for natural images. However, their performance in the medical domain remains suboptimal, even for relatively straightforward tasks, primarily due to the lack of large-scale, high-quality, specialized medical imaging datasets and the neglect of the diagnostic process that progresses from coarse to fine-grained. To address the first issue, we construct the CT-RATE-VQA dataset, which has 84K QA pairs. For the second issue, we propose MedReason-R1, a medical VLM with explicit reasoning process for disease diagnosis. MedReason-R1 incorporates a novel strategy that embeds zoom-in disease region-of-interest areas into the image, highlighting the crucial role of both global localization and disease-specific details in enhancing the model's diagnostic performance. Furthermore, we introduce the GRPO reinforcement learning framework to MedReason-R1, which enables effective reasoning without relying on costly manual annotations. Compared to recent general-purpose and medical VLMs, MedReason-R1 achieves state-of-the-art performance in CT disease diagnosis while retaining generalization. The code, checkpoints, and dataset are available at: https://github.com/Leevan001/MedReason-R1

Fenghe Tang, Chengqi Dong, Wenxin Ma et al.

Over the past decade, U-Net has been the dominant architecture in medical image segmentation, leading to the development of thousands of U-shaped variants. Despite its widespread adoption, there is still no comprehensive benchmark to systematically evaluate their performance and utility, largely because of insufficient statistical validation and limited consideration of efficiency and generalization across diverse datasets. To bridge this gap, we present U-Bench, the first large-scale, statistically rigorous benchmark that evaluates 100 U-Net variants across 28 datasets and 10 imaging modalities. Our contributions are threefold: (1) Comprehensive Evaluation: U-Bench evaluates models along three key dimensions: statistical robustness, zero-shot generalization, and computational efficiency. We introduce a novel metric, U-Score, which jointly captures the performance-efficiency trade-off, offering a deployment-oriented perspective on model progress. (2) Systematic Analysis and Model Selection Guidance: We summarize key findings from the large-scale evaluation and systematically analyze the impact of dataset characteristics and architectural paradigms on model performance. Based on these insights, we propose a model advisor agent to guide researchers in selecting the most suitable models for specific datasets and tasks. (3) Public Availability: We provide all code, models, protocols, and weights, enabling the community to reproduce our results and extend the benchmark with future methods. In summary, U-Bench not only exposes gaps in previous evaluations but also establishes a foundation for fair, reproducible, and practically relevant benchmarking in the next decade of U-Net-based segmentation models. The project can be accessed at: https://fenghetan9.github.io/ubench. Code is available at: https://github.com/FengheTan9/U-Bench.

Wenliang Li, Rui Yan, Xu Zhang et al.

Large language models (LLMs) have demonstrated notable potential in medical applications, yet they face substantial challenges in handling complex real-world clinical diagnoses using conventional prompting methods. Current prompt engineering and multi-agent approaches typically optimize isolated inferences, neglecting the accumulation of reusable clinical experience. To address this, this study proposes a novel Multi-Agent Clinical Diagnosis (MACD) framework, which allows LLMs to self-learn clinical knowledge via a multi-agent pipeline that summarizes, refines, and applies diagnostic insights. It mirrors how physicians develop expertise through experience, enabling more focused and accurate diagnosis on key disease-specific cues. We further extend it to a MACD-human collaborative workflow, where multiple LLM-based diagnostician agents engage in iterative consultations, supported by an evaluator agent and human oversight for cases where agreement is not reached. Evaluated on 4,390 real-world patient cases across seven diseases using diverse open-source LLMs (Llama-3.1 8B/70B, DeepSeek-R1-Distill-Llama 70B), MACD significantly improves primary diagnostic accuracy, outperforming established clinical guidelines with gains up to 22.3% (MACD). In direct comparison with physician-only diagnosis under the same evaluation protocol, MACD achieves comparable or superior performance, with improvements up to 16%. Furthermore, the MACD-human workflow yields an 18.6% improvement over physician-only diagnosis, demonstrating the synergistic potential of human-AI collaboration. Notably, the self-learned clinical knowledge exhibits strong cross-model stability, transferability across LLMs, and capacity for model-specific personalization.This work thus presents a scalable self-learning paradigm that bridges the gap between the intrinsic knowledge of LLMs.

Yingtai Li, Haoran Lai, Xiaoqian Zhou et al.

The emergence of Large Language Models (LLMs) presents unprecedented opportunities to revolutionize medical contrastive vision-language pre-training. In this paper, we show how LLMs can facilitate large-scale supervised pre-training, thereby advancing vision-language alignment. We begin by demonstrate that modern LLMs can automatically extract diagnostic labels from radiology reports with remarkable precision (>96\% AUC in our experiments) without complex prompt engineering, enabling the creation of large-scale "silver-standard" datasets at a minimal cost (~\$3 for 50k CT image-report pairs). Further, we find that vision encoder trained on this "silver-standard" dataset achieves performance comparable to those trained on labels extracted by specialized BERT-based models, thereby democratizing the access to large-scale supervised pre-training. Building on this foundation, we proceed to reveal that supervised pre-training fundamentally improves contrastive vision-language alignment. Our approach achieves state-of-the-art performance using only a 3D ResNet-18 with vanilla CLIP training, including 83.8\% AUC for zero-shot diagnosis on CT-RATE, 77.3\% AUC on RAD-ChestCT, and substantial improvements in cross-modal retrieval (MAP@50=53.7\% for image-image, Recall@100=52.2\% for report-image). These results demonstrate the potential of utilizing LLMs to facilitate {\bf more performant and scalable} medical AI systems. Our code is avaiable at https://github.com/SadVoxel/More-performant-and-scalable.

Rongsheng Wang, Fenghe Tang, Qingsong Yao et al.

Medical vision-language pre-training shows great potential in learning representative features from massive paired radiographs and reports. However, in computed tomography (CT) scans, the distribution of lesions which contain intricate structures is characterized by spatial sparsity. Besides, the complex and implicit relationships between different pathological descriptions in each sentence of the report and their corresponding sub-regions in radiographs pose additional challenges. In this paper, we propose a Similarity-Driven Cross-Granularity Pre-training (SimCroP) framework on chest CTs, which combines similarity-driven alignment and cross-granularity fusion to improve radiograph interpretation. We first leverage multi-modal masked modeling to optimize the encoder for understanding precise low-level semantics from radiographs. Then, similarity-driven alignment is designed to pre-train the encoder to adaptively select and align the correct patches corresponding to each sentence in reports. The cross-granularity fusion module integrates multimodal information across instance level and word-patch level, which helps the model better capture key pathology structures in sparse radiographs, resulting in improved performance for multi-scale downstream tasks. SimCroP is pre-trained on a large-scale paired CT-reports dataset and validated on image classification and segmentation tasks across five public datasets. Experimental results demonstrate that SimCroP outperforms both cutting-edge medical self-supervised learning methods and medical vision-language pre-training methods. Codes and models are available at https://github.com/ToniChopp/SimCroP.

Zhidong Yang, Xiuhui Shi, Wei Ba et al.

Whole slide image (WSI) analysis has emerged as an increasingly essential technique in computational pathology. Recent advances in the pathology foundation models (FMs) have demonstrated significant advantages in deriving meaningful patch-level or slide-level multi-scale features from WSIs. However, current pathology FMs have exhibited substantial heterogeneity caused by diverse private training datasets and different network architectures. This heterogeneity introduces performance variability when we utilize the features from different FMs in the downstream tasks. To fully explore the advantages of multiple FMs effectively, in this work, we propose a novel framework for the fusion of multi-scale heterogeneous pathology FMs, called FuseCPath, yielding a model with a superior ensemble performance. The main contributions of our framework can be summarized as follows: (i) To guarantee the representativeness of the training patches, we propose a multi-view clustering-based method to filter out the discriminative patches via multiple FMs' embeddings. (ii) To effectively fuse the patch-level FMs, we devise a cluster-level re-embedding strategy to online capture patch-level local features. (iii) To effectively fuse the slide-level FMs, we devise a collaborative distillation strategy to explore the connections between slide-level FMs. Extensive experiments demonstrate that the proposed FuseCPath achieves state-of-the-art performance across multiple tasks on diverse datasets.

Zhiqi Lv, Duofan Tu, Jun Li et al.

The application of large language models (LLMs) in clinical decision support faces significant challenges of "tunnel vision" and diagnostic hallucinations present in their processing unstructured electronic health records (EHRs). To address these challenges, we propose a novel chain-based clinical reasoning framework, called DxChain, which transforms the diagnostic workflow into an iterative process by mirroring a clinician's cognitive trajectory that consists of "Memory Anchoring", "Navigation" and "Verification" phases. DxChain introduces three key methodological innovations to elicit the potential of LLM: (i) a Profile-Then-Plan paradigm to mitigate cold-start hallucinations by establishing a panoramic patient baseline, (ii) a Medical Tree-of-Thoughts (Med-ToT) algorithm for strategic look ahead planning and resource aware navigation, and (iii) a Dialectical Diagnostic Verification procedure utilizing "Angel-Devil" adversarial debates to resolve complex evidence conflicts. Evaluated on two real world benchmarks, MIMIC-IV-Ext Cardiac Disease and MIMIC-IV-Ext CDM, DxChain achieves state-of-the-art performances in both diagnostic accuracy and logical consistency, offering a modular and reliable architecture for next-generation clinical AI. The code is at https://anonymous.4open.science/r/Dx-Chain.

Haoran Lai, Zihang Jiang, Kun Zhang et al.

Developing 3D vision-language models with robust clinical reasoning remains a challenge due to the inherent complexity of volumetric medical imaging, the tendency of models to overfit superficial report patterns, and the lack of interpretability-aware reward designs. In this paper, we propose Med3D-R1, a reinforcement learning framework with a two-stage training process: Supervised Fine-Tuning (SFT) and Reinforcement Learning (RL). During SFT stage, we introduce a residual alignment mechanism to bridge the gap between high-dimensional 3D features and textual embeddings, and an abnormality re-weighting strategy to emphasize clinically informative tokens and reduce structural bias in reports. In RL stage, we redesign the consistency reward to explicitly promote coherent, step-by-step diagnostic reasoning. We evaluate our method on medical multiple-choice visual question answering using two 3D diagnostic benchmarks, CT-RATE and RAD-ChestCT, where our model attains state-of-the-art accuracies of 41.92\% on CT-RATE and 44.99\% on RAD-ChestCT. These results indicate improved abnormality diagnosis and clinical reasoning and outperform prior methods on both benchmarks. Overall, our approach holds promise for enhancing real-world diagnostic workflows by enabling more reliable and transparent 3D medical vision-language systems.

Yingtai Li, Shuai Ming, Mingyue Zhao et al.

The development of radiology foundation models (RFMs) is hindered by a reliance on brute-force scaling. Existing approaches often directly translate methods for natural images, which prioritize scale over precision and hence lead to brittle and expensive models in clinical practice. To address this, we present a resource-efficient pre-training framework, GreenRFM, that achieves state-of-the-art performance. Our framework ensures robust generalization across diverse patient populations and imaging protocols, reducing computational requirements by orders of magnitude while surpassing complex, parameter-heavy models. These capabilities stem from principled supervision design that aims to maximally utilize supervisory signals via More distilled, Ubiquitous, Semantic-enforcing, and Task-aligning (MUST) supervision, rather than simply piling up the quantity of training data. We offer two GreenRFM configurations: (i) a performant model that establishes a new state-of-the-art using a single 24GB GPU within 24 hours, and (ii) a lightweight model that matches existing benchmarks with 6GB VRAM in 4 hours. We conduct extensive experiments using over 200,000 images from four institutions and of two modalities. GreenRFMs achieve superior performances on chest and abdominal CT datasets, regardless of public or private benchmark, surpassing a range of baseline models. In addition, the results on internal musculoskeletal MRI images show that the same supervision principles transfer between different modalities. Our performance and efficiency challenge the ``scale is all you need'' dogma and democratize the equitable development of state-of-the-art RFMs for clinicians even on a laptop.

Shuxin Yang, Xian Wu, Shen Ge et al.

Automatic radiology report generation is critical in clinics which can relieve experienced radiologists from the heavy workload and remind inexperienced radiologists of misdiagnosis or missed diagnose. Existing approaches mainly formulate radiology report generation as an image captioning task and adopt the encoder-decoder framework. However, in the medical domain, such pure data-driven approaches suffer from the following problems: 1) visual and textual bias problem; 2) lack of expert knowledge. In this paper, we propose a knowledge-enhanced radiology report generation approach introduces two types of medical knowledge: 1) General knowledge, which is input independent and provides the broad knowledge for report generation; 2) Specific knowledge, which is input dependent and provides the fine-grained knowledge for report generation. To fully utilize both the general and specific knowledge, we also propose a knowledge-enhanced multi-head attention mechanism. By merging the visual features of the radiology image with general knowledge and specific knowledge, the proposed model can improve the quality of generated reports. Experimental results on two publicly available datasets IU-Xray and MIMIC-CXR show that the proposed knowledge enhanced approach outperforms state-of-the-art image captioning based methods. Ablation studies also demonstrate that both general and specific knowledge can help to improve the performance of radiology report generation.

Cheng Peng, Haofu Liao, Gina Wong et al.

A radiograph visualizes the internal anatomy of a patient through the use of X-ray, which projects 3D information onto a 2D plane. Hence, radiograph analysis naturally requires physicians to relate the prior about 3D human anatomy to 2D radiographs. Synthesizing novel radiographic views in a small range can assist physicians in interpreting anatomy more reliably; however, radiograph view synthesis is heavily ill-posed, lacking in paired data, and lacking in differentiable operations to leverage learning-based approaches. To address these problems, we use Computed Tomography (CT) for radiograph simulation and design a differentiable projection algorithm, which enables us to achieve geometrically consistent transformations between the radiography and CT domains. Our method, XraySyn, can synthesize novel views on real radiographs through a combination of realistic simulation and finetuning on real radiographs. To the best of our knowledge, this is the first work on radiograph view synthesis. We show that by gaining an understanding of radiography in 3D space, our method can be applied to radiograph bone extraction and suppression without groundtruth bone labels.

Wei-An Lin, Haofu Liao, Cheng Peng et al.

Computed tomography (CT) is an imaging modality widely used for medical diagnosis and treatment. CT images are often corrupted by undesirable artifacts when metallic implants are carried by patients, which creates the problem of metal artifact reduction (MAR). Existing methods for reducing the artifacts due to metallic implants are inadequate for two main reasons. First, metal artifacts are structured and non-local so that simple image domain enhancement approaches would not suffice. Second, the MAR approaches which attempt to reduce metal artifacts in the X-ray projection (sinogram) domain inevitably lead to severe secondary artifact due to sinogram inconsistency. To overcome these difficulties, we propose an end-to-end trainable Dual Domain Network (DuDoNet) to simultaneously restore sinogram consistency and enhance CT images. The linkage between the sigogram and image domains is a novel Radon inversion layer that allows the gradients to back-propagate from the image domain to the sinogram domain during training. Extensive experiments show that our method achieves significant improvements over other single domain MAR approaches. To the best of our knowledge, it is the first end-to-end dual-domain network for MAR.

Haofu Liao, Yucheng Tang, Gareth Funka-Lea et al.

Using catheter ablation to treat atrial fibrillation increasingly relies on intracardiac echocardiography (ICE) for an anatomical delineation of the left atrium and the pulmonary veins that enter the atrium. However, it is a challenge to build an automatic contouring algorithm because ICE is noisy and provides only a limited 2D view of the 3D anatomy. This work provides the first automatic solution to segment the left atrium and the pulmonary veins from ICE. In this solution, we demonstrate the benefit of building a cross-modality framework that can leverage a database of diagnostic images to supplement the less available interventional images. To this end, we develop a novel deep neural network approach that uses the (i) 3D geometrical information provided by a position sensor embedded in the ICE catheter and the (ii) 3D image appearance information from a set of computed tomography cardiac volumes. We evaluate the proposed approach over 11,000 ICE images collected from 150 clinical patients. Experimental results show that our model is significantly better than a direct 2D image-to-image deep neural network segmentation, especially for less-observed structures.

Haofu Liao, Zhimin Huo, William J. Sehnert et al.

We present an effective post-processing method to reduce the artifacts from sparsely reconstructed cone-beam CT (CBCT) images. The proposed method is based on the state-of-the-art, image-to-image generative models with a perceptual loss as regulation. Unlike the traditional CT artifact-reduction approaches, our method is trained in an adversarial fashion that yields more perceptually realistic outputs while preserving the anatomical structures. To address the streak artifacts that are inherently local and appear across various scales, we further propose a novel discriminator architecture based on feature pyramid networks and a differentially modulated focus map to induce the adversarial training. Our experimental results show that the proposed method can greatly correct the cone-beam artifacts from clinical CBCT images reconstructed using 1/3 projections, and outperforms strong baseline methods both quantitatively and qualitatively.

Hui Ding, Hao Zhou, Shaohua Kevin Zhou et al.

Humans focus attention on different face regions when recognizing face attributes. Most existing face attribute classification methods use the whole image as input. Moreover, some of these methods rely on fiducial landmarks to provide defined face parts. In this paper, we propose a cascade network that simultaneously learns to localize face regions specific to attributes and performs attribute classification without alignment. First, a weakly-supervised face region localization network is designed to automatically detect regions (or parts) specific to attributes. Then multiple part-based networks and a whole-image-based network are separately constructed and combined together by the region switch layer and attribute relation layer for final attribute classification. A multi-net learning method and hint-based model compression is further proposed to get an effective localization model and a compact classification model, respectively. Our approach achieves significantly better performance than state-of-the-art methods on unaligned CelebA dataset, reducing the classification error by 30.9%.

Hui Ding, Shaohua Kevin Zhou, Rama Chellappa

Relatively small data sets available for expression recognition research make the training of deep networks for expression recognition very challenging. Although fine-tuning can partially alleviate the issue, the performance is still below acceptable levels as the deep features probably contain redun- dant information from the pre-trained domain. In this paper, we present FaceNet2ExpNet, a novel idea to train an expression recognition network based on static images. We first propose a new distribution function to model the high-level neurons of the expression network. Based on this, a two-stage training algorithm is carefully designed. In the pre-training stage, we train the convolutional layers of the expression net, regularized by the face net; In the refining stage, we append fully- connected layers to the pre-trained convolutional layers and train the whole network jointly. Visualization shows that the model trained with our method captures improved high-level expression semantics. Evaluations on four public expression databases, CK+, Oulu-CASIA, TFD, and SFEW demonstrate that our method achieves better results than state-of-the-art.

Quan Wang, Dijia Wu, Le Lu et al.

The automatic segmentation of human knee cartilage from 3D MR images is a useful yet challenging task due to the thin sheet structure of the cartilage with diffuse boundaries and inhomogeneous intensities. In this paper, we present an iterative multi-class learning method to segment the femoral, tibial and patellar cartilage simultaneously, which effectively exploits the spatial contextual constraints between bone and cartilage, and also between different cartilages. First, based on the fact that the cartilage grows in only certain area of the corresponding bone surface, we extract the distance features of not only to the surface of the bone, but more informatively, to the densely registered anatomical landmarks on the bone surface. Second, we introduce a set of iterative discriminative classifiers that at each iteration, probability comparison features are constructed from the class confidence maps derived by previously learned classifiers. These features automatically embed the semantic context information between different cartilages of interest. Validated on a total of 176 volumes from the Osteoarthritis Initiative (OAI) dataset, the proposed approach demonstrates high robustness and accuracy of segmentation in comparison with existing state-of-the-art MR cartilage segmentation methods.