Haoshen Li

Zifan Chen, Xinyu Nan, Jiazheng Li et al.

Volumetric segmentation is important in medical imaging, but current methods face challenges like requiring lots of manual annotations and being tailored to specific tasks, which limits their versatility. General segmentation models used for natural images don't perform well with the unique features of medical images. There's a strong need for an adaptable approach that can effectively handle different 3D medical structures and imaging modalities. In this study, we present PAM (Propagating Anything Model), a segmentation approach that uses a 2D prompt, like a bounding box or sketch, to create a complete 3D segmentation of medical image volumes. PAM works by modeling relationships between slices, maintaining information flow across the 3D structure. It combines a CNN-based UNet for processing within slices and a Transformer-based attention module for propagating information between slices, leading to better generalizability across various imaging modalities. PAM significantly outperformed existing models like MedSAM and SegVol, with an average improvement of over 18.1% in dice similarity coefficient (DSC) across 44 medical datasets and various object types. It also showed stable performance despite prompt deviations and different propagation setups, and faster inference speeds compared to other models. PAM's one-view prompt design made it more efficient, reducing interaction time by about 63.6% compared to two-view prompts. Thanks to its focus on structural relationships, PAM handled unseen and complex objects well, showing a unique ability to generalize to new situations. PAM represents an advancement in medical image segmentation, effectively reducing the need for extensive manual work and specialized training. Its adaptability makes it a promising tool for more automated and reliable analysis in clinical settings.

Yirui Wang, Qinji Yu, Ke Yan et al.

Lymph node (LN) assessment is a critical, indispensable yet very challenging task in the routine clinical workflow of radiology and oncology. Accurate LN analysis is essential for cancer diagnosis, staging, and treatment planning. Finding scatteredly distributed, low-contrast clinically relevant LNs in 3D CT is difficult even for experienced physicians under high inter-observer variations. Previous automatic LN detection works typically yield limited recall and high false positives (FPs) due to adjacent anatomies with similar image intensities, shapes, or textures (vessels, muscles, esophagus, etc). In this work, we propose a new LN DEtection TRansformer, named LN-DETR, to achieve more accurate performance. By enhancing the 2D backbone with a multi-scale 2.5D feature fusion to incorporate 3D context explicitly, more importantly, we make two main contributions to improve the representation quality of LN queries. 1) Considering that LN boundaries are often unclear, an IoU prediction head and a location debiased query selection are proposed to select LN queries of higher localization accuracy as the decoder query's initialization. 2) To reduce FPs, query contrastive learning is employed to explicitly reinforce LN queries towards their best-matched ground-truth queries over unmatched query predictions. Trained and tested on 3D CT scans of 1067 patients (with 10,000+ labeled LNs) via combining seven LN datasets from different body parts (neck, chest, and abdomen) and pathologies/cancers, our method significantly improves the performance of previous leading methods by > 4-5% average recall at the same FP rates in both internal and external testing. We further evaluate on the universal lesion detection task using NIH DeepLesion benchmark, and our method achieves the top performance of 88.46% averaged recall across 0.5 to 4 FPs per image, compared with other leading reported results.

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.