You Zhang

Zihan Li, Yunxiang Li, Qingde Li et al. · uw

Deep learning has been widely used in medical image segmentation and other aspects. However, the performance of existing medical image segmentation models has been limited by the challenge of obtaining sufficient high-quality labeled data due to the prohibitive data annotation cost. To alleviate this limitation, we propose a new text-augmented medical image segmentation model LViT (Language meets Vision Transformer). In our LViT model, medical text annotation is incorporated to compensate for the quality deficiency in image data. In addition, the text information can guide to generate pseudo labels of improved quality in the semi-supervised learning. We also propose an Exponential Pseudo label Iteration mechanism (EPI) to help the Pixel-Level Attention Module (PLAM) preserve local image features in semi-supervised LViT setting. In our model, LV (Language-Vision) loss is designed to supervise the training of unlabeled images using text information directly. For evaluation, we construct three multimodal medical segmentation datasets (image + text) containing X-rays and CT images. Experimental results show that our proposed LViT has superior segmentation performance in both fully-supervised and semi-supervised setting. The code and datasets are available at https://github.com/HUANGLIZI/LViT.

Kai Wang, Yunxiang Li, Michael Dohopolski et al.

For Head and Neck Cancers (HNC) patient management, automatic gross tumor volume (GTV) segmentation and accurate pre-treatment cancer recurrence prediction are of great importance to assist physicians in designing personalized management plans, which have the potential to improve the treatment outcome and quality of life for HNC patients. In this paper, we developed an automated primary tumor (GTVp) and lymph nodes (GTVn) segmentation method based on combined pre-treatment positron emission tomography/computed tomography (PET/CT) scans of HNC patients. We extracted radiomics features from the segmented tumor volume and constructed a multi-modality tumor recurrence-free survival (RFS) prediction model, which fused the prediction results from separate CT radiomics, PET radiomics, and clinical models. We performed 5-fold cross-validation to train and evaluate our methods on the MICCAI 2022 HEad and neCK TumOR segmentation and outcome prediction challenge (HECKTOR) dataset. The ensemble prediction results on the testing cohort achieved Dice scores of 0.77 and 0.73 for GTVp and GTVn segmentation, respectively, and a C-index value of 0.67 for RFS prediction. The code is publicly available (https://github.com/wangkaiwan/HECKTOR-2022-AIRT). Our team's name is AIRT.

Yunxiang Li, Hua-Chieh Shao, Xiao Liang et al.

Recently, the diffusion model has emerged as a superior generative model that can produce high quality and realistic images. However, for medical image translation, the existing diffusion models are deficient in accurately retaining structural information since the structure details of source domain images are lost during the forward diffusion process and cannot be fully recovered through learned reverse diffusion, while the integrity of anatomical structures is extremely important in medical images. For instance, errors in image translation may distort, shift, or even remove structures and tumors, leading to incorrect diagnosis and inadequate treatments. Training and conditioning diffusion models using paired source and target images with matching anatomy can help. However, such paired data are very difficult and costly to obtain, and may also reduce the robustness of the developed model to out-of-distribution testing data. We propose a frequency-guided diffusion model (FGDM) that employs frequency-domain filters to guide the diffusion model for structure-preserving image translation. Based on its design, FGDM allows zero-shot learning, as it can be trained solely on the data from the target domain, and used directly for source-to-target domain translation without any exposure to the source-domain data during training. We evaluated it on three cone-beam CT (CBCT)-to-CT translation tasks for different anatomical sites, and a cross-institutional MR imaging translation task. FGDM outperformed the state-of-the-art methods (GAN-based, VAE-based, and diffusion-based) in metrics of Frechet Inception Distance (FID), Peak Signal-to-Noise Ratio (PSNR), and Structural Similarity Index Measure (SSIM), showing its significant advantages in zero-shot medical image translation.

Yunxiang Li, Hua-Chieh Shao, Xiaoxue Qian et al.

Diffusion models have demonstrated significant potential in producing high-quality images in medical image translation to aid disease diagnosis, localization, and treatment. Nevertheless, current diffusion models have limited success in achieving faithful image translations that can accurately preserve the anatomical structures of medical images, especially for unpaired datasets. The preservation of structural and anatomical details is essential to reliable medical diagnosis and treatment planning, as structural mismatches can lead to disease misidentification and treatment errors. In this study, we introduce the Frequency Decoupled Diffusion Model (FDDM) for MR-to-CT conversion. FDDM first obtains the anatomical information of the CT image from the MR image through an initial conversion module. This anatomical information then guides a subsequent diffusion model to generate high-quality CT images. Our diffusion model uses a dual-path reverse diffusion process for low-frequency and high-frequency information, achieving a better balance between image quality and anatomical accuracy. We extensively evaluated FDDM using public datasets for brain MR-to-CT and pelvis MR-to-CT translations, demonstrating its superior performance to other GAN-based, VAE-based, and diffusion-based models. The evaluation metrics included Frechet Inception Distance (FID), Peak Signal-to-Noise Ratio (PSNR), and Structural Similarity Index Measure (SSIM). FDDM achieved the best scores on all metrics for both datasets, particularly excelling in FID, with scores of 25.9 for brain data and 29.2 for pelvis data, significantly outperforming other methods. These results demonstrate that FDDM can generate high-quality target domain images while maintaining the accuracy of translated anatomical structures.

Guoping Xu, Xiaoxue Qian, Hua Chieh Shao et al.

This study introduces SAMatch, a SAM-guided Match-based framework for semi-supervised medical image segmentation, aimed at improving pseudo label quality in data-scarce scenarios. While Match-based frameworks are effective, they struggle with low-quality pseudo labels due to the absence of ground truth. SAM, pre-trained on a large dataset, generalizes well across diverse tasks and assists in generating high-confidence prompts, which are then used to refine pseudo labels via fine-tuned SAM. SAMatch is trained end-to-end, allowing for dynamic interaction between the models. Experiments on the ACDC cardiac MRI, BUSI breast ultrasound, and MRLiver datasets show SAMatch achieving state-of-the-art results, with Dice scores of 89.36%, 77.76%, and 80.04%, respectively, using minimal labeled data. SAMatch effectively addresses challenges in semi-supervised segmentation, offering a powerful tool for segmentation in data-limited environments. Code and data are available at https://github.com/apple1986/SAMatch.

Guoping Xu, Christopher Kabat, You Zhang

Recent advances in medical image segmentation have been driven by deep learning; however, most existing methods remain limited by modality-specific designs and exhibit poor adaptability to dynamic medical imaging scenarios. The Segment Anything Model 2 (SAM2) and its related variants, which introduce a streaming memory mechanism for real-time video segmentation, present new opportunities for prompt-based, generalizable solutions. Nevertheless, adapting these models to medical video scenarios typically requires large-scale datasets for retraining or transfer learning, leading to high computational costs and the risk of catastrophic forgetting. To address these challenges, we propose DD-SAM2, an efficient adaptation framework for SAM2 that incorporates a Depthwise-Dilated Adapter (DD-Adapter) to enhance multi-scale feature extraction with minimal parameter overhead. This design enables effective fine-tuning of SAM2 on medical videos with limited training data. Unlike existing adapter-based methods focused solely on static images, DD-SAM2 fully exploits SAM2's streaming memory for medical video object tracking and segmentation. Comprehensive evaluations on TrackRad2025 (tumor segmentation) and EchoNet-Dynamic (left ventricle tracking) datasets demonstrate superior performance, achieving Dice scores of 0.93 and 0.97, respectively. To the best of our knowledge, this work provides an initial attempt at systematically exploring adapter-based SAM2 fine-tuning for medical video segmentation and tracking. Code, datasets, and models will be publicly available at https://github.com/apple1986/DD-SAM2.

Jiacheng Xie, Hua-Chieh Shao, Yunxiang Li et al.

Cone-beam computed tomography (CBCT) is widely used in image-guided radiotherapy. Reconstructing CBCTs from limited-angle acquisitions (LA-CBCT) is highly desired for improved imaging efficiency, dose reduction, and better mechanical clearance. LA-CBCT reconstruction, however, suffers from severe under-sampling artifacts, making it a highly ill-posed inverse problem. Diffusion models can generate data/images by reversing a data-noising process through learned data distributions; and can be incorporated as a denoiser/regularizer in LA-CBCT reconstruction. In this study, we developed a diffusion model-based framework, prior frequency-guided diffusion model (PFGDM), for robust and structure-preserving LA-CBCT reconstruction. PFGDM uses a conditioned diffusion model as a regularizer for LA-CBCT reconstruction, and the condition is based on high-frequency information extracted from patient-specific prior CT scans which provides a strong anatomical prior for LA-CBCT reconstruction. Specifically, we developed two variants of PFGDM (PFGDM-A and PFGDM-B) with different conditioning schemes. PFGDM-A applies the high-frequency CT information condition until a pre-optimized iteration step, and drops it afterwards to enable both similar and differing CT/CBCT anatomies to be reconstructed. PFGDM-B, on the other hand, continuously applies the prior CT information condition in every reconstruction step, while with a decaying mechanism, to gradually phase out the reconstruction guidance from the prior CT scans. The two variants of PFGDM were tested and compared with current available LA-CBCT reconstruction solutions, via metrics including PSNR and SSIM. PFGDM outperformed all traditional and diffusion model-based methods. PFGDM reconstructs high-quality LA-CBCTs under very-limited gantry angles, allowing faster and more flexible CBCT scans with dose reductions.

Zhiguo Zhou, Zhi-Jie Zhou, Hongxia Hao et al.

Radiomics aims to extract and analyze large numbers of quantitative features from medical images and is highly promising in staging, diagnosing, and predicting outcomes of cancer treatments. Nevertheless, several challenges need to be addressed to construct an optimal radiomics predictive model. First, the predictive performance of the model may be reduced when features extracted from an individual imaging modality are blindly combined into a single predictive model. Second, because many different types of classifiers are available to construct a predictive model, selecting an optimal classifier for a particular application is still challenging. In this work, we developed multi-modality and multi-classifier radiomics predictive models that address the aforementioned issues in currently available models. Specifically, a new reliable classifier fusion strategy was proposed to optimally combine output from different modalities and classifiers. In this strategy, modality-specific classifiers were first trained, and an analytic evidential reasoning (ER) rule was developed to fuse the output score from each modality to construct an optimal predictive model. One public data set and two clinical case studies were performed to validate model performance. The experimental results indicated that the proposed ER rule based radiomics models outperformed the traditional models that rely on a single classifier or simply use combined features from different modalities.