Winnie Chiu Wing Chu

Chaoxing Huang, Vincent Wai Sun Wong, Queenie Chan et al.

Objective: Quantitative $T_1ρ$ imaging has potential for assessment of biochemical alterations of liver pathologies. Deep learning methods have been employed to accelerate quantitative $T_1ρ$ imaging. To employ artificial intelligence-based quantitative imaging methods in complicated clinical environment, it is valuable to estimate the uncertainty of the predicated $T_1ρ$ values to provide the confidence level of the quantification results. The uncertainty should also be utilized to aid the post-hoc quantitative analysis and model learning tasks. Approach: To address this need, we propose a parametric map refinement approach for learning-based $T_1ρ$ mapping and train the model in a probabilistic way to model the uncertainty. We also propose to utilize the uncertainty map to spatially weight the training of an improved $T_1ρ$ mapping network to further improve the mapping performance and to remove pixels with unreliable $T_1ρ$ values in the region of interest. The framework was tested on a dataset of 51 patients with different liver fibrosis stages. Main results: Our results indicate that the learning-based map refinement method leads to a relative mapping error of less than 3% and provides uncertainty estimation simultaneously. The estimated uncertainty reflects the actual error level, and it can be used to further reduce relative $T_1ρ$ mapping error to 2.60% as well as removing unreliable pixels in the region of interest effectively. Significance: Our studies demonstrate the proposed approach has potential to provide a learning-based quantitative MRI system for trustworthy $T_1ρ$ mapping of the liver.

Sunan He, Yuxiang Nie, Hongmei Wang et al.

Generalist foundation models (GFMs) are renowned for their exceptional capability and flexibility in effectively generalizing across diverse tasks and modalities. In the field of medicine, while GFMs exhibit superior generalizability based on their extensive intrinsic knowledge as well as proficiency in instruction following and in-context learning, specialist models excel in precision due to their domain knowledge. In this work, for the first time, we explore the synergy between the GFM and specialist models, to enable precise medical image analysis on a broader scope. Specifically, we propose a cooperative framework, Generalist-Specialist Collaboration (GSCo), which consists of two stages, namely the construction of GFM and specialists, and collaborative inference on downstream tasks. In the construction stage, we develop MedDr, the largest open-source GFM tailored for medicine, showcasing exceptional instruction-following and in-context learning capabilities. Meanwhile, a series of lightweight specialists are crafted for downstream tasks with low computational cost. In the collaborative inference stage, we introduce two cooperative mechanisms, Mixture-of-Expert Diagnosis and Retrieval-Augmented Diagnosis, to harvest the generalist's in-context learning abilities alongside the specialists' domain expertise. For a comprehensive evaluation, we curate a large-scale benchmark featuring 28 datasets and about 250,000 images. Extensive results demonstrate that MedDr consistently outperforms state-of-the-art GFMs on downstream datasets. Furthermore, GSCo exceeds both GFMs and specialists across all out-of-domain disease diagnosis datasets. These findings indicate a significant paradigm shift in the application of GFMs, transitioning from separate models for specific tasks to a collaborative approach between GFMs and specialists, thereby advancing the frontiers of generalizable AI in medicine.

Xiaogen Zhou, Yiyou Sun, Min Deng et al.

Multimodal learning leverages complementary information derived from different modalities, thereby enhancing performance in medical image segmentation. However, prevailing multimodal learning methods heavily rely on extensive well-annotated data from various modalities to achieve accurate segmentation performance. This dependence often poses a challenge in clinical settings due to limited availability of such data. Moreover, the inherent anatomical misalignment between different imaging modalities further complicates the endeavor to enhance segmentation performance. To address this problem, we propose a novel semi-supervised multimodal segmentation framework that is robust to scarce labeled data and misaligned modalities. Our framework employs a novel cross modality collaboration strategy to distill modality-independent knowledge, which is inherently associated with each modality, and integrates this information into a unified fusion layer for feature amalgamation. With a channel-wise semantic consistency loss, our framework ensures alignment of modality-independent information from a feature-wise perspective across modalities, thereby fortifying it against misalignments in multimodal scenarios. Furthermore, our framework effectively integrates contrastive consistent learning to regulate anatomical structures, facilitating anatomical-wise prediction alignment on unlabeled data in semi-supervised segmentation tasks. Our method achieves competitive performance compared to other multimodal methods across three tasks: cardiac, abdominal multi-organ, and thyroid-associated orbitopathy segmentations. It also demonstrates outstanding robustness in scenarios involving scarce labeled data and misaligned modalities.

Qianhan Feng, Zhongzhen Huang, Yakun Zhu et al.

Experienced physicians develop diagnostic expertise through clinical practice, acquiring not only disease knowledge but also the ability to differentiate confusable conditions. Current medical vision-language models (VLMs) lack this capability -- their parameters encode static knowledge that does not evolve across diagnostic encounters. We propose MedExpMem, an experience memory framework enabling VLM-based diagnostic agents to accumulate differential diagnosis expertise. Unlike retrieval-augmented generation, which retrieves encyclopedic disease descriptions, MedExpMem memorizes discriminative experience derived from the agent's own diagnostic failures and organizes them as pairwise differential notes encoding key discriminators, actionable decision rules and reasoning error patterns. The framework adopts a two-phase construction process mirroring physician learning: initial practice exposes knowledge gaps, and reflective re-diagnosis refines understanding. When encountering new cases, the agent retrieves experience memory to guide differential reasoning. We evaluate MedExpMem on a radiology benchmark spanning 11 subspecialties. Results demonstrate consistent accuracy improvements, maximum 7.0%, across diverse models and scales. Analytical experiments validate experience quality and robustness, demonstrating MedExpMem as a competitive method addresses medical adaptation needs beyond the reach of parameteric learning.