Shangqi Gao

Shangqi Gao, Hangqi Zhou, Yibo Gao et al.

Although supervised deep-learning has achieved promising performance in medical image segmentation, many methods cannot generalize well on unseen data, limiting their real-world applicability. To address this problem, we propose a deep learning-based Bayesian framework, which jointly models image and label statistics, utilizing the domain-irrelevant contour of a medical image for segmentation. Specifically, we first decompose an image into components of contour and basis. Then, we model the expected label as a variable only related to the contour. Finally, we develop a variational Bayesian framework to infer the posterior distributions of these variables, including the contour, the basis, and the label. The framework is implemented with neural networks, thus is referred to as deep Bayesian segmentation. Results on the task of cross-sequence cardiac MRI segmentation show that our method set a new state of the art for model generalizability. Particularly, the BayeSeg model trained with LGE MRI generalized well on T2 images and outperformed other models with great margins, i.e., over 0.47 in terms of average Dice. Our code is available at https://zmiclab.github.io/projects.html.

Kaiwen Wan, Lei Li, Dengqiang Jia et al.

Medical images are generally acquired with limited field-of-view (FOV), which could lead to incomplete regions of interest (ROI), and thus impose a great challenge on medical image analysis. This is particularly evident for the learning-based multi-target landmark detection, where algorithms could be misleading to learn primarily the variation of background due to the varying FOV, failing the detection of targets. Based on learning a navigation policy, instead of predicting targets directly, reinforcement learning (RL)-based methods have the potential totackle this challenge in an efficient manner. Inspired by this, in this work we propose a multi-agent RL framework for simultaneous multi-target landmark detection. This framework is aimed to learn from incomplete or (and) complete images to form an implicit knowledge of global structure, which is consolidated during the training stage for the detection of targets from either complete or incomplete test images. To further explicitly exploit the global structural information from incomplete images, we propose to embed a shape model into the RL process. With this prior knowledge, the proposed RL model can not only localize dozens of targetssimultaneously, but also work effectively and robustly in the presence of incomplete images. We validated the applicability and efficacy of the proposed method on various multi-target detection tasks with incomplete images from practical clinics, using body dual-energy X-ray absorptiometry (DXA), cardiac MRI and head CT datasets. Results showed that our method could predict whole set of landmarks with incomplete training images up to 80% missing proportion (average distance error 2.29 cm on body DXA), and could detect unseen landmarks in regions with missing image information outside FOV of target images (average distance error 6.84 mm on 3D half-head CT).

Francesca Fati, Felipe Coutinho, Marika Reinius et al.

Purpose. High-grade serous ovarian carcinoma (HGSOC) is characterized by pronounced biological and spatial heterogeneity and is frequently diagnosed at an advanced stage. Neoadjuvant chemotherapy (NACT) followed by delayed primary surgery is commonly employed in patients unsuitable for primary cytoreduction. The Chemotherapy Response Score (CRS) is a validated histopathological biomarker of response to NACT, but it is only available postoperatively. In this study, we investigate whether pre-treatment computed tomography (CT) imaging and clinical data can be used to predict CRS as an investigational decision-support adjunct to inform multidisciplinary team (MDT) discussions regarding expected treatment response. Methods. We proposed a 2.5D multimodal deep learning framework that processes lesion-dense omental slices using a pre-trained Vision Transformer encoder and integrates the resulting visual representations with clinical variables through an intermediate fusion module to predict CRS. Results. Our multimodal model, integrating imaging and clinical data, achieved a ROC-AUC of 0.95 alongside 95% accuracy and 80% precision on the internal test cohort (IEO, n=41 patients). On the external test set (OV04, n=70 patients), it achieved a ROC-AUC of 0.68, alongside 67% accuracy and 75% precision. Conclusion. These preliminary results demonstrate the feasibility of transformer-based deep learning for preoperative prediction of CRS in HGSOC using routine clinical data and CT imaging. As an investigational, pre-treatment decision-support tool, this approach may assist MDT discussions by providing early, non-invasive estimates of treatment response.

Ke Liu, Shangde Gao, Yichao Fu et al.

Medical image segmentation is inherently influenced by data uncertainty, arising from ambiguous boundaries in medical scans and inter-observer variability in diagnosis. To address this challenge, previous works formulated the multi-rater medical image segmentation task, where multiple experts provide separate annotations for each image. However, existing models are typically constrained to either generate diverse segmentation that lacks expert specificity or to produce personalized outputs that merely replicate individual annotators. We propose Probabilistic modeling of multi-rater medical image Segmentation (ProSeg) that simultaneously enables both diversification and personalization. Specifically, we introduce two latent variables to model expert annotation preferences and image boundary ambiguity. Their conditional probabilistic distributions are then obtained through variational inference, allowing segmentation outputs to be generated by sampling from these distributions. Extensive experiments on both the nasopharyngeal carcinoma dataset (NPC) and the lung nodule dataset (LIDC-IDRI) demonstrate that our ProSeg achieves a new state-of-the-art performance, providing segmentation results that are both diverse and expert-personalized. Code can be found in https://github.com/AI4MOL/ProSeg.

Shangqi Gao, Hangqi Zhou, Yibo Gao et al.

Due to the cross-domain distribution shift aroused from diverse medical imaging systems, many deep learning segmentation methods fail to perform well on unseen data, which limits their real-world applicability. Recent works have shown the benefits of extracting domain-invariant representations on domain generalization. However, the interpretability of domain-invariant features remains a great challenge. To address this problem, we propose an interpretable Bayesian framework (BayeSeg) through Bayesian modeling of image and label statistics to enhance model generalizability for medical image segmentation. Specifically, we first decompose an image into a spatial-correlated variable and a spatial-variant variable, assigning hierarchical Bayesian priors to explicitly force them to model the domain-stable shape and domain-specific appearance information respectively. Then, we model the segmentation as a locally smooth variable only related to the shape. Finally, we develop a variational Bayesian framework to infer the posterior distributions of these explainable variables. The framework is implemented with neural networks, and thus is referred to as deep Bayesian segmentation. Quantitative and qualitative experimental results on prostate segmentation and cardiac segmentation tasks have shown the effectiveness of our proposed method. Moreover, we investigated the interpretability of BayeSeg by explaining the posteriors and analyzed certain factors that affect the generalization ability through further ablation studies. Our code will be released via https://zmiclab.github.io/projects.html, once the manuscript is accepted for publication.

Jiyao Liu, Shangqi Gao, Yuxin Li et al.

Multi-modal Magnetic Resonance Imaging (MRI) translation leverages information from source MRI sequences to generate target modalities, enabling comprehensive diagnosis while overcoming the limitations of acquiring all sequences. While existing deep-learning-based multi-modal MRI translation methods have shown promising potential, they still face two key challenges: 1) lack of reliable uncertainty quantification for synthesized images, and 2) limited robustness when deployed across different medical centers. To address these challenges, we propose a novel framework that reformulates multi-modal MRI translation as a multi-modal evidential regression problem with distribution calibration. Our approach incorporates two key components: 1) an evidential regression module that estimates uncertainties from different source modalities and an explicit distribution mixture strategy for transparent multi-modal fusion, and 2) a distribution calibration mechanism that adapts to source-target mapping shifts to ensure consistent performance across different medical centers. Extensive experiments on three datasets from the BraTS2023 challenge demonstrate that our framework achieves superior performance and robustness across domains.

Jiyao Liu, Shangqi Gao, Lihao Liu et al.

Real-world MRI reconstruction systems face the open-world challenge: test data from unseen imaging centers, anatomical structures, or acquisition protocols can differ drastically from training data, causing severe performance degradation. Existing methods struggle with this challenge. To address this, we propose BiasRecon, a bias-calibrated adaptation framework grounded in the minimal intervention principle: preserve what transfers, calibrate what does not. Concretely, BiasRecon formulates open-world adaptation as an alternating optimization framework that jointly optimizes three components: (1) frequency-guided prior calibration that introduces layer-wise calibration variables to selectively modulate frequency-specific features of the pre-trained score network via self-supervised k-space signals, (2) score-based denoising that leverages the calibrated generative prior for high-fidelity image reconstruction, and (3) adaptive regularization that employs Stein's Unbiased Risk Estimator to dynamically balance the prior-measurement trade-off, matching test-time noise characteristics without requiring ground truth. By intervening minimally and precisely through this alternating scheme, BiasRecon achieves robust adaptation with fewer than 100 tunable parameters. Extensive experiments across four datasets demonstrate state-of-the-art performance on open-world reconstruction tasks.

Yibo Gao, Hangqi Zhou, Zheyao Gao et al.

The pursuit of decision safety in clinical applications highlights the potential of concept-based methods in medical imaging. While these models offer active interpretability, they often suffer from concept leakages, where unintended information within soft concept representations undermines both interpretability and generalizability. Moreover, most concept-based models focus solely on local explanations (instance-level), neglecting the global decision logic (dataset-level). To address these limitations, we propose Concept Rule Learner (CRL), a novel framework to learn Boolean logical rules from binarized visual concepts. CRL employs logical layers to capture concept correlations and extract clinically meaningful rules, thereby providing both local and global interpretability. Experiments on two medical image classification tasks show that CRL achieves competitive performance with existing methods while significantly improving generalizability to out-of-distribution data. The code of our work is available at https://github.com/obiyoag/crl.

Shuaike Shen, Ke Liu, Jiaqing Xie et al.

Foundation models for medical image segmentation struggle under out-of-distribution (OOD) shifts, often producing fragmented false positives on OOD tumors. We introduce R$^{2}$Seg, a training-free framework for robust OOD tumor segmentation that operates via a two-stage Reason-and-Reject process. First, the Reason step employs an LLM-guided anatomical reasoning planner to localize organ anchors and generate multi-scale ROIs. Second, the Reject step applies two-sample statistical testing to candidates generated by a frozen foundation model (BiomedParse) within these ROIs. This statistical rejection filter retains only candidates significantly different from normal tissue, effectively suppressing false positives. Our framework requires no parameter updates, making it compatible with zero-update test-time augmentation and avoiding catastrophic forgetting. On multi-center and multi-modal tumor segmentation benchmarks, R$^{2}$Seg substantially improves Dice, specificity, and sensitivity over strong baselines and the original foundation models. Code are available at https://github.com/Eurekashen/R2Seg.

Shangqi Gao, Sihan Wang, Yibo Gao et al.

To evaluate the translational capabilities of foundation models, we develop a pathological concept learning approach focused on kidney cancer. By leveraging TNM staging guidelines and pathology reports, we build comprehensive pathological concepts for kidney cancer. Then, we extract deep features from whole slide images using foundation models, construct pathological graphs to capture spatial correlations, and trained graph neural networks to identify these concepts. Finally, we demonstrate the effectiveness of this approach in kidney cancer survival analysis, highlighting its explainability and fairness in identifying low- and high-risk patients. The source code has been released by https://github.com/shangqigao/RadioPath.

Shangqi Gao, Xiahai Zhuang

Single image super-resolution (SR) is extremely difficult if the upscaling factors of image pairs are unknown and different from each other, which is common in real image SR. To tackle the difficulty, we develop two multi-scale deep neural networks (MsDNN) in this work. Firstly, due to the high computation complexity in high-resolution spaces, we process an input image mainly in two different downscaling spaces, which could greatly lower the usage of GPU memory. Then, to reconstruct the details of an image, we design a multi-scale residual network (MsRN) in the downscaling spaces based on the residual blocks. Besides, we propose a multi-scale dense network based on the dense blocks to compare with MsRN. Finally, our empirical experiments show the robustness of MsDNN for image SR when the upscaling factor is unknown. According to the preliminary results of NTIRE 2019 image SR challenge, our team (ZXHresearch@fudan) ranks 21-st among all participants. The implementation of MsDNN is released https://github.com/shangqigao/gsq-image-SR

Sihan Wang, Suiyang Jiang, Yibo Gao et al.

Traditional AI-based healthcare systems often rely on single-modal data, limiting diagnostic accuracy due to incomplete information. However, recent advancements in foundation models show promising potential for enhancing diagnosis combining multi-modal information. While these models excel in static tasks, they struggle with dynamic diagnosis, failing to manage multi-turn interactions and often making premature diagnostic decisions due to insufficient persistence in information collection.To address this, we propose a multi-agent framework inspired by consultation flow and reinforcement learning (RL) to simulate the entire consultation process, integrating multiple clinical information for effective diagnosis. Our approach incorporates a hierarchical action set, structured from clinic consultation flow and medical textbook, to effectively guide the decision-making process. This strategy improves agent interactions, enabling them to adapt and optimize actions based on the dynamic state. We evaluated our framework on a public dynamic diagnosis benchmark. The proposed framework evidentially improves the baseline methods and achieves state-of-the-art performance compared to existing foundation model-based methods.

Daniël Boeke, Cedrik Blommestijn, Rebecca N. Wray et al.

Recurrence risk estimation in clear cell renal cell carcinoma (ccRCC) is essential for guiding postoperative surveillance and treatment. The Leibovich score remains widely used for stratifying distant recurrence risk but offers limited patient-level resolution and excludes imaging information. This study evaluates multimodal recurrence prediction by integrating preoperative computed tomography (CT) and postoperative histopathology whole-slide images (WSIs). A modular deep learning framework with pretrained encoders and Cox-based survival modeling was tested across unimodal, late fusion, and intermediate fusion setups. In a real-world ccRCC cohort, WSI-based models consistently outperformed CT-only models, underscoring the prognostic strength of pathology. Intermediate fusion further improved performance, with the best model (TITAN-CONCH with ResNet-18) approaching the adjusted Leibovich score. Random tie-breaking narrowed the gap between the clinical baseline and learned models, suggesting discretization may overstate individualized performance. Using simple embedding concatenation, radiology added value primarily through fusion. These findings demonstrate the feasibility of foundation model-based multimodal integration for personalized ccRCC risk prediction. Future work should explore more expressive fusion strategies, larger multimodal datasets, and general-purpose CT encoders to better match pathology modeling capacity.

Sihan Wang, Shangqi Gao, Fuping Wu et al.

Image decomposition aims to analyze an image into elementary components, which is essential for numerous downstream tasks and also by nature provides certain interpretability to the analysis. Deep learning can be powerful for such tasks, but surprisingly their combination with a focus on interpretability and generalizability is rarely explored. In this work, we introduce a novel framework for interpretable deep image decomposition, combining hierarchical Bayesian modeling and deep learning to create an architecture-modularized and model-generalizable deep neural network (DNN). The proposed framework includes three steps: (1) hierarchical Bayesian modeling of image decomposition, (2) transforming the inference problem into optimization tasks, and (3) deep inference via a modularized Bayesian DNN. We further establish a theoretical connection between the loss function and the generalization error bound, which inspires a new test-time adaptation approach for out-of-distribution scenarios. We instantiated the application using two downstream tasks, \textit{i.e.}, image denoising, and unsupervised anomaly detection, and the results demonstrated improved generalizability as well as interpretability of our methods. The source code will be released upon the acceptance of this paper.

Shangqi Gao, Xiahai Zhuang

Modeling statistics of image priors is useful for image super-resolution, but little attention has been paid from the massive works of deep learning-based methods. In this work, we propose a Bayesian image restoration framework, where natural image statistics are modeled with the combination of smoothness and sparsity priors. Concretely, firstly we consider an ideal image as the sum of a smoothness component and a sparsity residual, and model real image degradation including blurring, downscaling, and noise corruption. Then, we develop a variational Bayesian approach to infer their posteriors. Finally, we implement the variational approach for single image super-resolution (SISR) using deep neural networks, and propose an unsupervised training strategy. The experiments on three image restoration tasks, \textit{i.e.,} ideal SISR, realistic SISR, and real-world SISR, demonstrate that our method has superior model generalizability against varying noise levels and degradation kernels and is effective in unsupervised SISR. The code and resulting models are released via \url{https://zmiclab.github.io/projects.html}.

Dengqiang Jia, Shangqi Gao, Qunlong Chen et al.

Registration networks have shown great application potentials in medical image analysis. However, supervised training methods have a great demand for large and high-quality labeled datasets, which is time-consuming and sometimes impractical due to data sharing issues. Unsupervised image registration algorithms commonly employ intensity-based similarity measures as loss functions without any manual annotations. These methods estimate the parameterized transformations between pairs of moving and fixed images through the optimization of the network parameters during training. However, these methods become less effective when the image quality varies, e.g., some images are corrupted by substantial noise or artifacts. In this work, we propose a novel approach based on a low-rank representation, i.e., Regnet-LRR, to tackle the problem. We project noisy images into a noise-free low-rank space, and then compute the similarity between the images. Based on the low-rank similarity measure, we train the registration network to predict the dense deformation fields of noisy image pairs. We highlight that the low-rank projection is reformulated in a way that the registration network can successfully update gradients. With two tasks, i.e., cardiac and abdominal intra-modality registration, we demonstrate that the low-rank representation can boost the generalization ability and robustness of models as well as bring significant improvements in noisy data registration scenarios.

Hangqi Zhou, Chao Huang, Shangqi Gao et al.

Super-resolution (SR) is an ill-posed problem, which means that infinitely many high-resolution (HR) images can be degraded to the same low-resolution (LR) image. To study the one-to-many stochastic SR mapping, we implicitly represent the non-local self-similarity of natural images and develop a Variational Sparse framework for Super-Resolution (VSpSR) via neural networks. Since every small patch of a HR image can be well approximated by the sparse representation of atoms in an over-complete dictionary, we design a two-branch module, i.e., VSpM, to explore the SR space. Concretely, one branch of VSpM extracts patch-level basis from the LR input, and the other branch infers pixel-wise variational distributions with respect to the sparse coefficients. By repeatedly sampling coefficients, we could obtain infinite sparse representations, and thus generate diverse HR images. According to the preliminary results of NTIRE 2021 challenge on learning SR space, our team (FudanZmic21) ranks 7-th in terms of released scores. The implementation of VSpSR is released at https://zmiclab.github.io/.

Shangqi Gao, Xiahai Zhuang

The principal rank-one (RO) components of an image represent the self-similarity of the image, which is an important property for image restoration. However, the RO components of a corrupted image could be decimated by the procedure of image denoising. We suggest that the RO property should be utilized and the decimation should be avoided in image restoration. To achieve this, we propose a new framework comprised of two modules, i.e., the RO decomposition and RO reconstruction. The RO decomposition is developed to decompose a corrupted image into the RO components and residual. This is achieved by successively applying RO projections to the image or its residuals to extract the RO components. The RO projections, based on neural networks, extract the closest RO component of an image. The RO reconstruction is aimed to reconstruct the important information, respectively from the RO components and residual, as well as to restore the image from this reconstructed information. Experimental results on four tasks, i.e., noise-free image super-resolution (SR), realistic image SR, gray-scale image denoising, and color image denoising, show that the method is effective and efficient for image restoration, and it delivers superior performance for realistic image SR and color image denoising.