Yalin Zheng

Hongrun Zhang, Yanda Meng, Yitian Zhao et al.

Multiple instance learning (MIL) has been increasingly used in the classification of histopathology whole slide images (WSIs). However, MIL approaches for this specific classification problem still face unique challenges, particularly those related to small sample cohorts. In these, there are limited number of WSI slides (bags), while the resolution of a single WSI is huge, which leads to a large number of patches (instances) cropped from this slide. To address this issue, we propose to virtually enlarge the number of bags by introducing the concept of pseudo-bags, on which a double-tier MIL framework is built to effectively use the intrinsic features. Besides, we also contribute to deriving the instance probability under the framework of attention-based MIL, and utilize the derivation to help construct and analyze the proposed framework. The proposed method outperforms other latest methods on the CAMELYON-16 by substantially large margins, and is also better in performance on the TCGA lung cancer dataset. The proposed framework is ready to be extended for wider MIL applications. The code is available at: https://github.com/hrzhang1123/DTFD-MIL

Yanda Meng, Joshua Bridge, Meng Wei et al.

This paper proposes an adaptive auxiliary task learning based approach for object counting problems. Unlike existing auxiliary task learning based methods, we develop an attention-enhanced adaptively shared backbone network to enable both task-shared and task-tailored features learning in an end-to-end manner. The network seamlessly combines standard Convolution Neural Network (CNN) and Graph Convolution Network (GCN) for feature extraction and feature reasoning among different domains of tasks. Our approach gains enriched contextual information by iteratively and hierarchically fusing the features across different task branches of the adaptive CNN backbone. The whole framework pays special attention to the objects' spatial locations and varied density levels, informed by object (or crowd) segmentation and density level segmentation auxiliary tasks. In particular, thanks to the proposed dilated contrastive density loss function, our network benefits from individual and regional context supervision in terms of pixel-independent and pixel-dependent feature learning mechanisms, along with strengthened robustness. Experiments on seven challenging multi-domain datasets demonstrate that our method achieves superior performance to the state-of-the-art auxiliary task learning based counting methods. Our code is made publicly available at: https://github.com/smallmax00/Counting_With_Adaptive_Auxiliary

Feixiang Zhou, Jianyang Xie, Zhuangzhi Gao et al.

The missing-modality problem poses a significant challenge in image-tabular multimodal learning across a wide range of multimedia applications, including product understanding, recommendation systems, and medical diagnosis. This challenge is particularly pronounced when the two modalities are highly heterogeneous, as images and tabular attributes differ substantially in their semantic granularity and data distributions. Existing methods learn modality-invariant representations through disentanglement and alignment over global token-averaged features, capturing only coarse cross-modal consistency and overlooking fine-grained semantic and distributional misalignment, which hampers the exploitation of complementary cues under missing modalities. To address this, we propose DFPL, a novel framework for fine-grained prototype learning. Specifically, Shared-Specific Prototype Modeling (SSPM) extracts compact and diverse shared and modality-specific prototypes, and further performs prototype-level disentanglement to suppress redundant intra-modality correlations. Additionally, we propose a Prototype-guided Fine-grained Alignment (PFA) module that jointly enforces prototype-level distribution matching and prototype-to-class semantic alignment within a unified prototype space, thereby preserving both fine-grained distributional and semantic consistency across modalities. We further introduce a Class-aware Multi-scale Aggregation (CMA) module to adaptively aggregate shared semantics and modality-specific characteristics from global and prototype levels for robust predictions. Extensive experiments on three diverse image-tabular benchmarks demonstrate the superiority of our method compared to the previous approaches under various missing-modality settings. Code will be made publicly available.

Qinkai Yu, Jianyang Xie, Anh Nguyen et al.

Diabetic retinopathy (DR) is a complication of diabetes and usually takes decades to reach sight-threatening levels. Accurate and robust detection of DR severity is critical for the timely management and treatment of diabetes. However, most current DR grading methods suffer from insufficient robustness to data variability (\textit{e.g.} colour fundus images), posing a significant difficulty for accurate and robust grading. In this work, we propose a novel DR grading framework CLIP-DR based on three observations: 1) Recent pre-trained visual language models, such as CLIP, showcase a notable capacity for generalisation across various downstream tasks, serving as effective baseline models. 2) The grading of image-text pairs for DR often adheres to a discernible natural sequence, yet most existing DR grading methods have primarily overlooked this aspect. 3) A long-tailed distribution among DR severity levels complicates the grading process. This work proposes a novel ranking-aware prompting strategy to help the CLIP model exploit the ordinal information. Specifically, we sequentially design learnable prompts between neighbouring text-image pairs in two different ranking directions. Additionally, we introduce a Similarity Matrix Smooth module into the structure of CLIP to balance the class distribution. Finally, we perform extensive comparisons with several state-of-the-art methods on the GDRBench benchmark, demonstrating our CLIP-DR's robustness and superior performance. The implementation code is available \footnote{\url{https://github.com/Qinkaiyu/CLIP-DR}

Yuchen Zhang, Yanda Meng, Yalin Zheng

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Accurate segmentation of the left atrial (LA) and LA scars can provide valuable information to predict treatment outcomes in AF. In this paper, we proposed to automatically segment LA cavity and quantify LA scars with late gadolinium enhancement Magnetic Resonance Imagings (LGE-MRIs). We adopted nnU-Net as the baseline model and exploited the importance of LA boundary characteristics with the TopK loss as the loss function. Specifically, a focus on LA boundary pixels is achieved during training, which provides a more accurate boundary prediction. On the other hand, a distance map transformation of the predicted LA boundary is regarded as an additional input for the LA scar prediction, which provides marginal constraint on scar locations. We further designed a novel uncertainty-aware module (UAM) to produce better results for predictions with high uncertainty. Experiments on the LAScarQS 2022 dataset demonstrated our model's superior performance on the LA cavity and LA scar segmentation. Specifically, we achieved 88.98\% and 64.08\% Dice coefficient for LA cavity and scar segmentation, respectively. We will make our implementation code public available at https://github.com/level6626/Boundary-focused-nnU-Net.

Hongrun Zhang, Liam Burrows, Yanda Meng et al.

Image segmentation is a fundamental task in the field of imaging and vision. Supervised deep learning for segmentation has achieved unparalleled success when sufficient training data with annotated labels are available. However, annotation is known to be expensive to obtain, especially for histopathology images where the target regions are usually with high morphology variations and irregular shapes. Thus, weakly supervised learning with sparse annotations of points is promising to reduce the annotation workload. In this work, we propose a contrast-based variational model to generate segmentation results, which serve as reliable complementary supervision to train a deep segmentation model for histopathology images. The proposed method considers the common characteristics of target regions in histopathology images and can be trained in an end-to-end manner. It can generate more regionally consistent and smoother boundary segmentation, and is more robust to unlabeled `novel' regions. Experiments on two different histology datasets demonstrate its effectiveness and efficiency in comparison to previous models.

Qinkai Yu, Chong Zhang, Gaojie Jin et al.

Annotating medical data for training AI models is often costly and limited due to the shortage of specialists with relevant clinical expertise. This challenge is further compounded by privacy and ethical concerns associated with sensitive patient information. As a result, well-trained medical segmentation models on private datasets constitute valuable intellectual property requiring robust protection mechanisms. Existing model protection techniques primarily focus on classification and generative tasks, while segmentation models-crucial to medical image analysis-remain largely underexplored. In this paper, we propose a novel, stealthy, and harmless method, StealthMark, for verifying the ownership of medical segmentation models under black-box conditions. Our approach subtly modulates model uncertainty without altering the final segmentation outputs, thereby preserving the model's performance. To enable ownership verification, we incorporate model-agnostic explanation methods, e.g. LIME, to extract feature attributions from the model outputs. Under specific triggering conditions, these explanations reveal a distinct and verifiable watermark. We further design the watermark as a QR code to facilitate robust and recognizable ownership claims. We conducted extensive experiments across four medical imaging datasets and five mainstream segmentation models. The results demonstrate the effectiveness, stealthiness, and harmlessness of our method on the original model's segmentation performance. For example, when applied to the SAM model, StealthMark consistently achieved ASR above 95% across various datasets while maintaining less than a 1% drop in Dice and AUC scores, significantly outperforming backdoor-based watermarking methods and highlighting its strong potential for practical deployment. Our implementation code is made available at: https://github.com/Qinkaiyu/StealthMark.

Baoru Huang, Tuan Vo, Chayun Kongtongvattana et al.

Real-time visual feedback from catheterization analysis is crucial for enhancing surgical safety and efficiency during endovascular interventions. However, existing datasets are often limited to specific tasks, small scale, and lack the comprehensive annotations necessary for broader endovascular intervention understanding. To tackle these limitations, we introduce CathAction, a large-scale dataset for catheterization understanding. Our CathAction dataset encompasses approximately 500,000 annotated frames for catheterization action understanding and collision detection, and 25,000 ground truth masks for catheter and guidewire segmentation. For each task, we benchmark recent related works in the field. We further discuss the challenges of endovascular intentions compared to traditional computer vision tasks and point out open research questions. We hope that CathAction will facilitate the development of endovascular intervention understanding methods that can be applied to real-world applications. The dataset is available at https://airvlab.github.io/cathaction/.

Yanda Meng, Xu Chen, Dongxu Gao et al.

In this paper, we propose a novel multi-level aggregation network to regress the coordinates of the vertices of a 3D face from a single 2D image in an end-to-end manner. This is achieved by seamlessly combining standard convolutional neural networks (CNNs) with Graph Convolution Networks (GCNs). By iteratively and hierarchically fusing the features across different layers and stages of the CNNs and GCNs, our approach can provide a dense face alignment and 3D face reconstruction simultaneously for the benefit of direct feature learning of 3D face mesh. Experiments on several challenging datasets demonstrate that our method outperforms state-of-the-art approaches on both 2D and 3D face alignment tasks.

Shouyue Liu, Jinkui Hao, Yanwu Xu et al.

Optical Coherence Tomography Angiography (OCTA) is a promising tool for detecting Alzheimer's disease (AD) by imaging the retinal microvasculature. Ophthalmologists commonly use region-based analysis, such as the ETDRS grid, to study OCTA image biomarkers and understand the correlation with AD. However, existing studies have used general deep computer vision methods, which present challenges in providing interpretable results and leveraging clinical prior knowledge. To address these challenges, we propose a novel deep-learning framework called Polar-Net. Our approach involves mapping OCTA images from Cartesian coordinates to polar coordinates, which allows for the use of approximate sector convolution and enables the implementation of the ETDRS grid-based regional analysis method commonly used in clinical practice. Furthermore, Polar-Net incorporates clinical prior information of each sector region into the training process, which further enhances its performance. Additionally, our framework adapts to acquire the importance of the corresponding retinal region, which helps researchers and clinicians understand the model's decision-making process in detecting AD and assess its conformity to clinical observations. Through evaluations on private and public datasets, we have demonstrated that Polar-Net outperforms existing state-of-the-art methods and provides more valuable pathological evidence for the association between retinal vascular changes and AD. In addition, we also show that the two innovative modules introduced in our framework have a significant impact on improving overall performance.

Xin Zhang, Liangxiu Han, Tam Sobeih et al.

Corneal Confocal Microscopy (CCM) is a sensitive tool for assessing small-fiber damage in Diabetic Peripheral Neuropathy (DPN), yet the development of robust, automated deep learning-based diagnostic models is limited by scarce labelled data and fine-grained variability in corneal nerve morphology. Although Artificial Intelligence (AI)-driven foundation generative models excel at natural image synthesis, they often struggle in medical imaging due to limited domain-specific training, compromising the anatomical fidelity required for clinical analysis. To overcome these limitations, we propose a Weight-Decomposed Low-Rank Adaptation (WDLoRA)-based multimodal generative framework for clinically guided CCM image synthesis. WDLoRA is a parameter-efficient fine-tuning (PEFT) mechanism that decouples magnitude and directional weight updates, enabling foundation generative models to independently learn the orientation (nerve topology) and intensity (stromal contrast) required for medical realism. By jointly conditioning on nerve segmentation masks and disease-specific clinical prompts, the model synthesises anatomically coherent images across the DPN spectrum (Control, T1NoDPN, T1DPN). A comprehensive three-pillar evaluation demonstrates that the proposed framework achieves state-of-the-art visual fidelity (Fréchet Inception Distance (FID): 5.18) and structural integrity (Structural Similarity Index Measure (SSIM): 0.630), significantly outperforming GAN and standard diffusion baselines. Crucially, the synthetic images preserve gold-standard clinical biomarkers and are statistically equivalent to real patient data. When used to train automated diagnostic models, the synthetic dataset improves downstream diagnostic accuracy by 2.1% and segmentation performance by 2.2%, validating the framework's potential to alleviate data bottlenecks in medical AI.

Qinkai Yu, Wei Zhou, Hantao Liu et al.

As a long-term complication of diabetes, diabetic retinopathy (DR) progresses slowly, potentially taking years to threaten vision. An accurate and robust evaluation of its severity is vital to ensure prompt management and care. Ordinal regression leverages the underlying inherent order between categories to achieve superior performance beyond traditional classification. However, there exist challenges leading to lower DR classification performance: 1) The uneven distribution of DR severity levels, characterized by a long-tailed pattern, adds complexity to the grading process. 2)The ambiguity in defining category boundaries introduces additional challenges, making the classification process more complex and prone to inconsistencies. This work proposes a novel autoregressive ordinal regression method called AOR-DR to address the above challenges by leveraging the clinical knowledge of inherent ordinal information in DR grading dataset settings. Specifically, we decompose the DR grading task into a series of ordered steps by fusing the prediction of the previous steps with extracted image features as conditions for the current prediction step. Additionally, we exploit the diffusion process to facilitate conditional probability modeling, enabling the direct use of continuous global image features for autoregression without relearning contextual information from patch-level features. This ensures the effectiveness of the autoregressive process and leverages the capabilities of pre-trained large-scale foundation models. Extensive experiments were conducted on four large-scale publicly available color fundus datasets, demonstrating our model's effectiveness and superior performance over six recent state-of-the-art ordinal regression methods. The implementation code is available at https://github.com/Qinkaiyu/AOR-DR.

Jianyang Xie, Yitian Zhao, Yanda Meng et al.

Spatial-temporal graph convolutional networks (ST-GCNs) showcase impressive performance in skeleton-based human action recognition (HAR). However, despite the development of numerous models, their recognition performance does not differ significantly after aligning the input settings. With this observation, we hypothesize that ST-GCNs are over-parameterized for HAR, a conjecture subsequently confirmed through experiments employing the lottery ticket hypothesis. Additionally, a novel sparse ST-GCNs generator is proposed, which trains a sparse architecture from a randomly initialized dense network while maintaining comparable performance levels to the dense components. Moreover, we generate multi-level sparsity ST-GCNs by integrating sparse structures at various sparsity levels and demonstrate that the assembled model yields a significant enhancement in HAR performance. Thorough experiments on four datasets, including NTU-RGB+D 60(120), Kinetics-400, and FineGYM, demonstrate that the proposed sparse ST-GCNs can achieve comparable performance to their dense components. Even with 95% fewer parameters, the sparse ST-GCNs exhibit a degradation of <1% in top-1 accuracy. Meanwhile, the multi-level sparsity ST-GCNs, which require only 66% of the parameters of the dense ST-GCNs, demonstrate an improvement of >1% in top-1 accuracy. The code is available at https://github.com/davelailai/Sparse-ST-GCN.

Junchao Zhu, Ruining Deng, Junlin Guo et al.

Spatial transcriptomics (ST) is an emerging technology that enables researchers to investigate the molecular relationships underlying tissue morphology. However, acquiring ST data remains prohibitively expensive, and traditional fixed-grid sampling strategies lead to redundant measurements of morphologically similar or biologically uninformative regions, thus resulting in scarce data that constrain current methods. The well-established single-cell sequencing field, however, could provide rich biological data as an effective auxiliary source to mitigate this limitation. To bridge these gaps, we introduce SCR2-ST, a unified framework that leverages single-cell prior knowledge to guide efficient data acquisition and accurate expression prediction. SCR2-ST integrates a single-cell guided reinforcement learning-based (SCRL) active sampling and a hybrid regression-retrieval prediction network SCR2Net. SCRL combines single-cell foundation model embeddings with spatial density information to construct biologically grounded reward signals, enabling selective acquisition of informative tissue regions under constrained sequencing budgets. SCR2Net then leverages the actively sampled data through a hybrid architecture combining regression-based modeling with retrieval-augmented inference, where a majority cell-type filtering mechanism suppresses noisy matches and retrieved expression profiles serve as soft labels for auxiliary supervision. We evaluated SCR2-ST on three public ST datasets, demonstrating SOTA performance in both sampling efficiency and prediction accuracy, particularly under low-budget scenarios. Code is publicly available at: https://github.com/hrlblab/SCR2ST

Boyi Zheng, Yalin Zheng, Hrvoje Bogunović et al.

In this work, we propose PSScreen V2, a partially supervised self-training framework for multiple retinal disease screening. Unlike previous methods that rely on fully labelled or single-domain datasets, PSScreen V2 is designed to learn from multiple partially labelled datasets with different distributions, addressing both label absence and domain shift challenges. To this end, PSScreen V2 adopts a three-branch architecture with one teacher and two student networks. The teacher branch generates pseudo labels from weakly augmented images to address missing labels, while the two student branches introduce novel feature augmentation strategies: Low-Frequency Dropout (LF-Dropout), which enhances domain robustness by randomly discarding domain-related low-frequency components, and Low-Frequency Uncertainty (LF-Uncert), which estimates uncertain domain variability via adversarially learned Gaussian perturbations of low-frequency statistics. Extensive experiments on multiple in-domain and out-of-domain fundus datasets demonstrate that PSScreen V2 achieves state-of-the-art performance and superior domain generalization ability. Furthermore, compatibility tests with diverse backbones, including the vision foundation model DINOv2, as well as evaluations on chest X-ray datasets, highlight the universality and adaptability of the proposed framework. The codes are available at https://github.com/boyiZheng99/PSScreen_V2.

Feixiang Zhou, Zhuangzhi Gao, He Zhao et al.

Accurate segmentation of tubular structures, such as vascular networks, plays a critical role in various medical domains. A remaining significant challenge in this task is structural fragmentation, which can adversely impact downstream applications. Existing methods primarily focus on designing various loss functions to constrain global topological structures. However, they often overlook local discontinuity regions, leading to suboptimal segmentation results. To overcome this limitation, we propose a novel Global-to-Local Connectivity Preservation (GLCP) framework that can simultaneously perceive global and local structural characteristics of tubular networks. Specifically, we propose an Interactive Multi-head Segmentation (IMS) module to jointly learn global segmentation, skeleton maps, and local discontinuity maps, respectively. This enables our model to explicitly target local discontinuity regions while maintaining global topological integrity. In addition, we design a lightweight Dual-Attention-based Refinement (DAR) module to further improve segmentation quality by refining the resulting segmentation maps. Extensive experiments on both 2D and 3D datasets demonstrate that our GLCP achieves superior accuracy and continuity in tubular structure segmentation compared to several state-of-the-art approaches. The source codes will be available at https://github.com/FeixiangZhou/GLCP.

Qinkai Yu, Jianyang Xie, Yitian Zhao et al.

Multimodal ophthalmic imaging-based diagnosis integrates color fundus image with optical coherence tomography (OCT) to provide a comprehensive view of ocular pathologies. However, the uneven global distribution of healthcare resources often results in real-world clinical scenarios encountering incomplete multimodal data, which significantly compromises diagnostic accuracy. Existing commonly used pipelines, such as modality imputation and distillation methods, face notable limitations: 1)Imputation methods struggle with accurately reconstructing key lesion features, since OCT lesions are localized, while fundus images vary in style. 2)distillation methods rely heavily on fully paired multimodal training data. To address these challenges, we propose a novel multimodal alignment and fusion framework capable of robustly handling missing modalities in the task of ophthalmic diagnostics. By considering the distinctive feature characteristics of OCT and fundus images, we emphasize the alignment of semantic features within the same category and explicitly learn soft matching between modalities, allowing the missing modality to utilize existing modality information, achieving robust cross-modal feature alignment under the missing modality. Specifically, we leverage the Optimal Transport for multi-scale modality feature alignment: class-wise alignment through predicted class prototypes and feature-wise alignment via cross-modal shared feature transport. Furthermore, we propose an asymmetric fusion strategy that effectively exploits the distinct characteristics of OCT and fundus modalities. Extensive evaluations on three large ophthalmic multimodal datasets demonstrate our model's superior performance under various modality-incomplete scenarios, achieving Sota performance in both complete modality and inter-modality incompleteness conditions. Code is available at https://github.com/Qinkaiyu/RIMA

Xu Chen, Xiangde Luo, Yitian Zhao et al.

Image segmentation is a fundamental topic in image processing and has been studied for many decades. Deep learning-based supervised segmentation models have achieved state-of-the-art performance but most of them are limited by using pixel-wise loss functions for training without geometrical constraints. Inspired by Euler's Elastica model and recent active contour models introduced into the field of deep learning, we propose a novel active contour with elastica (ACE) loss function incorporating Elastica (curvature and length) and region information as geometrically-natural constraints for the image segmentation tasks. We introduce the mean curvature i.e. the average of all principal curvatures, as a more effective image prior to representing curvature in our ACE loss function. Furthermore, based on the definition of the mean curvature, we propose a fast solution to approximate the ACE loss in three-dimensional (3D) by using Laplace operators for 3D image segmentation. We evaluate our ACE loss function on four 2D and 3D natural and biomedical image datasets. Our results show that the proposed loss function outperforms other mainstream loss functions on different segmentation networks. Our source code is available at https://github.com/HiLab-git/ACELoss.

Chengzhi Liu, Zile Huang, Zhe Chen et al.

Ophthalmologists typically require multimodal data sources to improve diagnostic accuracy in clinical decisions. However, due to medical device shortages, low-quality data and data privacy concerns, missing data modalities are common in real-world scenarios. Existing deep learning methods tend to address it by learning an implicit latent subspace representation for different modality combinations. We identify two significant limitations of these methods: (1) implicit representation constraints that hinder the model's ability to capture modality-specific information and (2) modality heterogeneity, causing distribution gaps and redundancy in feature representations. To address these, we propose an Incomplete Modality Disentangled Representation (IMDR) strategy, which disentangles features into explicit independent modal-common and modal-specific features by guidance of mutual information, distilling informative knowledge and enabling it to reconstruct valuable missing semantics and produce robust multimodal representations. Furthermore, we introduce a joint proxy learning module that assists IMDR in eliminating intra-modality redundancy by exploiting the extracted proxies from each class. Experiments on four ophthalmology multimodal datasets demonstrate that the proposed IMDR outperforms the state-of-the-art methods significantly.

Weiyi Zhang, Peranut Chotcomwongse, Yinwen Li et al.

Diabetic macular edema (DME) significantly contributes to visual impairment in diabetic patients. Treatment responses to intravitreal therapies vary, highlighting the need for patient stratification to predict therapeutic benefits and enable personalized strategies. To our knowledge, this study is the first to explore pre-treatment stratification for predicting DME treatment responses. To advance this research, we organized the 2nd Asia-Pacific Tele-Ophthalmology Society (APTOS) Big Data Competition in 2021. The competition focused on improving predictive accuracy for anti-VEGF therapy responses using ophthalmic OCT images. We provided a dataset containing tens of thousands of OCT images from 2,000 patients with labels across four sub-tasks. This paper details the competition's structure, dataset, leading methods, and evaluation metrics. The competition attracted strong scientific community participation, with 170 teams initially registering and 41 reaching the final round. The top-performing team achieved an AUC of 80.06%, highlighting the potential of AI in personalized DME treatment and clinical decision-making.

Meng Wang, Tian Lin, Qingshan Hou et al.

Artificial intelligence (AI) shows remarkable potential in medical imaging diagnostics, yet most current models require retraining when applied across different clinical settings, limiting their scalability. We introduce GlobeReady, a clinician-friendly AI platform that enables fundus disease diagnosis that operates without retraining, fine-tuning, or the needs for technical expertise. GlobeReady demonstrates high accuracy across imaging modalities: 93.9-98.5% for 11 fundus diseases using color fundus photographs (CPFs) and 87.2-92.7% for 15 fundus diseases using optic coherence tomography (OCT) scans. By leveraging training-free local feature augmentation, GlobeReady platform effectively mitigates domain shifts across centers and populations, achieving accuracies of 88.9-97.4% across five centers on average in China, 86.3-96.9% in Vietnam, and 73.4-91.0% in Singapore, and 90.2-98.9% in the UK. Incorporating a bulit-in confidence-quantifiable diagnostic mechanism further enhances the platform's accuracy to 94.9-99.4% with CFPs and 88.2-96.2% with OCT, while enabling identification of out-of-distribution cases with 86.3% accuracy across 49 common and rare fundus diseases using CFPs, and 90.6% accuracy across 13 diseases using OCT. Clinicians from countries rated GlobeReady highly for usability and clinical relevance (average score 4.6/5). These findings demonstrate GlobeReady's robustness, generalizability and potential to support global ophthalmic care without technical barriers.

Biwen Meng, Xi Long, Wanrong Yang et al.

Deep learning has made significant progress in addressing challenges in various fields including computational pathology (CPath). However, due to the complexity of the domain shift problem, the performance of existing models will degrade, especially when it comes to multi-domain or cross-domain tasks. In this paper, we propose a Test-time style transfer (T3s) that uses a bidirectional mapping mechanism to project the features of the source and target domains into a unified feature space, enhancing the generalization ability of the model. To further increase the style expression space, we introduce a Cross-domain style diversification module (CSDM) to ensure the orthogonality between style bases. In addition, data augmentation and low-rank adaptation techniques are used to improve feature alignment and sensitivity, enabling the model to adapt to multi-domain inputs effectively. Our method has demonstrated effectiveness on three unseen datasets.

Zhuangzhi Gao, Feixiang Zhou, He Zhao et al.

Segmenting curvilinear structures in medical images is essential for analyzing morphological patterns in clinical applications. Integrating topological properties, such as connectivity, improves segmentation accuracy and consistency. However, extracting and embedding such properties - especially from Persistence Diagrams (PD) - is challenging due to their non-differentiability and computational cost. Existing approaches mostly encode topology through handcrafted loss functions, which generalize poorly across tasks. In this paper, we propose PIs-Regressor, a simple yet effective module that learns persistence image (PI) - finite, differentiable representations of topological features - directly from data. Together with Topology SegNet, which fuses these features in both downsampling and upsampling stages, our framework integrates topology into the network architecture itself rather than auxiliary losses. Unlike existing methods that depend heavily on handcrafted loss functions, our approach directly incorporates topological information into the network structure, leading to more robust segmentation. Our design is flexible and can be seamlessly combined with other topology-based methods to further enhance segmentation performance. Experimental results show that integrating topological features enhances model robustness, effectively handling challenges like overexposure and blurring in medical imaging. Our approach on three curvilinear benchmarks demonstrate state-of-the-art performance in both pixel-level accuracy and topological fidelity.

Zhuangzhi Gao, Hongyi Qin, He Zhao et al.

Multimodal large language models (MLLMs) hold promise for integrating diverse data modalities, but current medical adaptations such as LLaVA-Med often fail to fully exploit the synergy between color fundus photography (CFP) and optical coherence tomography (OCT), and offer limited interpretability of quantitative biomarkers. We introduce GROK, a grounded multimodal large language model that jointly processes CFP, OCT, and text to deliver clinician-grade diagnoses of ocular and systemic disease. GROK comprises three core modules: Knowledge-Guided Instruction Generation, CLIP-Style OCT-Biomarker Alignment, and Supervised Instruction Fine-Tuning, which together establish a quantitative-to-qualitative diagnostic chain of thought, mirroring real clinical reasoning when producing detailed lesion annotations. To evaluate our approach, we introduce the Grounded Ophthalmic Understanding benchmark, which covers six disease categories and three tasks: macro-level diagnostic classification, report generation quality, and fine-grained clinical assessment of the generated chain of thought. Experiments show that, with only LoRA (Low-Rank Adaptation) fine-tuning of a 7B-parameter Qwen2 backbone, GROK outperforms comparable 7B and 32B baselines on both report quality and fine-grained clinical metrics, and even exceeds OpenAI o3. Code and data are publicly available in the GROK repository.

Weicheng Liao, Zan Chen, Jianyang Xie et al.

Ultra-Wide-Field (UWF) retinal imaging has revolutionized retinal diagnostics by providing a comprehensive view of the retina. However, it often suffers from quality-degrading factors such as blurring and uneven illumination, which obscure fine details and mask pathological information. While numerous retinal image enhancement methods have been proposed for other fundus imageries, they often fail to address the unique requirements in UWF, particularly the need to preserve pathological details. In this paper, we propose a novel frequency-aware self-supervised learning method for UWF image enhancement. It incorporates frequency-decoupled image deblurring and Retinex-guided illumination compensation modules. An asymmetric channel integration operation is introduced in the former module, so as to combine global and local views by leveraging high- and low-frequency information, ensuring the preservation of fine and broader structural details. In addition, a color preservation unit is proposed in the latter Retinex-based module, to provide multi-scale spatial and frequency information, enabling accurate illumination estimation and correction. Experimental results demonstrate that the proposed work not only enhances visualization quality but also improves disease diagnosis performance by restoring and correcting fine local details and uneven intensity. To the best of our knowledge, this work is the first attempt for UWF image enhancement, offering a robust and clinically valuable tool for improving retinal disease management.

Pusheng Xu, Xia Gong, Xiaolan Chen et al.

Purpose: To develop a bilingual multimodal visual question answering (VQA) benchmark for evaluating VLMs in ophthalmology. Methods: Ophthalmic image posts and associated captions published between January 1, 2016, and December 31, 2024, were collected from WeChat Official Accounts. Based on these captions, bilingual question-answer (QA) pairs in Chinese and English were generated using GPT-4o-mini. QA pairs were categorized into six subsets by question type and language: binary (Binary_CN, Binary_EN), single-choice (Single-choice_CN, Single-choice_EN), and open-ended (Open-ended_CN, Open-ended_EN). The benchmark was used to evaluate the performance of three VLMs: GPT-4o, Gemini 2.0 Flash, and Qwen2.5-VL-72B-Instruct. Results: The final OphthalWeChat dataset included 3,469 images and 30,120 QA pairs across 9 ophthalmic subspecialties, 548 conditions, 29 imaging modalities, and 68 modality combinations. Gemini 2.0 Flash achieved the highest overall accuracy (0.548), outperforming GPT-4o (0.522, P < 0.001) and Qwen2.5-VL-72B-Instruct (0.514, P < 0.001). It also led in both Chinese (0.546) and English subsets (0.550). Subset-specific performance showed Gemini 2.0 Flash excelled in Binary_CN (0.687), Single-choice_CN (0.666), and Single-choice_EN (0.646), while GPT-4o ranked highest in Binary_EN (0.717), Open-ended_CN (BLEU-1: 0.301; BERTScore: 0.382), and Open-ended_EN (BLEU-1: 0.183; BERTScore: 0.240). Conclusions: This study presents the first bilingual VQA benchmark for ophthalmology, distinguished by its real-world context and inclusion of multiple examinations per patient. The dataset reflects authentic clinical decision-making scenarios and enables quantitative evaluation of VLMs, supporting the development of accurate, specialized, and trustworthy AI systems for eye care.

Yanda Meng, Hongrun Zhang, Dongxu Gao et al.

Segmentation is an essential operation of image processing. The convolution operation suffers from a limited receptive field, while global modelling is fundamental to segmentation tasks. In this paper, we apply graph convolution into the segmentation task and propose an improved \textit{Laplacian}. Different from existing methods, our \textit{Laplacian} is data-dependent, and we introduce two attention diagonal matrices to learn a better vertex relationship. In addition, it takes advantage of both region and boundary information when performing graph-based information propagation. Specifically, we model and reason about the boundary-aware region-wise correlations of different classes through learning graph representations, which is capable of manipulating long range semantic reasoning across various regions with the spatial enhancement along the object's boundary. Our model is well-suited to obtain global semantic region information while also accommodates local spatial boundary characteristics simultaneously. Experiments on two types of challenging datasets demonstrate that our method outperforms the state-of-the-art approaches on the segmentation of polyps in colonoscopy images and of the optic disc and optic cup in colour fundus images.

Yanda Meng, Hongrun Zhang, Yitian Zhao et al.

Semi-supervised approaches for crowd counting attract attention, as the fully supervised paradigm is expensive and laborious due to its request for a large number of images of dense crowd scenarios and their annotations. This paper proposes a spatial uncertainty-aware semi-supervised approach via regularized surrogate task (binary segmentation) for crowd counting problems. Different from existing semi-supervised learning-based crowd counting methods, to exploit the unlabeled data, our proposed spatial uncertainty-aware teacher-student framework focuses on high confident regions' information while addressing the noisy supervision from the unlabeled data in an end-to-end manner. Specifically, we estimate the spatial uncertainty maps from the teacher model's surrogate task to guide the feature learning of the main task (density regression) and the surrogate task of the student model at the same time. Besides, we introduce a simple yet effective differential transformation layer to enforce the inherent spatial consistency regularization between the main task and the surrogate task in the student model, which helps the surrogate task to yield more reliable predictions and generates high-quality uncertainty maps. Thus, our model can also address the task-level perturbation problems that occur spatial inconsistency between the primary and surrogate tasks in the student model. Experimental results on four challenging crowd counting datasets demonstrate that our method achieves superior performance to the state-of-the-art semi-supervised methods.

Shuai Yu, Jianyang Xie, Jinkui Hao et al.

Optical Coherence Tomography Angiography (OCTA) has been increasingly used in the management of eye and systemic diseases in recent years. Manual or automatic analysis of blood vessel in 2D OCTA images (en face angiograms) is commonly used in clinical practice, however it may lose rich 3D spatial distribution information of blood vessels or capillaries that are useful for clinical decision-making. In this paper, we introduce a novel 3D vessel reconstruction framework based on the estimation of vessel depth maps from OCTA images. First, we design a network with structural constraints to predict the depth of blood vessels in OCTA images. In order to promote the accuracy of the predicted depth map at both the overall structure- and pixel- level, we combine MSE and SSIM loss as the training loss function. Finally, the 3D vessel reconstruction is achieved by utilizing the estimated depth map and 2D vessel segmentation results. Experimental results demonstrate that our method is effective in the depth prediction and 3D vessel reconstruction for OCTA images.% results may be used to guide subsequent vascular analysis

Lei Mou, Yitian Zhao, Huazhu Fu et al.

Automated detection of curvilinear structures, e.g., blood vessels or nerve fibres, from medical and biomedical images is a crucial early step in automatic image interpretation associated to the management of many diseases. Precise measurement of the morphological changes of these curvilinear organ structures informs clinicians for understanding the mechanism, diagnosis, and treatment of e.g. cardiovascular, kidney, eye, lung, and neurological conditions. In this work, we propose a generic and unified convolution neural network for the segmentation of curvilinear structures and illustrate in several 2D/3D medical imaging modalities. We introduce a new curvilinear structure segmentation network (CS2-Net), which includes a self-attention mechanism in the encoder and decoder to learn rich hierarchical representations of curvilinear structures. Two types of attention modules - spatial attention and channel attention - are utilized to enhance the inter-class discrimination and intra-class responsiveness, to further integrate local features with their global dependencies and normalization, adaptively. Furthermore, to facilitate the segmentation of curvilinear structures in medical images, we employ a 1x3 and a 3x1 convolutional kernel to capture boundary features. ...

Yuhui Ma, Huaying Hao, Huazhu Fu et al.

Optical Coherence Tomography Angiography (OCT-A) is a non-invasive imaging technique, and has been increasingly used to image the retinal vasculature at capillary level resolution. However, automated segmentation of retinal vessels in OCT-A has been under-studied due to various challenges such as low capillary visibility and high vessel complexity, despite its significance in understanding many eye-related diseases. In addition, there is no publicly available OCT-A dataset with manually graded vessels for training and validation. To address these issues, for the first time in the field of retinal image analysis we construct a dedicated Retinal OCT-A SEgmentation dataset (ROSE), which consists of 229 OCT-A images with vessel annotations at either centerline-level or pixel level. This dataset has been released for public access to assist researchers in the community in undertaking research in related topics. Secondly, we propose a novel Split-based Coarse-to-Fine vessel segmentation network (SCF-Net), with the ability to detect thick and thin vessels separately. In the SCF-Net, a split-based coarse segmentation (SCS) module is first introduced to produce a preliminary confidence map of vessels, and a split-based refinement (SRN) module is then used to optimize the shape/contour of the retinal microvasculature. Thirdly, we perform a thorough evaluation of the state-of-the-art vessel segmentation models and our SCF-Net on the proposed ROSE dataset. The experimental results demonstrate that our SCF-Net yields better vessel segmentation performance in OCT-A than both traditional methods and other deep learning methods.

Joshua Bridge, Simon P. Harding, Yalin Zheng

Prognostic models aim to predict the future course of a disease or condition and are a vital component of personalized medicine. Statistical models make use of longitudinal data to capture the temporal aspect of disease progression; however, these models require prior feature extraction. Deep learning avoids explicit feature extraction, meaning we can develop models for images where features are either unknown or impossible to quantify accurately. Previous prognostic models using deep learning with imaging data require annotation during training or only utilize a single time point. We propose a novel deep learning method to predict the progression of diseases using longitudinal imaging data with uneven time intervals, which requires no prior feature extraction. Given previous images from a patient, our method aims to predict whether the patient will progress onto the next stage of the disease. The proposed method uses InceptionV3 to produce feature vectors for each image. In order to account for uneven intervals, a novel interval scaling is proposed. Finally, a Recurrent Neural Network is used to prognosticate the disease. We demonstrate our method on a longitudinal dataset of color fundus images from 4903 eyes with age-related macular degeneration (AMD), taken from the Age-Related Eye Disease Study, to predict progression to late AMD. Our method attains a testing sensitivity of 0.878, a specificity of 0.887, and an area under the receiver operating characteristic of 0.950. We compare our method to previous methods, displaying superior performance in our model. Class activation maps display how the network reaches the final decision.