Xiahai Zhuang

Ke Zhang, Xiahai Zhuang

Curating a large set of fully annotated training data can be costly, especially for the tasks of medical image segmentation. Scribble, a weaker form of annotation, is more obtainable in practice, but training segmentation models from limited supervision of scribbles is still challenging. To address the difficulties, we propose a new framework for scribble learning-based medical image segmentation, which is composed of mix augmentation and cycle consistency and thus is referred to as CycleMix. For augmentation of supervision, CycleMix adopts the mixup strategy with a dedicated design of random occlusion, to perform increments and decrements of scribbles. For regularization of supervision, CycleMix intensifies the training objective with consistency losses to penalize inconsistent segmentation, which results in significant improvement of segmentation performance. Results on two open datasets, i.e., ACDC and MSCMRseg, showed that the proposed method achieved exhilarating performance, demonstrating comparable or even better accuracy than the fully-supervised methods. The code and expert-made scribble annotations for MSCMRseg are publicly available at https://github.com/BWGZK/CycleMix.

Ke Zhang, Xiahai Zhuang

Cardiac segmentation is an essential step for the diagnosis of cardiovascular diseases. However, pixel-wise dense labeling is both costly and time-consuming. Scribble, as a form of sparse annotation, is more accessible than full annotations. However, it's particularly challenging to train a segmentation network with weak supervision from scribbles. To tackle this problem, we propose a new scribble-guided method for cardiac segmentation, based on the Positive-Unlabeled (PU) learning framework and global consistency regularization, and termed as ShapePU. To leverage unlabeled pixels via PU learning, we first present an Expectation-Maximization (EM) algorithm to estimate the proportion of each class in the unlabeled pixels. Given the estimated ratios, we then introduce the marginal probability maximization to identify the classes of unlabeled pixels. To exploit shape knowledge, we apply cutout operations to training images, and penalize the inconsistent segmentation results. Evaluated on two open datasets, i.e, ACDC and MSCMRseg, our scribble-supervised ShapePU surpassed the fully supervised approach respectively by 1.4% and 9.8% in average Dice, and outperformed the state-of-the-art weakly supervised and PU learning methods by large margins. Our code is available at https://github.com/BWGZK/ShapePU.

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.

Yuanye Liu, Siyuan Zhou, Ke Zhang et al.

Pre-trained Vision Transformers (ViTs) are increasingly deployed for medical image classification. However, correcting their inevitable failure cases in dynamic clinical scenarios poses a critical challenge. Conventional fine-tuning approaches inherently suffer from catastrophic forgetting, severely degrading previously acquired diagnostic capabilities. Such instability fundamentally compromises clinical safety. Addressing this vulnerability requires an active, controllable, and reliable intervention mechanism that is both theoretically grounded and inherently interpretable. To this end, we propose X-Edit (eXact, eXplicit, and eXplainable Editing), an efficient null-space model editing framework. X-Edit transitions the editing process from iterative gradient-based optimization to a theoretically grounded, closed-form solution. Specifically, we first explicitly localize the influential layers via causal tracing governing the erroneous prediction. Subsequently, we construct an orthogonal null-space projection matrix from a curated anchor set. By geometrically constraining the exact parameter update strictly within this null space, we provide mathematical guarantees that the intervention rectifies targeted errors without perturbing established diagnostic representations. Extensive evaluations on six medical imaging benchmarks demonstrate that X-Edit comprehensively suppresses catastrophic forgetting while achieving superior edit success rates. Our code is available at https://github.com/HenryLau7/X-Edit.

Zheyao Gao, Lei Li, Fuping Wu et al.

Distributed learning has shown great potential in medical image analysis. It allows to use multi-center training data with privacy protection. However, data distributions in local centers can vary from each other due to different imaging vendors, and annotation protocols. Such variation degrades the performance of learning-based methods. To mitigate the influence, two groups of methods have been proposed for different aims, i.e., the global methods and the personalized methods. The former are aimed to improve the performance of a single global model for all test data from unseen centers (known as generic data); while the latter target multiple models for each center (denoted as local data). However, little has been researched to achieve both goals simultaneously. In this work, we propose a new framework of distributed learning that bridges the gap between two groups, and improves the performance for both generic and local data. Specifically, our method decouples the predictions for generic data and local data, via distribution-conditioned adaptation matrices. Results on multi-center left atrial (LA) MRI segmentation showed that our method demonstrated superior performance over existing methods on both generic and local data. Our code is available at https://github.com/key1589745/decouple_predict

Junyi Qiu, Lei Li, Sihan Wang et al.

Myocardial pathology segmentation (MyoPS) can be a prerequisite for the accurate diagnosis and treatment planning of myocardial infarction. However, achieving this segmentation is challenging, mainly due to the inadequate and indistinct information from an image. In this work, we develop an end-to-end deep neural network, referred to as MyoPS-Net, to flexibly combine five-sequence cardiac magnetic resonance (CMR) images for MyoPS. To extract precise and adequate information, we design an effective yet flexible architecture to extract and fuse cross-modal features. This architecture can tackle different numbers of CMR images and complex combinations of modalities, with output branches targeting specific pathologies. To impose anatomical knowledge on the segmentation results, we first propose a module to regularize myocardium consistency and localize the pathologies, and then introduce an inclusiveness loss to utilize relations between myocardial scars and edema. We evaluated the proposed MyoPS-Net on two datasets, i.e., a private one consisting of 50 paired multi-sequence CMR images and a public one from MICCAI2020 MyoPS Challenge. Experimental results showed that MyoPS-Net could achieve state-of-the-art performance in various scenarios. Note that in practical clinics, the subjects may not have full sequences, such as missing LGE CMR or mapping CMR scans. We therefore conducted extensive experiments to investigate the performance of the proposed method in dealing with such complex combinations of different CMR sequences. Results proved the superiority and generalizability of MyoPS-Net, and more importantly, indicated a practical clinical application.

Chengyan Wang, Jun Lyu, Shuo Wang et al.

Cardiac magnetic resonance imaging (CMR) has emerged as a valuable diagnostic tool for cardiac diseases. However, a limitation of CMR is its slow imaging speed, which causes patient discomfort and introduces artifacts in the images. There has been growing interest in deep learning-based CMR imaging algorithms that can reconstruct high-quality images from highly under-sampled k-space data. However, the development of deep learning methods requires large training datasets, which have not been publicly available for CMR. To address this gap, we released a dataset that includes multi-contrast, multi-view, multi-slice and multi-coil CMR imaging data from 300 subjects. Imaging studies include cardiac cine and mapping sequences. Manual segmentations of the myocardium and chambers of all the subjects are also provided within the dataset. Scripts of state-of-the-art reconstruction algorithms were also provided as a point of reference. Our aim is to facilitate the advancement of state-of-the-art CMR image reconstruction by introducing standardized evaluation criteria and making the dataset freely accessible to the research community. Researchers can access the dataset at https://www.synapse.org/#!Synapse:syn51471091/wiki/.

Ke Zhang, Xiahai Zhuang

Curating a large scale fully-annotated dataset can be both labour-intensive and expertise-demanding, especially for medical images. To alleviate this problem, we propose to utilize solely scribble annotations for weakly supervised segmentation. Existing solutions mainly leverage selective losses computed solely on annotated areas and generate pseudo gold standard segmentation by propagating labels to adjacent areas. However, these methods could suffer from the inaccurate and sometimes unrealistic pseudo segmentation due to the insufficient supervision and incomplete shape features. Different from previous efforts, we first investigate the principle of ''good scribble annotations'', which leads to efficient scribble forms via supervision maximization and randomness simulation. Furthermore, we introduce regularization terms to encode the spatial relationship and shape prior, where a new formulation is developed to estimate the mixture ratios of label classes. These ratios are critical in identifying the unlabeled pixels for each class and correcting erroneous predictions, thus the accurate estimation lays the foundation for the incorporation of spatial prior. Finally, we integrate the efficient scribble supervision with the prior into a unified framework, denoted as ZScribbleSeg, and apply the method to multiple scenarios. Leveraging only scribble annotations, ZScribbleSeg set new state-of-the-arts on four segmentation tasks using ACDC, MSCMRseg, MyoPS and PPSS datasets.

Lei Li, Wangbin Ding, Liqun Huang et al.

Multi-modality cardiac imaging plays a key role in the management of patients with cardiovascular diseases. It allows a combination of complementary anatomical, morphological and functional information, increases diagnosis accuracy, and improves the efficacy of cardiovascular interventions and clinical outcomes. Fully-automated processing and quantitative analysis of multi-modality cardiac images could have a direct impact on clinical research and evidence-based patient management. However, these require overcoming significant challenges including inter-modality misalignment and finding optimal methods to integrate information from different modalities. This paper aims to provide a comprehensive review of multi-modality imaging in cardiology, the computing methods, the validation strategies, the related clinical workflows and future perspectives. For the computing methodologies, we have a favored focus on the three tasks, i.e., registration, fusion and segmentation, which generally involve multi-modality imaging data, \textit{either combining information from different modalities or transferring information across modalities}. The review highlights that multi-modality cardiac imaging data has the potential of wide applicability in the clinic, such as trans-aortic valve implantation guidance, myocardial viability assessment, and catheter ablation therapy and its patient selection. Nevertheless, many challenges remain unsolved, such as missing modality, combination of imaging and non-imaging data, and uniform analysis and representation of different modalities. There is also work to do in defining how the well-developed techniques fit in clinical workflows and how much additional and relevant information they introduce. These problems are likely to continue to be an active field of research and the questions to be answered in the future.

Xinzhe Luo, Xiahai Zhuang

This paper presents a generic probabilistic framework for estimating the statistical dependency and finding the anatomical correspondences among an arbitrary number of medical images. The method builds on a novel formulation of the $N$-dimensional joint intensity distribution by representing the common anatomy as latent variables and estimating the appearance model with nonparametric estimators. Through connection to maximum likelihood and the expectation-maximization algorithm, an information\hyp{}theoretic metric called $\mathcal{X}$-metric and a co-registration algorithm named $\mathcal{X}$-CoReg are induced, allowing groupwise registration of the $N$ observed images with computational complexity of $\mathcal{O}(N)$. Moreover, the method naturally extends for a weakly-supervised scenario where anatomical labels of certain images are provided. This leads to a combined\hyp{}computing framework implemented with deep learning, which performs registration and segmentation simultaneously and collaboratively in an end-to-end fashion. Extensive experiments were conducted to demonstrate the versatility and applicability of our model, including multimodal groupwise registration, motion correction for dynamic contrast enhanced magnetic resonance images, and deep combined computing for multimodal medical images. Results show the superiority of our method in various applications in terms of both accuracy and efficiency, highlighting the advantage of the proposed representation of the imaging process.

Zheyao Gao, Yuanye Liu, Fuping Wu et al.

Staging of liver fibrosis is important in the diagnosis and treatment planning of patients suffering from liver diseases. Current deep learning-based methods using abdominal magnetic resonance imaging (MRI) usually take a sub-region of the liver as an input, which nevertheless could miss critical information. To explore richer representations, we formulate this task as a multi-view learning problem and employ multiple sub-regions of the liver. Previously, features or predictions are usually combined in an implicit manner, and uncertainty-aware methods have been proposed. However, these methods could be challenged to capture cross-view representations, which can be important in the accurate prediction of staging. Therefore, we propose a reliable multi-view learning method with interpretable combination rules, which can model global representations to improve the accuracy of predictions. Specifically, the proposed method estimates uncertainties based on subjective logic to improve reliability, and an explicit combination rule is applied based on Dempster-Shafer's evidence theory with good power of interpretability. Moreover, a data-efficient transformer is introduced to capture representations in the global view. Results evaluated on enhanced MRI data show that our method delivers superior performance over existing multi-view learning methods.

Ke Zhang, Xiahai Zhuang

Partially-supervised learning can be challenging for segmentation due to the lack of supervision for unlabeled structures, and the methods directly applying fully-supervised learning could lead to incompatibility, meaning ground truth is not in the solution set of the optimization problem given the loss function. To address the challenge, we propose a deep compatible learning (DCL) framework, which trains a single multi-label segmentation network using images with only partial structures annotated. We first formulate the partially-supervised segmentation as an optimization problem compatible with missing labels, and prove its compatibility. Then, we equip the model with a conditional segmentation strategy, to propagate labels from multiple partially-annotated images to the target. Additionally, we propose a dual learning strategy, which learns two opposite mappings of label propagation simultaneously, to provide substantial supervision for unlabeled structures. The two strategies are formulated into compatible forms, termed as conditional compatibility and dual compatibility, respectively. We show this framework is generally applicable for conventional loss functions. The approach attains significant performance improvement over existing methods, especially in the situation where only a small training dataset is available. Results on three segmentation tasks have shown that the proposed framework could achieve performance matching fully-supervised models.

Wangbin Ding, Lei Li, Junyi Qiu et al.

Myocardial pathology segmentation (MyoPS) is critical for the risk stratification and treatment planning of myocardial infarction (MI). Multi-sequence cardiac magnetic resonance (MS-CMR) images can provide valuable information. For instance, balanced steady-state free precession cine sequences present clear anatomical boundaries, while late gadolinium enhancement and T2-weighted CMR sequences visualize myocardial scar and edema of MI, respectively. Existing methods usually fuse anatomical and pathological information from different CMR sequences for MyoPS, but assume that these images have been spatially aligned. However, MS-CMR images are usually unaligned due to the respiratory motions in clinical practices, which poses additional challenges for MyoPS. This work presents an automatic MyoPS framework for unaligned MS-CMR images. Specifically, we design a combined computing model for simultaneous image registration and information fusion, which aggregates multi-sequence features into a common space to extract anatomical structures (i.e., myocardium). Consequently, we can highlight the informative regions in the common space via the extracted myocardium to improve MyoPS performance, considering the spatial relationship between myocardial pathologies and myocardium. Experiments on a private MS-CMR dataset and a public dataset from the MYOPS2020 challenge show that our framework could achieve promising performance for fully automatic MyoPS.

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).

Yuanye Liu, Yibo Gao, Yuanyang Chen et al.

Evidential Deep Learning (EDL) has emerged as an efficient, sampling-free strategy for uncertainty estimation. A series of EDL variants have been proposed to address specific limitations of the original framework, achieving notable success. However, the underlying theoretical structure of EDL and the relationships among these variants have received limited systematic investigation. In this work, we establish a principled theoretical foundation for EDL by interpreting it within a generalized Bayesian framework that includes prior specification, posterior update, and training objective. We further characterize evidential uncertainty from a Bayesian distributional uncertainty viewpoint, established via asymptotic analysis. Building on this perspective, we further propose Generalized Evidential Deep Learning (GEDL), a unified and extensible framework that explicitly disentangles the roles of individual components and systematically relates GEDL to existing variants. Extensive experiments demonstrate that GEDL yields comparable results on classification, uncertainty estimation and OOD detections, with theoretical grounding.

Jinye Li, Chenxi Fu, Minghang Zheng et al.

Cardiac function evaluation necessitates continuous, non-invasive monitoring, a capability limited in MRI. Millimeter-wave (mmWave) radar and its Synthetic Aperture Radar (SAR) mode offer a privacy-preserving and portable point-of-care clinical applications. However, reconstructing high-fidelity 3D cardiac geometry from SAR remains an open challenge. Traditional radar methods generate sparse point clouds that lack continuous surface topology. Meanwhile, direct application of optical reconstruction networks performs poorly due to the severe speckle noise and ambiguous boundaries inherent in SAR images. To bridge this gap, we propose SAR2Mesh, a novel framework that reformulates the task as a coarse-to-fine mesh deformation process. By initializing with a topological template, our approach explicitly preserves anatomical connectivity through progressive mesh deformation.We introduce a geometry-aware feature projection module to extract multi-view features via 3D-to-2D sampling, and a physics-informed radar loss to enforce consistency between the predicted geometry and raw radar echoes. Furthermore, we present Cardiac Mesh-SAR, the first large-scale paired SAR-mesh dataset. Extensive experiments demonstrate that SAR2Mesh significantly outperforms existing image-based baselines, achieving accurate and physically consistent cardiac reconstructions.

Yuanye Liu, Nannan Shi, Zhejia Zhang et al.

Despite years of methodological progress, how far AI has come in liver fibrosis staging has never been systematically evaluated under the heterogeneous, multi-center conditions that define clinical practice. To address this gap, we introduce LiFS, a large-scale dataset and benchmark derived from the MICCAI 2025 CARE-Liver challenge, comprising 610 patients across multiple centers and scanners with multi-sequence MRI. To the best of our knowledge, LiFS is the first benchmark providing complete gadoxetic acid-enhanced sequences with histopathology-confirmed annotations from diverse real-world scanners. Through systematic evaluation of 9 independently developed methods selected from 96 registered teams against in-cohort radiologist reference results, our findings address how far current AI has progressed toward clinical-level liver fibrosis staging from three complementary perspectives. First, against radiologists, the best AI methods were broadly comparable to the senior radiologist and significantly exceeded the junior radiologist in selected settings, while median AI performance generally approached junior-radiologist levels. Second, from a data perspective, cross-center heterogeneity, label imbalance, and contrast-enhanced sequence variability emerge as the dominant challenges for AI methods. Third, from a technical perspective, methodological design choices, including spatial registration, input dimensionality, multi-modal fusion strategy, and backbone architecture, appear to modulate cross-center robustness, although no single choice alone closes the gap. Overall, LiFS provides a rigorous real-world benchmark for positioning the current state of AI in liver fibrosis staging and for enabling future research on the key challenges that limit clinically reliable deployment.

Xin Wang, Xinzhe Luo, Xiahai Zhuang

Multimodal groupwise registration aligns internal structures in a group of medical images. Current approaches to this problem involve developing similarity measures over the joint intensity profile of all images, which may be computationally prohibitive for large image groups and unstable under various conditions. To tackle these issues, we propose BInGo, a general unsupervised hierarchical Bayesian framework based on deep learning, to learn intrinsic structural representations to measure the similarity of multimodal images. Particularly, a variational auto-encoder with a novel posterior is proposed, which facilitates the disentanglement learning of structural representations and spatial transformations, and characterizes the imaging process from the common structure with shape transition and appearance variation. Notably, BInGo is scalable to learn from small groups, whereas being tested for large-scale groupwise registration, thus significantly reducing computational costs. We compared BInGo with five iterative or deep learning methods on three public intrasubject and intersubject datasets, i.e. BraTS, MS-CMR of the heart, and Learn2Reg abdomen MR-CT, and demonstrated its superior accuracy and computational efficiency, even for very large group sizes (e.g., over 1300 2D images from MS-CMR in each group).

Sihan Wang, Fuping Wu, Lei Li et al.

Cardiac segmentation is in great demand for clinical practice. Due to the enormous labor of manual delineation, unsupervised segmentation is desired. The ill-posed optimization problem of this task is inherently challenging, requiring well-designed constraints. In this work, we propose an unsupervised framework for multi-class segmentation with both intensity and shape constraints. Firstly, we extend a conventional non-convex energy function as an intensity constraint and implement it with U-Net. For shape constraint, synthetic images are generated from anatomical labels via image-to-image translation, as shape supervision for the segmentation network. Moreover, augmentation invariance is applied to facilitate the segmentation network to learn the latent features in terms of shape. We evaluated the proposed framework using the public datasets from MICCAI2019 MSCMR Challenge and achieved promising results on cardiac MRIs with Dice scores of 0.5737, 0.7796, and 0.6287 in Myo, LV, and RV, respectively.

Yinsong Xu, Aidong Men, Yang Liu et al.

In deep learning, initializing models with pre-trained weights has become the de facto practice for various downstream tasks. Many unsupervised domain adaptation (UDA) methods typically adopt a backbone pre-trained on ImageNet, and focus on reducing the source-target domain discrepancy. However, the impact of pre-training on adaptation received little attention. In this study, we delve into UDA from the novel perspective of pre-training. We first demonstrate the impact of pre-training by analyzing the dynamic distribution discrepancies between pre-training data domain and the source/ target domain during adaptation. Then, we reveal that the target error also stems from the pre-training in the following two factors: 1) empirically, target error arises from the gradually degenerative pre-trained knowledge during adaptation; 2) theoretically, the error bound depends on difference between the gradient of loss function, \ie, on the target domain and pre-training data domain. To address these two issues, we redefine UDA as a three-domain problem, \ie, source domain, target domain, and pre-training data domain; then we propose a novel framework, named TriDA. We maintain the pre-trained knowledge and improve the error bound by incorporating pre-training data into adaptation for both vanilla UDA and source-free UDA scenarios. For efficiency, we introduce a selection strategy for pre-training data, and offer a solution with synthesized images when pre-training data is unavailable during adaptation. Notably, TriDA is effective even with a small amount of pre-training or synthesized images, and seamlessly complements the two scenario UDA methods, demonstrating state-of-the-art performance across multiple benchmarks. We hope our work provides new insights for better understanding and application of domain adaptation.

Ke Zhang, Bomin Wang, Hangqi Zhou et al.

Curating fully annotated datasets for medical image segmentation is labour-intensive and expertise-demanding. To alleviate this problem, prior studies have explored scribble annotations for weakly supervised segmentation. Existing solutions mainly compute losses on annotated areas and generate pseudo labels by propagating annotations to adjacent regions. However, these methods often suffer from inaccurate and unrealistic segmentations due to insufficient supervision and incomplete shape information. In contrast, we first investigate the principle of good scribble annotations, which leads to efficient scribble forms via supervision maximization and randomness simulation. We further introduce regularization terms to encode the spatial relationship and the shape constraints, where the EM algorithm is utilized to estimate the mixture ratios of label classes. These ratios are critical in identifying the unlabeled pixels for each class and correcting erroneous predictions, thus the accurate estimation lays the foundation for the incorporation of spatial prior. Finally, we integrate the efficient scribble supervision with the prior into a framework, referred to as ZScribbleSeg, and apply it to multiple scenarios. Leveraging only scribble annotations, ZScribbleSeg achieves competitive performance on six segmentation tasks including ACDC, MSCMRseg, BTCV, MyoPS, Decathlon-BrainTumor and Decathlon-Prostate. Our code will be released via https://github.com/DLwbm123/ZScribbleSeg.

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.

Yuanye Liu, Zheyao Gao, Nannan Shi et al.

Accurate staging of liver fibrosis from magnetic resonance imaging (MRI) is crucial in clinical practice. While conventional methods often focus on a specific sub-region, multi-view learning captures more information by analyzing multiple patches simultaneously. However, previous multi-view approaches could not typically calculate uncertainty by nature, and they generally integrate features from different views in a black-box fashion, hence compromising reliability as well as interpretability of the resulting models. In this work, we propose a new multi-view method based on evidential learning, referred to as MERIT, which tackles the two challenges in a unified framework. MERIT enables uncertainty quantification of the predictions to enhance reliability, and employs a logic-based combination rule to improve interpretability. Specifically, MERIT models the prediction from each sub-view as an opinion with quantified uncertainty under the guidance of the subjective logic theory. Furthermore, a distribution-aware base rate is introduced to enhance performance, particularly in scenarios involving class distribution shifts. Finally, MERIT adopts a feature-specific combination rule to explicitly fuse multi-view predictions, thereby enhancing interpretability. Results have showcased the effectiveness of the proposed MERIT, highlighting the reliability and offering both ad-hoc and post-hoc interpretability. They also illustrate that MERIT can elucidate the significance of each view in the decision-making process for liver fibrosis staging. Our code has be released via https://github.com/HenryLau7/MERIT.

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.

An Sui, Yuzhu Li, Gunter Schumann et al.

Uncertainty quantification complements model predictions by characterizing their reliability, which is essential for high-stakes decision making such as medical image segmentation. However, most existing methods reduce uncertainty to a scalar confidence estimate, leaving its spatial distribution semantically underconstrained. In this work, we focus on uncertainty interpretability, namely, whether estimated uncertainty behaves in a human-understandable manner with respect to sources of ambiguity. We identify three perception-aligned principles requiring the spatial distribution of uncertainty to reflect: (1) image contrast between structures, (2) severity of image corruption, and (3) geometric complexity in anatomical structures. Accordingly, we develop a principle-guided uncertainty supervision framework (PriUS) based on evidential learning, in which the corresponding supervision objectives are explicitly enforced during training. We further introduce quantitative metrics to measure the consistency between predicted uncertainty and image attributes that induce ambiguity. Experiments on ACDC, ISIC, and WHS datasets showed that, compared with state-of-the-art methods, PriUS produced more consistent uncertainty estimates while maintaining competitive segmentation performance.

Bomin Wang, Hangqi Zhou, Yibo Gao et al.

Continual learning (CL) is essential for deploying medical image segmentation models in clinical environments where imaging domains, anatomical targets, and diagnostic tasks evolve over time. However, continual segmentation still faces three main challenges. First, the scenarios for this task remain insufficiently standardized for real-world clinical settings. Second, existing research has been primarily focused on mitigating forgetting, overlooking the other essential properties such as plasticity. Third, a benchmark work with comprehensive evaluation on existing methods is stll desirable. To address these gaps, we present such benchmark study of continual medical image segmentation. We first define three clinically motivated scenarios, namely Domain-CL, Class-CL, and Organ-CL, to respectively capture the cross-center domain shift, the incremental anatomical structure segmentation, and the cross-organ segmentation. We then introduce an evaluation framework that measures not only general performance and forgetting, but also plasticity, forward generalizability, parameter efficiency, and replay burden. The results, from extensive experiments with representative CL methods, showed that it was still challenging to develop a model that could satisfy all the requirements simultaneously. Nevertheless, these studies also suggested that the replay-based methods achieve the best overall balance between stability and plasticity, the parameter-isolation methods should be effective at reducing forgetting, though at the cost of increased model size, and the forward generalizability remain a significantly understudied aspect of this research field. Finally, we discuss related learning paradigms and outline future directions for continual medical image segmentation.

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.

Yuzhu Li, An Sui, Fuping Wu et al.

Uncertainty estimation has been widely studied in medical image segmentation as a tool to provide reliability, particularly in deep learning approaches. However, previous methods generally lack effective supervision in uncertainty estimation, leading to low interpretability and robustness of the predictions. In this work, we propose a self-supervised approach to guide the learning of uncertainty. Specifically, we introduce three principles about the relationships between the uncertainty and the image gradients around boundaries and noise. Based on these principles, two uncertainty supervision losses are designed. These losses enhance the alignment between model predictions and human interpretation. Accordingly, we introduce novel quantitative metrics for evaluating the interpretability and robustness of uncertainty. Experimental results demonstrate that compared to state-of-the-art approaches, the proposed method can achieve competitive segmentation performance and superior results in out-of-distribution (OOD) scenarios while significantly improving the interpretability and robustness of uncertainty estimation. Code is available via https://github.com/suiannaius/SURE.

Yibo Gao, Zheyao Gao, Xin Gao et al.

Due to the high stakes in medical decision-making, there is a compelling demand for interpretable deep learning methods in medical image analysis. Concept Bottleneck Models (CBM) have emerged as an active interpretable framework incorporating human-interpretable concepts into decision-making. However, their concept predictions may lack reliability when applied to clinical diagnosis, impeding concept explanations' quality. To address this, we propose an evidential Concept Embedding Model (evi-CEM), which employs evidential learning to model the concept uncertainty. Additionally, we offer to leverage the concept uncertainty to rectify concept misalignments that arise when training CBMs using vision-language models without complete concept supervision. With the proposed methods, we can enhance concept explanations' reliability for both supervised and label-efficient settings. Furthermore, we introduce concept uncertainty for effective test-time intervention. Our evaluation demonstrates that evi-CEM achieves superior performance in terms of concept prediction, and the proposed concept rectification effectively mitigates concept misalignments for label-efficient training. Our code is available at https://github.com/obiyoag/evi-CEM.

Bomin Wang, Xinzhe Luo, Xiahai Zhuang

Current deep learning approaches in medical image registration usually face the challenges of distribution shift and data collection, hindering real-world deployment. In contrast, universal medical image registration aims to perform registration on a wide range of clinically relevant tasks simultaneously, thus having tremendous potential for clinical applications. In this paper, we present the first attempt to achieve the goal of universal 3D medical image registration in sequential learning scenarios by proposing a continual learning method. Specifically, we utilize meta-learning with experience replay to mitigating the problem of catastrophic forgetting. To promote the generalizability of meta-continual learning, we further propose sharpness-aware meta-continual learning (SAMCL). We validate the effectiveness of our method on four datasets in a continual learning setup, including brain MR, abdomen CT, lung CT, and abdomen MR-CT image pairs. Results have shown the potential of SAMCL in realizing universal image registration, which performs better than or on par with vanilla sequential or centralized multi-task training strategies.The source code will be available from https://github.com/xzluo97/Continual-Reg.

Kai-Ni Wang, Xin Yang, Juzheng Miao et al.

Multi-sequence cardiac magnetic resonance (CMR) provides essential pathology information (scar and edema) to diagnose myocardial infarction. However, automatic pathology segmentation can be challenging due to the difficulty of effectively exploring the underlying information from the multi-sequence CMR data. This paper aims to tackle the scar and edema segmentation from multi-sequence CMR with a novel auto-weighted supervision framework, where the interactions among different supervised layers are explored under a task-specific objective using reinforcement learning. Furthermore, we design a coarse-to-fine framework to boost the small myocardial pathology region segmentation with shape prior knowledge. The coarse segmentation model identifies the left ventricle myocardial structure as a shape prior, while the fine segmentation model integrates a pixel-wise attention strategy with an auto-weighted supervision model to learn and extract salient pathological structures from the multi-sequence CMR data. Extensive experimental results on a publicly available dataset from Myocardial pathology segmentation combining multi-sequence CMR (MyoPS 2020) demonstrate our method can achieve promising performance compared with other state-of-the-art methods. Our method is promising in advancing the myocardial pathology assessment on multi-sequence CMR data. To motivate the community, we have made our code publicly available via https://github.com/soleilssss/AWSnet/tree/master.

Lei Li, Wangbin Ding, Liqun Huang et al.

Right ventricular (RV) segmentation from magnetic resonance imaging (MRI) is a crucial step for cardiac morphology and function analysis. However, automatic RV segmentation from MRI is still challenging, mainly due to the heterogeneous intensity, the complex variable shapes, and the unclear RV boundary. Moreover, current methods for the RV segmentation tend to suffer from performance degradation at the basal and apical slices of MRI. In this work, we propose an automatic RV segmentation framework, where the information from long-axis (LA) views is utilized to assist the segmentation of short-axis (SA) views via information transition. Specifically, we employed the transformed segmentation from LA views as a prior information, to extract the ROI from SA views for better segmentation. The information transition aims to remove the surrounding ambiguous regions in the SA views. %, such as the tricuspid valve regions. We tested our model on a public dataset with 360 multi-center, multi-vendor and multi-disease subjects that consist of both LA and SA MRIs. Our experimental results show that including LA views can be effective to improve the accuracy of the SA segmentation. Our model is publicly available at https://github.com/NanYoMy/MMs-2.

Wangbin Ding, Lei Li, Xiahai Zhuang et al.

Multi-modality medical images can provide relevant or complementary information for a target (organ, tumor or tissue). Registering multi-modality images to a common space can fuse these comprehensive information, and bring convenience for clinical application. Recently, neural networks have been widely investigated to boost registration methods. However, it is still challenging to develop a multi-modality registration network due to the lack of robust criteria for network training. In this work, we propose a multi-modality registration network (MMRegNet), which can perform registration between multi-modality images. Meanwhile, we present spatially encoded gradient information to train MMRegNet in an unsupervised manner. The proposed network was evaluated on MM-WHS 2017. Results show that MMRegNet can achieve promising performance for left ventricle cardiac registration tasks. Meanwhile, to demonstrate the versatility of MMRegNet, we further evaluate the method with a liver dataset from CHAOS 2019. Source code will be released publicly\footnote{https://github.com/NanYoMy/mmregnet} once the manuscript is accepted.

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

Lin Xi, Yingliang Ma, Xiahai Zhuang

We introduce a novel FSVOS model that employs a local matching strategy to restrict the search space to the most relevant neighboring pixels. Rather than relying on inefficient standard im2col-like implementations (e.g., spatial convolutions, depthwise convolutions and feature-shifting mechanisms) or hardware-specific CUDA kernels (e.g., deformable and neighborhood attention), which often suffer from limited portability across non-CUDA devices, we reorganize the local sampling process through a direction-based sampling perspective. Specifically, we implement a non-parametric sampling mechanism that enables dynamically varying sampling regions. This approach provides the flexibility to adapt to diverse spatial structures without the computational costs of parametric layers and the need for model retraining. To further enhance feature coherence across frames, we design a supervised spatio-temporal contrastive learning scheme that enforces consistency in feature representations. In addition, we introduce a publicly available benchmark dataset for multi-object segmentation in X-ray angiography videos (MOSXAV), featuring detailed, manually labeled segmentation ground truth. Extensive experiments on the CADICA, XACV, and MOSXAV datasets show that our proposed FSVOS method outperforms current state-of-the-art video segmentation methods in terms of segmentation accuracy and generalization capability (i.e., seen and unseen categories). This work offers enhanced flexibility and potential for a wide range of clinical applications.

Yuanye Liu, Hanxiao Zhang, Nannan Shi et al.

Liver fibrosis represents a significant global health burden, necessitating accurate staging for effective clinical management. This report introduces the LiQA (Liver Fibrosis Quantification and Analysis) dataset, established as part of the CARE 2024 challenge. Comprising $440$ patients with multi-phase, multi-center MRI scans, the dataset is curated to benchmark algorithms for Liver Segmentation (LiSeg) and Liver Fibrosis Staging (LiFS) under complex real-world conditions, including domain shifts, missing modalities, and spatial misalignment. We further describe the challenge's top-performing methodology, which integrates a semi-supervised learning framework with external data for robust segmentation, and utilizes a multi-view consensus approach with Class Activation Map (CAM)-based regularization for staging. Evaluation of this baseline demonstrates that leveraging multi-source data and anatomical constraints significantly enhances model robustness in clinical settings.

Guang Yang, Jingkun Chen, Xicheng Sheng et al.

Late gadolinium enhancement MRI (LGE MRI) is the gold standard for the detection of myocardial scars for post myocardial infarction (MI). LGE MRI requires the injection of a contrast agent, which carries potential side effects and increases scanning time and patient discomfort. To address these issues, we propose a novel framework that combines cardiac motion observed in cine MRI with image texture information to segment the myocardium and scar tissue in the left ventricle. Cardiac motion tracking can be formulated as a full cardiac image cycle registration problem, which can be solved via deep neural networks. Experimental results prove that the proposed method can achieve scar segmentation based on non-contrasted cine images with comparable accuracy to LGE MRI. This demonstrates its potential as an alternative to contrast-enhanced techniques for scar detection.

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.

Jiangbo Pei, Ruizhe Li, Aidong Men et al.

Conventional Multi-Source Free Domain Adaptation (MSFDA) assumes that each source domain provides a single source model, and all source models adopt a uniform architecture. This paper introduces Zoo-MSFDA, a more general setting that allows each source domain to offer a zoo of multiple source models with different architectures. While it enriches the source knowledge, Zoo-MSFDA risks being dominated by suboptimal/harmful models. To address this issue, we theoretically analyze the model selection problem in Zoo-MSFDA, and introduce two principles: transferability principle and diversity principle. Recognizing the challenge of measuring transferability, we subsequently propose a novel Source-Free Unsupervised Transferability Estimation (SUTE). It enables assessing and comparing transferability across multiple source models with different architectures under domain shift, without requiring target labels and source data. Based on above, we introduce a Selection, Ensemble, and Adaptation (SEA) framework to address Zoo-MSFDA, which consists of: 1) source models selection based on the proposed principles and SUTE; 2) ensemble construction based on SUTE-estimated transferability; 3) target-domain adaptation of the ensemble model. Evaluations demonstrate that our SEA framework, with the introduced Zoo-MSFDA setting, significantly improves adaptation performance (e.g., 13.5% on DomainNet). Additionally, our SUTE achieves state-of-the-art performance in transferability estimation.

Xinzhe Luo, Xin Wang, Linda Shapiro et al.

This article presents a general Bayesian learning framework for multi-modal groupwise image registration. The method builds on probabilistic modelling of the image generative process, where the underlying common anatomy and geometric variations of the observed images are explicitly disentangled as latent variables. Therefore, groupwise image registration is achieved via hierarchical Bayesian inference. We propose a novel hierarchical variational auto-encoding architecture to realise the inference procedure of the latent variables, where the registration parameters can be explicitly estimated in a mathematically interpretable fashion. Remarkably, this new paradigm learns groupwise image registration in an unsupervised closed-loop self-reconstruction process, sparing the burden of designing complex image-based similarity measures. The computationally efficient disentangled network architecture is also inherently scalable and flexible, allowing for groupwise registration on large-scale image groups with variable sizes. Furthermore, the inferred structural representations from multi-modal images via disentanglement learning are capable of capturing the latent anatomy of the observations with visual semantics. Extensive experiments were conducted to validate the proposed framework, including four different datasets from cardiac, brain, and abdominal medical images. The results have demonstrated the superiority of our method over conventional similarity-based approaches in terms of accuracy, efficiency, scalability, and interpretability.

Xiaoyue Liu, Xicheng Sheng, Xiahai Zhuang et al.

Cardiac digital twins (CDTs) provide personalized in-silico cardiac representations and hold great potential for precision medicine in cardiology. However, whole-heart CDT models that simulate the full organ-scale electromechanics of all four heart chambers remain limited. In this work, we propose a weakly supervised learning model to reconstruct 4D (3D+t) heart mesh directly from multi-view 2D cardiac cine MRIs. This is achieved by learning a self-supervised mapping between cine MRIs and 4D cardiac meshes, enabling the generation of personalized heart models that closely correspond to input cine MRIs. The resulting 4D heart meshes can facilitate the automatic extraction of key cardiac variables, including ejection fraction and dynamic chamber volume changes with high temporal resolution. It demonstrates the feasibility of inferring personalized 4D heart models from cardiac MRIs, paving the way for an efficient CDT platform for precision medicine. The code will be publicly released once the manuscript is accepted.

Wangbin Ding, Lei Li, Junyi Qiu et al.

Myocardial infarction (MI) is a leading cause of death worldwide. Late gadolinium enhancement (LGE) and T2-weighted cardiac magnetic resonance (CMR) imaging can respectively identify scarring and edema areas, both of which are essential for MI risk stratification and prognosis assessment. Although combining complementary information from multi-sequence CMR is useful, acquiring these sequences can be time-consuming and prohibitive, e.g., due to the administration of contrast agents. Cine CMR is a rapid and contrast-free imaging technique that can visualize both motion and structural abnormalities of the myocardium induced by acute MI. Therefore, we present a new end-to-end deep neural network, referred to as CineMyoPS, to segment myocardial pathologies, \ie scars and edema, solely from cine CMR images. Specifically, CineMyoPS extracts both motion and anatomy features associated with MI. Given the interdependence between these features, we design a consistency loss (resembling the co-training strategy) to facilitate their joint learning. Furthermore, we propose a time-series aggregation strategy to integrate MI-related features across the cardiac cycle, thereby enhancing segmentation accuracy for myocardial pathologies. Experimental results on a multi-center dataset demonstrate that CineMyoPS achieves promising performance in myocardial pathology segmentation, motion estimation, and anatomy segmentation.

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.

Zi Wang, Fanwen Wang, Chen Qin et al.

Cardiac magnetic resonance imaging (MRI) has emerged as a clinically gold-standard technique for diagnosing cardiac diseases, thanks to its ability to provide diverse information with multiple modalities and anatomical views. Accelerated cardiac MRI is highly expected to achieve time-efficient and patient-friendly imaging, and then advanced image reconstruction approaches are required to recover high-quality, clinically interpretable images from undersampled measurements. However, the lack of publicly available cardiac MRI k-space dataset in terms of both quantity and diversity has severely hindered substantial technological progress, particularly for data-driven artificial intelligence. Here, we provide a standardized, diverse, and high-quality CMRxRecon2024 dataset to facilitate the technical development, fair evaluation, and clinical transfer of cardiac MRI reconstruction approaches, towards promoting the universal frameworks that enable fast and robust reconstructions across different cardiac MRI protocols in clinical practice. To the best of our knowledge, the CMRxRecon2024 dataset is the largest and most protocal-diverse publicly available cardiac k-space dataset. It is acquired from 330 healthy volunteers, covering commonly used modalities, anatomical views, and acquisition trajectories in clinical cardiac MRI workflows. Besides, an open platform with tutorials, benchmarks, and data processing tools is provided to facilitate data usage, advanced method development, and fair performance evaluation.

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}.

Wangbin Ding, Lei Li, Xiahai Zhuang et al.

Multi-atlas segmentation (MAS) is a promising framework for medical image segmentation. Generally, MAS methods register multiple atlases, i.e., medical images with corresponding labels, to a target image; and the transformed atlas labels can be combined to generate target segmentation via label fusion schemes. Many conventional MAS methods employed the atlases from the same modality as the target image. However, the number of atlases with the same modality may be limited or even missing in many clinical applications. Besides, conventional MAS methods suffer from the computational burden of registration or label fusion procedures. In this work, we design a novel cross-modality MAS framework, which uses available atlases from a certain modality to segment a target image from another modality. To boost the computational efficiency of the framework, both the image registration and label fusion are achieved by well-designed deep neural networks. For the atlas-to-target image registration, we propose a bi-directional registration network (BiRegNet), which can efficiently align images from different modalities. For the label fusion, we design a similarity estimation network (SimNet), which estimates the fusion weight of each atlas by measuring its similarity to the target image. SimNet can learn multi-scale information for similarity estimation to improve the performance of label fusion. The proposed framework was evaluated by the left ventricle and liver segmentation tasks on the MM-WHS and CHAOS datasets, respectively. Results have shown that the framework is effective for cross-modality MAS in both registration and label fusion.

Lei Li, Fuping Wu, Sihan Wang et al.

Assessment of myocardial viability is essential in diagnosis and treatment management of patients suffering from myocardial infarction, and classification of pathology on myocardium is the key to this assessment. This work defines a new task of medical image analysis, i.e., to perform myocardial pathology segmentation (MyoPS) combining three-sequence cardiac magnetic resonance (CMR) images, which was first proposed in the MyoPS challenge, in conjunction with MICCAI 2020. The challenge provided 45 paired and pre-aligned CMR images, allowing algorithms to combine the complementary information from the three CMR sequences for pathology segmentation. In this article, we provide details of the challenge, survey the works from fifteen participants and interpret their methods according to five aspects, i.e., preprocessing, data augmentation, learning strategy, model architecture and post-processing. In addition, we analyze the results with respect to different factors, in order to examine the key obstacles and explore potential of solutions, as well as to provide a benchmark for future research. We conclude that while promising results have been reported, the research is still in the early stage, and more in-depth exploration is needed before a successful application to the clinics. Note that MyoPS data and evaluation tool continue to be publicly available upon registration via its homepage (www.sdspeople.fudan.edu.cn/zhuangxiahai/0/myops20/).

Lei Li, Fuping Wu, Sihang Wang et al.

Accurate cardiac computing, analysis and modeling from multi-modality images are important for the diagnosis and treatment of cardiac disease. Late gadolinium enhancement magnetic resonance imaging (LGE MRI) is a promising technique to visualize and quantify myocardial infarction (MI) and atrial scars. Automating quantification of MI and atrial scars can be challenging due to the low image quality and complex enhancement patterns of LGE MRI. Moreover, compared with the other sequences LGE MRIs with gold standard labels are particularly limited, which represents another obstacle for developing novel algorithms for automatic segmentation and quantification of LGE MRIs. This chapter aims to summarize the state-of-the-art and our recent advanced contributions on deep learning based multi-modality cardiac image analysis. Firstly, we introduce two benchmark works for multi-sequence cardiac MRI based myocardial and pathology segmentation. Secondly, two novel frameworks for left atrial scar segmentation and quantification from LGE MRI were presented. Thirdly, we present three unsupervised domain adaptation techniques for cross-modality cardiac image segmentation.