Yuanyuan Peng

Meng Wang, Tian Lin, Lianyu Wang et al.

Failure to recognize samples from the classes unseen during training is a major limitation of artificial intelligence in the real-world implementation for recognition and classification of retinal anomalies. We established an uncertainty-inspired open-set (UIOS) model, which was trained with fundus images of 9 retinal conditions. Besides assessing the probability of each category, UIOS also calculated an uncertainty score to express its confidence. Our UIOS model with thresholding strategy achieved an F1 score of 99.55%, 97.01% and 91.91% for the internal testing set, external target categories (TC)-JSIEC dataset and TC-unseen testing set, respectively, compared to the F1 score of 92.20%, 80.69% and 64.74% by the standard AI model. Furthermore, UIOS correctly predicted high uncertainty scores, which would prompt the need for a manual check in the datasets of non-target categories retinal diseases, low-quality fundus images, and non-fundus images. UIOS provides a robust method for real-world screening of retinal anomalies.

Yuanyuan Peng, Lin Pan, Pengpeng Luan et al.

Automatic segmentation of curvilinear objects in medical images plays an important role in the diagnosis and evaluation of human diseases, yet it is a challenging uncertainty in the complex segmentation tasks due to different issues such as various image appearances, low contrast between curvilinear objects and their surrounding backgrounds, thin and uneven curvilinear structures, and improper background illumination conditions. To overcome these challenges, we present a unique curvilinear structure segmentation framework based on an oriented derivative of stick (ODoS) filter and a deep learning network for curvilinear object segmentation in medical images. Currently, a large number of deep learning models emphasize developing deep architectures and ignore capturing the structural features of curvilinear objects, which may lead to unsatisfactory results. Consequently, a new approach that incorporates an ODoS filter as part of a deep learning network is presented to improve the spatial attention of curvilinear objects. Specifically, the input image is transfered into four-channel image constructed by the ODoS filter. In which, the original image is considered the principal part to describe various image appearance and complex background illumination conditions, a multi-step strategy is used to enhance the contrast between curvilinear objects and their surrounding backgrounds, and a vector field is applied to discriminate thin and uneven curvilinear structures. Subsequently, a deep learning framework is employed to extract various structural features for curvilinear object segmentation in medical images. The performance of the computational model is validated in experiments conducted on the publicly available DRIVE, STARE and CHASEDB1 datasets. The experimental results indicate that the presented model yields surprising results compared with those of some state-of-the-art methods.

Yuanyuan Peng, Wen Li, Xiong Li et al.

Retinal vessel segmentation is crucial for diagnosis and assessment of ocular diseases. Notably, segmentation of small retinal vessels has been consistently recognized as a challenging and complex task. To tackle this challenge, we design a hybrid CNN-Mamba fusion network that integrates polygon scanning mamba and space-frequency collaborative attention mechanism for the detection of small vessels. Considering that the traditional mamba architecture with horizontal-vertical scanning may compromise the topological integrity of target structures and result in local discontinuities in small retinal vessels, we present a polygon scanning visual state space model (PS-VSS) to identify small vessel structural features by multi-layer reverse scanning way. Which effectively preserves pixels connectivity, thereby substantially mitigating the loss of information pertaining to small vessels. Furthermore, as we all known that the spatial domain prioritizes positional and structural information, while the frequency domain emphasizes global perception and local detail components, a space-frequency collaborative attention mechanism (SFCAM) is introduced within the skip connection to extract efficient features from the spatial and frequency domains. This strategy empowers the model to dynamically enhance the key features while effectively suppressing clutters. To assess the efficacy of our model, it was tested on three publicly available datasets: DRIVE, STARE, and CHASE_DB1. Compared to manual annotations, our model demonstrated F1 scores of 0.8283, 0.8282, and 0.8251, Area Under Curve (AUC) values of 0.9806, 0.9840, and 0.9866, and Sensitivity (SE) values of of 0.8268, 0.8314, and 0.8484 across three datasets, respectively. The effectiveness of our model was validated through both visual inspection and quantitative analysis.

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.

Miao Jing, Mengting Jia, Junling Lin et al.

Recent advances in vision-language models (VLMs) have achieved remarkable performance on standard medical benchmarks, yet their true clinical reasoning ability remains unclear. Existing datasets predominantly emphasize classification accuracy, creating an evaluation illusion in which models appear proficient while still failing at high-stakes diagnostic reasoning. We introduce Neural-MedBench, a compact yet reasoning-intensive benchmark specifically designed to probe the limits of multimodal clinical reasoning in neurology. Neural-MedBench integrates multi-sequence MRI scans, structured electronic health records, and clinical notes, and encompasses three core task families: differential diagnosis, lesion recognition, and rationale generation. To ensure reliable evaluation, we develop a hybrid scoring pipeline that combines LLM-based graders, clinician validation, and semantic similarity metrics. Through systematic evaluation of state-of-the-art VLMs, including GPT-4o, Claude-4, and MedGemma, we observe a sharp performance drop compared to conventional datasets. Error analysis shows that reasoning failures, rather than perceptual errors, dominate model shortcomings. Our findings highlight the necessity of a Two-Axis Evaluation Framework: breadth-oriented large datasets for statistical generalization, and depth-oriented, compact benchmarks such as Neural-MedBench for reasoning fidelity. We release Neural-MedBench at https://neuromedbench.github.io/ as an open and extensible diagnostic testbed, which guides the expansion of future benchmarks and enables rigorous yet cost-effective assessment of clinically trustworthy AI.

Yuanyuan Peng, Aidi Lin, Meng Wang et al.

Inability to express the confidence level and detect unseen classes has limited the clinical implementation of artificial intelligence in the real-world. We developed a foundation model with uncertainty estimation (FMUE) to detect 11 retinal conditions on optical coherence tomography (OCT). In the internal test set, FMUE achieved a higher F1 score of 96.76% than two state-of-the-art algorithms, RETFound and UIOS, and got further improvement with thresholding strategy to 98.44%. In the external test sets obtained from other OCT devices, FMUE achieved an accuracy of 88.75% and 92.73% before and after thresholding. Our model is superior to two ophthalmologists with a higher F1 score (95.17% vs. 61.93% &71.72%). Besides, our model correctly predicts high uncertainty scores for samples with ambiguous features, of non-target-category diseases, or with low-quality to prompt manual checks and prevent misdiagnosis. FMUE provides a trustworthy method for automatic retinal anomalies detection in the real-world clinical open set environment.

Meng Wang, Tian Lin, Aidi Lin et al.

Previous foundation models for fundus images were pre-trained with limited disease categories and knowledge base. Here we introduce a knowledge-rich vision-language model (RetiZero) that leverages knowledge from more than 400 fundus diseases. For RetiZero's pretraining, we compiled 341,896 fundus images paired with texts, sourced from public datasets, ophthalmic literature, and online resources, encompassing a diverse range of diseases across multiple ethnicities and countries. RetiZero exhibits remarkable performance in several downstream tasks, including zero-shot disease recognition, image-to-image retrieval, AI-assisted clinical diagnosis,few-shot fine-tuning, and internal- and cross-domain disease identification. In zero-shot scenarios, RetiZero achieves Top-5 accuracies of 0.843 for 15 diseases and 0.756 for 52 diseases. For image retrieval, it achieves Top-5 scores of 0.950 and 0.886 for the same sets, respectively. AI-assisted clinical diagnosis results show that RetiZero's Top-3 zero-shot performance surpasses the average of 19 ophthalmologists from Singapore, China, and the United States. RetiZero substantially enhances clinicians' accuracy in diagnosing fundus diseases, in particularly rare ones. These findings underscore the value of integrating the RetiZero into clinical settings, where various fundus diseases are encountered.

Yuanyuan Peng, Pengpeng Luan, Zixu Zhang

Accurately segmenting blood vessels in retinal fundus images is crucial in the early screening, diagnosing, and evaluating some ocular diseases, yet it poses a nontrivial uncertainty for the segmentation task due to various factors such as significant light variations, uneven curvilinear structures, and non-uniform contrast. As a result, a multiple attention-guided fusion network (MAF-Net) is proposed to accurately detect blood vessels in retinal fundus images. Currently, traditional UNet-based models may lose partial information due to explicitly modeling long-distance dependencies, which may lead to unsatisfactory results. To enrich contextual information for the loss of scene information compensation, an attention fusion mechanism that combines the channel attention with spatial attention mechanisms constructed by Transformer is employed to extract various features of blood vessels from retinal fundus images. Subsequently, a unique spatial attention mechanism is applied in the skip connection to filter out redundant information and noise from low-level features, thus enabling better integration with high-level features. In addition, a DropOut layer is employed to randomly discard some neurons, which can prevent overfitting of the deep learning network and improve its generalization performance. Experimental results were verified in public datasets DRIVE, STARE and CHASEDB1 with F1 scores of 0.818, 0.836 and 0.811, and Acc values of 0.968, 0.973 and 0.973, respectively. Both visual inspection and quantitative evaluation demonstrate that our method produces satisfactory results compared to some state-of-the-art methods.

Yuanyuan Peng, Pengpeng Luan, Hongbin Tu et al.

Priori knowledge of pulmonary anatomy plays a vital role in diagnosis of lung diseases. In CT images, pulmonary fissure segmentation is a formidable mission due to various of factors. To address the challenge, an useful approach based on ODoS filter and shape features is presented for pulmonary fissure segmentation. Here, we adopt an ODoS filter by merging the orientation information and magnitude information to highlight structure features for fissure enhancement, which can effectively distinguish between pulmonary fissures and clutters. Motivated by the fact that pulmonary fissures appear as linear structures in 2D space and planar structures in 3D space in orientation field, an orientation curvature criterion and an orientation partition scheme are fused to separate fissure patches and other structures in different orientation partition, which can suppress parts of clutters. Considering the shape difference between pulmonary fissures and tubular structures in magnitude field, a shape measure approach and a 3D skeletonization model are combined to segment pulmonary fissures for clutters removal. When applying our scheme to 55 chest CT scans which acquired from a publicly available LOLA11 datasets, the median F1-score, False Discovery Rate (FDR), and False Negative Rate (FNR) respectively are 0.896, 0.109, and 0.100, which indicates that the presented method has a satisfactory pulmonary fissure segmentation performance.

Yuanyuan Peng, Zixu Zhang, Hongbin Tu et al.

Background: The 2019 novel coronavirus disease (COVID-19) has been spread widely in the world, causing a huge threat to people's living environment. Objective: Under computed tomography (CT) imaging, the structure features of COVID-19 lesions are complicated and varied greatly in different cases. To accurately locate COVID-19 lesions and assist doctors to make the best diagnosis and treatment plan, a deep-supervised ensemble learning network is presented for COVID-19 lesion segmentation in CT images. Methods: Considering the fact that a large number of COVID-19 CT images and the corresponding lesion annotations are difficult to obtained, a transfer learning strategy is employed to make up for the shortcoming and alleviate the overfitting problem. Based on the reality that traditional single deep learning framework is difficult to extract COVID-19 lesion features effectively, which may cause some lesions to be undetected. To overcome the problem, a deep-supervised ensemble learning network is presented to combine with local and global features for COVID-19 lesion segmentation. Results: The performance of the proposed method was validated in experiments with a publicly available dataset. Compared with manual annotations, the proposed method acquired a high intersection over union (IoU) of 0.7279. Conclusion: A deep-supervised ensemble learning network was presented for coronavirus pneumonia lesion segmentation in CT images. The effectiveness of the proposed method was verified by visual inspection and quantitative evaluation. Experimental results shown that the proposed mehtod has a perfect performance in COVID-19 lesion segmentation.