Le Lü

Zihan Li, Yunxiang Li, Qingde Li et al. · uw

Deep learning has been widely used in medical image segmentation and other aspects. However, the performance of existing medical image segmentation models has been limited by the challenge of obtaining sufficient high-quality labeled data due to the prohibitive data annotation cost. To alleviate this limitation, we propose a new text-augmented medical image segmentation model LViT (Language meets Vision Transformer). In our LViT model, medical text annotation is incorporated to compensate for the quality deficiency in image data. In addition, the text information can guide to generate pseudo labels of improved quality in the semi-supervised learning. We also propose an Exponential Pseudo label Iteration mechanism (EPI) to help the Pixel-Level Attention Module (PLAM) preserve local image features in semi-supervised LViT setting. In our model, LV (Language-Vision) loss is designed to supervise the training of unlabeled images using text information directly. For evaluation, we construct three multimodal medical segmentation datasets (image + text) containing X-rays and CT images. Experimental results show that our proposed LViT has superior segmentation performance in both fully-supervised and semi-supervised setting. The code and datasets are available at https://github.com/HUANGLIZI/LViT.

Lin Tian, Zi Li, Fengze Liu et al. · harvard

Image registration is a fundamental medical image analysis task. Ideally, registration should focus on aligning semantically corresponding voxels, i.e., the same anatomical locations. However, existing methods often optimize similarity measures computed directly on intensities or on hand-crafted features, which lack anatomical semantic information. These similarity measures may lead to sub-optimal solutions where large deformations, complex anatomical differences, or cross-modality imagery exist. In this work, we introduce a fast and accurate method for unsupervised 3D medical image registration building on top of a Self-supervised Anatomical eMbedding (SAM) algorithm, which is capable of computing dense anatomical correspondences between two images at the voxel level. We name our approach SAM-Enhanced registration (SAME++), which decomposes image registration into four steps: affine transformation, coarse deformation, deep non-parametric transformation, and instance optimization. Using SAM embeddings, we enhance these steps by finding more coherent correspondence and providing features with better semantic guidance. We extensively evaluated SAME++ using more than 50 labeled organs on three challenging inter-subject registration tasks of different body parts. As a complete registration framework, SAME++ markedly outperforms leading methods by $4.2\%$ - $8.2\%$ in terms of Dice score while being orders of magnitude faster than numerical optimization-based methods. Code is available at \url{https://github.com/alibaba-damo-academy/same}.

Zi Li, Lin Tian, Tony C. W. Mok et al. · harvard

Estimating displacement vector field via a cost volume computed in the feature space has shown great success in image registration, but it suffers excessive computation burdens. Moreover, existing feature descriptors only extract local features incapable of representing the global semantic information, which is especially important for solving large transformations. To address the discussed issues, we propose SAMConvex, a fast coarse-to-fine discrete optimization method for CT registration that includes a decoupled convex optimization procedure to obtain deformation fields based on a self-supervised anatomical embedding (SAM) feature extractor that captures both local and global information. To be specific, SAMConvex extracts per-voxel features and builds 6D correlation volumes based on SAM features, and iteratively updates a flow field by performing lookups on the correlation volumes with a coarse-to-fine scheme. SAMConvex outperforms the state-of-the-art learning-based methods and optimization-based methods over two inter-patient registration datasets (Abdomen CT and HeadNeck CT) and one intra-patient registration dataset (Lung CT). Moreover, as an optimization-based method, SAMConvex only takes $\sim2$s ($\sim5s$ with instance optimization) for one paired images.

Heng Guo, Jianfeng Zhang, Ke Yan et al.

Automatic parsing of human anatomies at the instance-level from 3D computed tomography (CT) is a prerequisite step for many clinical applications. The presence of pathologies, broken structures or limited field-of-view (FOV) can all make anatomy parsing algorithms vulnerable. In this work, we explore how to leverage and implement the successful detection-then-segmentation paradigm for 3D medical data, and propose a steerable, robust, and efficient computing framework for detection, identification, and segmentation of anatomies in CT scans. Considering the complicated shapes, sizes, and orientations of anatomies, without loss of generality, we present a nine degrees of freedom (9-DoF) pose estimation solution in full 3D space using a novel single-stage, non-hierarchical representation. Our whole framework is executed in a steerable manner where any anatomy of interest can be directly retrieved to further boost inference efficiency. We have validated our method on three medical imaging parsing tasks: ribs, spine, and abdominal organs. For rib parsing, CT scans have been annotated at the rib instance-level for quantitative evaluation, similarly for spine vertebrae and abdominal organs. Extensive experiments on 9-DoF box detection and rib instance segmentation demonstrate the high efficiency and effectiveness of our framework (with the identification rate of 97.0% and the segmentation Dice score of 90.9%), compared favorably against several strong baselines (e.g., CenterNet, FCOS, and nnU-Net). For spine parsing and abdominal multi-organ segmentation, our method achieves competitive results on par with state-of-the-art methods on the public CTSpine1K dataset and FLARE22 competition, respectively. Our annotations, code, and models are available at: https://github.com/alibaba-damo-academy/Med_Query.

Yankai Jiang, Mingze Sun, Heng Guo et al.

Self-supervised learning (SSL) has recently achieved promising performance for 3D medical image analysis tasks. Most current methods follow existing SSL paradigm originally designed for photographic or natural images, which cannot explicitly and thoroughly exploit the intrinsic similar anatomical structures across varying medical images. This may in fact degrade the quality of learned deep representations by maximizing the similarity among features containing spatial misalignment information and different anatomical semantics. In this work, we propose a new self-supervised learning framework, namely Alice, that explicitly fulfills Anatomical invariance modeling and semantic alignment via elaborately combining discriminative and generative objectives. Alice introduces a new contrastive learning strategy which encourages the similarity between views that are diversely mined but with consistent high-level semantics, in order to learn invariant anatomical features. Moreover, we design a conditional anatomical feature alignment module to complement corrupted embeddings with globally matched semantics and inter-patch topology information, conditioned by the distribution of local image content, which permits to create better contrastive pairs. Our extensive quantitative experiments on three 3D medical image analysis tasks demonstrate and validate the performance superiority of Alice, surpassing the previous best SSL counterpart methods and showing promising ability for united representation learning. Codes are available at https://github.com/alibaba-damo-academy/alice.

Wei Zhu, Le Lu, Jing Xiao et al.

Deep learning methods can struggle to handle domain shifts not seen in training data, which can cause them to not generalize well to unseen domains. This has led to research attention on domain generalization (DG), which aims to the model's generalization ability to out-of-distribution. Adversarial domain generalization is a popular approach to DG, but conventional approaches (1) struggle to sufficiently align features so that local neighborhoods are mixed across domains; and (2) can suffer from feature space over collapse which can threaten generalization performance. To address these limitations, we propose localized adversarial domain generalization with space compactness maintenance~(LADG) which constitutes two major contributions. First, we propose an adversarial localized classifier as the domain discriminator, along with a principled primary branch. This constructs a min-max game whereby the aim of the featurizer is to produce locally mixed domains. Second, we propose to use a coding-rate loss to alleviate feature space over collapse. We conduct comprehensive experiments on the Wilds DG benchmark to validate our approach, where LADG outperforms leading competitors on most datasets.

Jieneng Chen, Yingda Xia, Jiawen Yao et al.

Human readers or radiologists routinely perform full-body multi-organ multi-disease detection and diagnosis in clinical practice, while most medical AI systems are built to focus on single organs with a narrow list of a few diseases. This might severely limit AI's clinical adoption. A certain number of AI models need to be assembled non-trivially to match the diagnostic process of a human reading a CT scan. In this paper, we construct a Unified Tumor Transformer (CancerUniT) model to jointly detect tumor existence & location and diagnose tumor characteristics for eight major cancers in CT scans. CancerUniT is a query-based Mask Transformer model with the output of multi-tumor prediction. We decouple the object queries into organ queries, tumor detection queries and tumor diagnosis queries, and further establish hierarchical relationships among the three groups. This clinically-inspired architecture effectively assists inter- and intra-organ representation learning of tumors and facilitates the resolution of these complex, anatomically related multi-organ cancer image reading tasks. CancerUniT is trained end-to-end using a curated large-scale CT images of 10,042 patients including eight major types of cancers and occurring non-cancer tumors (all are pathology-confirmed with 3D tumor masks annotated by radiologists). On the test set of 631 patients, CancerUniT has demonstrated strong performance under a set of clinically relevant evaluation metrics, substantially outperforming both multi-disease methods and an assembly of eight single-organ expert models in tumor detection, segmentation, and diagnosis. This moves one step closer towards a universal high performance cancer screening tool.

Jieneng Chen, Jieru Mei, Xianhang Li et al.

Medical image segmentation plays a crucial role in advancing healthcare systems for disease diagnosis and treatment planning. The u-shaped architecture, popularly known as U-Net, has proven highly successful for various medical image segmentation tasks. However, U-Net's convolution-based operations inherently limit its ability to model long-range dependencies effectively. To address these limitations, researchers have turned to Transformers, renowned for their global self-attention mechanisms, as alternative architectures. One popular network is our previous TransUNet, which leverages Transformers' self-attention to complement U-Net's localized information with the global context. In this paper, we extend the 2D TransUNet architecture to a 3D network by building upon the state-of-the-art nnU-Net architecture, and fully exploring Transformers' potential in both the encoder and decoder design. We introduce two key components: 1) A Transformer encoder that tokenizes image patches from a convolution neural network (CNN) feature map, enabling the extraction of global contexts, and 2) A Transformer decoder that adaptively refines candidate regions by utilizing cross-attention between candidate proposals and U-Net features. Our investigations reveal that different medical tasks benefit from distinct architectural designs. The Transformer encoder excels in multi-organ segmentation, where the relationship among organs is crucial. On the other hand, the Transformer decoder proves more beneficial for dealing with small and challenging segmented targets such as tumor segmentation. Extensive experiments showcase the significant potential of integrating a Transformer-based encoder and decoder into the u-shaped medical image segmentation architecture. TransUNet outperforms competitors in various medical applications.

Zhentao Tan, Yue Wu, Qiankun Liu et al.

Image restoration under adverse weather conditions (e.g., rain, snow and haze) is a fundamental computer vision problem and has important indications for various downstream applications. Different from early methods that are specially designed for specific type of weather, most recent works tend to remove various adverse weather effects simultaneously through either spatial feature representation learning or semantic information embedding. Inspired by the various successful applications of large-scale pre-trained models (e.g, CLIP), in this paper, we explore the potential benefits of them for this task through both spatial feature representation learning and semantic information embedding aspects: 1) for spatial feature representation learning, we design a Spatially-Adaptive Residual (\textbf{SAR}) Encoder to extract degraded areas adaptively. To facilitate its training, we propose a Soft Residual Distillation (\textbf{CLIP-SRD}) strategy to transfer the spatial knowledge from CLIP between clean and adverse weather images; 2) for semantic information embedding, we propose a CLIP Weather Prior (\textbf{CWP}) embedding module to make the network handle different weather conditions adaptively. This module integrates the sample specific weather prior extracted by CLIP image encoder together with the distribution specific information learned by a set of parameters, and embeds them through a cross attention mechanism. Extensive experiments demonstrate that our proposed method can achieve state-of-the-art performance under different and challenging adverse weather conditions. Code will be made available.

Mingze Yuan, Yingda Xia, Hexin Dong et al.

Real-world medical image segmentation has tremendous long-tailed complexity of objects, among which tail conditions correlate with relatively rare diseases and are clinically significant. A trustworthy medical AI algorithm should demonstrate its effectiveness on tail conditions to avoid clinically dangerous damage in these out-of-distribution (OOD) cases. In this paper, we adopt the concept of object queries in Mask Transformers to formulate semantic segmentation as a soft cluster assignment. The queries fit the feature-level cluster centers of inliers during training. Therefore, when performing inference on a medical image in real-world scenarios, the similarity between pixels and the queries detects and localizes OOD regions. We term this OOD localization as MaxQuery. Furthermore, the foregrounds of real-world medical images, whether OOD objects or inliers, are lesions. The difference between them is less than that between the foreground and background, possibly misleading the object queries to focus redundantly on the background. Thus, we propose a query-distribution (QD) loss to enforce clear boundaries between segmentation targets and other regions at the query level, improving the inlier segmentation and OOD indication. Our proposed framework is tested on two real-world segmentation tasks, i.e., segmentation of pancreatic and liver tumors, outperforming previous state-of-the-art algorithms by an average of 7.39% on AUROC, 14.69% on AUPR, and 13.79% on FPR95 for OOD localization. On the other hand, our framework improves the performance of inlier segmentation by an average of 5.27% DSC when compared with the leading baseline nnUNet.

Ke Yan, Xiaoli Yin, Yingda Xia et al.

Liver tumor segmentation and classification are important tasks in computer aided diagnosis. We aim to address three problems: liver tumor screening and preliminary diagnosis in non-contrast computed tomography (CT), and differential diagnosis in dynamic contrast-enhanced CT. A novel framework named Pixel-Lesion-pAtient Network (PLAN) is proposed. It uses a mask transformer to jointly segment and classify each lesion with improved anchor queries and a foreground-enhanced sampling loss. It also has an image-wise classifier to effectively aggregate global information and predict patient-level diagnosis. A large-scale multi-phase dataset is collected containing 939 tumor patients and 810 normal subjects. 4010 tumor instances of eight types are extensively annotated. On the non-contrast tumor screening task, PLAN achieves 95% and 96% in patient-level sensitivity and specificity. On contrast-enhanced CT, our lesion-level detection precision, recall, and classification accuracy are 92%, 89%, and 86%, outperforming widely used CNN and transformers for lesion segmentation. We also conduct a reader study on a holdout set of 250 cases. PLAN is on par with a senior human radiologist, showing the clinical significance of our results.

Fakai Wang, Chi-Tung Cheng, Chien-Wei Peng et al.

Liver cancer has high morbidity and mortality rates in the world. Multi-phase CT is a main medical imaging modality for detecting/identifying and diagnosing liver tumors. Automatically detecting and classifying liver lesions in CT images have the potential to improve the clinical workflow. This task remains challenging due to liver lesions' large variations in size, appearance, image contrast, and the complexities of tumor types or subtypes. In this work, we customize a multi-object labeling tool for multi-phase CT images, which is used to curate a large-scale dataset containing 1,631 patients with four-phase CT images, multi-organ masks, and multi-lesion (six major types of liver lesions confirmed by pathology) masks. We develop a two-stage liver lesion detection pipeline, where the high-sensitivity detecting algorithms in the first stage discover as many lesion proposals as possible, and the lesion-reclassification algorithms in the second stage remove as many false alarms as possible. The multi-sensitivity lesion detection algorithm maximizes the information utilization of the individual probability maps of segmentation, and the lesion-shuffle augmentation effectively explores the texture contrast between lesions and the liver. Independently tested on 331 patient cases, the proposed model achieves high sensitivity and specificity for malignancy classification in the multi-phase contrast-enhanced CT (99.2%, 97.1%, diagnosis setting) and in the noncontrast CT (97.3%, 95.7%, screening setting).

Minfeng Xu, Heng Guo, Jianfeng Zhang et al.

Accurate and robust abdominal multi-organ segmentation from CT imaging of different modalities is a challenging task due to complex inter- and intra-organ shape and appearance variations among abdominal organs. In this paper, we propose a probabilistic multi-organ segmentation network with hierarchical spatial-wise feature modulation to capture flexible organ semantic variants and inject the learnt variants into different scales of feature maps for guiding segmentation. More specifically, we design an input decomposition module via a conditional variational auto-encoder to learn organ-specific distributions on the low dimensional latent space and model richer organ semantic variations that is conditioned on input images.Then by integrating these learned variations into the V-Net decoder hierarchically via spatial feature transformation, which has the ability to convert the variations into conditional Affine transformation parameters for spatial-wise feature maps modulating and guiding the fine-scale segmentation. The proposed method is trained on the publicly available AbdomenCT-1K dataset and evaluated on two other open datasets, i.e., 100 challenging/pathological testing patient cases from AbdomenCT-1K fully-supervised abdominal organ segmentation benchmark and 90 cases from TCIA+&BTCV dataset. Highly competitive or superior quantitative segmentation results have been achieved using these datasets for four abdominal organs of liver, kidney, spleen and pancreas with reported Dice scores improved by 7.3% for kidneys and 9.7% for pancreas, while being ~7 times faster than two strong baseline segmentation methods(nnUNet and CoTr).

Hexin Dong, Jiawen Yao, Yuxing Tang et al.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer in which the tumor-vascular involvement greatly affects the resectability and, thus, overall survival of patients. However, current prognostic prediction methods fail to explicitly and accurately investigate relationships between the tumor and nearby important vessels. This paper proposes a novel learnable neural distance that describes the precise relationship between the tumor and vessels in CT images of different patients, adopting it as a major feature for prognosis prediction. Besides, different from existing models that used CNNs or LSTMs to exploit tumor enhancement patterns on dynamic contrast-enhanced CT imaging, we improved the extraction of dynamic tumor-related texture features in multi-phase contrast-enhanced CT by fusing local and global features using CNN and transformer modules, further enhancing the features extracted across multi-phase CT images. We extensively evaluated and compared the proposed method with existing methods in the multi-center (n=4) dataset with 1,070 patients with PDAC, and statistical analysis confirmed its clinical effectiveness in the external test set consisting of three centers. The developed risk marker was the strongest predictor of overall survival among preoperative factors and it has the potential to be combined with established clinical factors to select patients at higher risk who might benefit from neoadjuvant therapy.

Fan Bai, Ke Yan, Xiaoyu Bai et al.

Medical image analysis using deep learning is often challenged by limited labeled data and high annotation costs. Fine-tuning the entire network in label-limited scenarios can lead to overfitting and suboptimal performance. Recently, prompt tuning has emerged as a more promising technique that introduces a few additional tunable parameters as prompts to a task-agnostic pre-trained model, and updates only these parameters using supervision from limited labeled data while keeping the pre-trained model unchanged. However, previous work has overlooked the importance of selective labeling in downstream tasks, which aims to select the most valuable downstream samples for annotation to achieve the best performance with minimum annotation cost. To address this, we propose a framework that combines selective labeling with prompt tuning (SLPT) to boost performance in limited labels. Specifically, we introduce a feature-aware prompt updater to guide prompt tuning and a TandEm Selective LAbeling (TESLA) strategy. TESLA includes unsupervised diversity selection and supervised selection using prompt-based uncertainty. In addition, we propose a diversified visual prompt tuning strategy to provide multi-prompt-based discrepant predictions for TESLA. We evaluate our method on liver tumor segmentation and achieve state-of-the-art performance, outperforming traditional fine-tuning with only 6% of tunable parameters, also achieving 94% of full-data performance by labeling only 5% of the data.

Jianpeng Zhang, Xianghua Ye, Jianfeng Zhang et al.

Lung cancer is a leading cause of death worldwide and early screening is critical for improving survival outcomes. In clinical practice, the contextual structure of nodules and the accumulated experience of radiologists are the two core elements related to the accuracy of identification of benign and malignant nodules. Contextual information provides comprehensive information about nodules such as location, shape, and peripheral vessels, and experienced radiologists can search for clues from previous cases as a reference to enrich the basis of decision-making. In this paper, we propose a radiologist-inspired method to simulate the diagnostic process of radiologists, which is composed of context parsing and prototype recalling modules. The context parsing module first segments the context structure of nodules and then aggregates contextual information for a more comprehensive understanding of the nodule. The prototype recalling module utilizes prototype-based learning to condense previously learned cases as prototypes for comparative analysis, which is updated online in a momentum way during training. Building on the two modules, our method leverages both the intrinsic characteristics of the nodules and the external knowledge accumulated from other nodules to achieve a sound diagnosis. To meet the needs of both low-dose and noncontrast screening, we collect a large-scale dataset of 12,852 and 4,029 nodules from low-dose and noncontrast CTs respectively, each with pathology- or follow-up-confirmed labels. Experiments on several datasets demonstrate that our method achieves advanced screening performance on both low-dose and noncontrast scenarios.

Xiaoyu Bai, Fan Bai, Xiaofei Huo et al.

Radiotherapists require accurate registration of MR/CT images to effectively use information from both modalities. In a typical registration pipeline, rigid or affine transformations are applied to roughly align the fixed and moving images before proceeding with the deformation step. While recent learning-based methods have shown promising results in the rigid/affine step, these methods often require images with similar field-of-view (FOV) for successful alignment. As a result, aligning images with different FOVs remains a challenging task. Self-supervised landmark detection methods like self-supervised Anatomical eMbedding (SAM) have emerged as a useful tool for mapping and cropping images to similar FOVs. However, these methods are currently limited to intra-modality use only. To address this limitation and enable cross-modality matching, we propose a new approach called Cross-SAM. Our approach utilizes a novel iterative process that alternates between embedding learning and CT-MRI registration. We start by applying aggressive contrast augmentation on both CT and MRI images to train a SAM model. We then use this SAM to identify corresponding regions on paired images using robust grid-points matching, followed by a point-set based affine/rigid registration, and a deformable fine-tuning step to produce registered paired images. We use these registered pairs to enhance the matching ability of SAM, which is then processed iteratively. We use the final model for cross-modality matching tasks. We evaluated our approach on two CT-MRI affine registration datasets and found that Cross-SAM achieved robust affine registration on both datasets, significantly outperforming other methods and achieving state-of-the-art performance.

Zhanghexuan Ji, Dazhou Guo, Puyang Wang et al.

Deep learning empowers the mainstream medical image segmentation methods. Nevertheless current deep segmentation approaches are not capable of efficiently and effectively adapting and updating the trained models when new incremental segmentation classes (along with new training datasets or not) are required to be added. In real clinical environment, it can be preferred that segmentation models could be dynamically extended to segment new organs/tumors without the (re-)access to previous training datasets due to obstacles of patient privacy and data storage. This process can be viewed as a continual semantic segmentation (CSS) problem, being understudied for multi-organ segmentation. In this work, we propose a new architectural CSS learning framework to learn a single deep segmentation model for segmenting a total of 143 whole-body organs. Using the encoder/decoder network structure, we demonstrate that a continually-trained then frozen encoder coupled with incrementally-added decoders can extract and preserve sufficiently representative image features for new classes to be subsequently and validly segmented. To maintain a single network model complexity, we trim each decoder progressively using neural architecture search and teacher-student based knowledge distillation. To incorporate with both healthy and pathological organs appearing in different datasets, a novel anomaly-aware and confidence learning module is proposed to merge the overlapped organ predictions, originated from different decoders. Trained and validated on 3D CT scans of 2500+ patients from four datasets, our single network can segment total 143 whole-body organs with very high accuracy, closely reaching the upper bound performance level by training four separate segmentation models (i.e., one model per dataset/task).

Mingze Yuan, Yingda Xia, Xin Chen et al.

Gastric cancer is the third leading cause of cancer-related mortality worldwide, but no guideline-recommended screening test exists. Existing methods can be invasive, expensive, and lack sensitivity to identify early-stage gastric cancer. In this study, we explore the feasibility of using a deep learning approach on non-contrast CT scans for gastric cancer detection. We propose a novel cluster-induced Mask Transformer that jointly segments the tumor and classifies abnormality in a multi-task manner. Our model incorporates learnable clusters that encode the texture and shape prototypes of gastric cancer, utilizing self- and cross-attention to interact with convolutional features. In our experiments, the proposed method achieves a sensitivity of 85.0% and specificity of 92.6% for detecting gastric tumors on a hold-out test set consisting of 100 patients with cancer and 148 normal. In comparison, two radiologists have an average sensitivity of 73.5% and specificity of 84.3%. We also obtain a specificity of 97.7% on an external test set with 903 normal cases. Our approach performs comparably to established state-of-the-art gastric cancer screening tools like blood testing and endoscopy, while also being more sensitive in detecting early-stage cancer. This demonstrates the potential of our approach as a novel, non-invasive, low-cost, and accurate method for opportunistic gastric cancer screening.

Bo Zhou, Yingda Xia, Jiawen Yao et al.

Pancreatic cancer is one of the leading causes of cancer-related death. Accurate detection, segmentation, and differential diagnosis of the full taxonomy of pancreatic lesions, i.e., normal, seven major types of lesions, and other lesions, is critical to aid the clinical decision-making of patient management and treatment. However, existing works focus on segmentation and classification for very specific lesion types (PDAC) or groups. Moreover, none of the previous work considers using lesion prevalence-related non-imaging patient information to assist the differential diagnosis. To this end, we develop a meta-information-aware dual-path transformer and exploit the feasibility of classification and segmentation of the full taxonomy of pancreatic lesions. Specifically, the proposed method consists of a CNN-based segmentation path (S-path) and a transformer-based classification path (C-path). The S-path focuses on initial feature extraction by semantic segmentation using a UNet-based network. The C-path utilizes both the extracted features and meta-information for patient-level classification based on stacks of dual-path transformer blocks that enhance the modeling of global contextual information. A large-scale multi-phase CT dataset of 3,096 patients with pathology-confirmed pancreatic lesion class labels, voxel-wise manual annotations of lesions from radiologists, and patient meta-information, was collected for training and evaluations. Our results show that our method can enable accurate classification and segmentation of the full taxonomy of pancreatic lesions, approaching the accuracy of the radiologist's report and significantly outperforming previous baselines. Results also show that adding the common meta-information, i.e., gender and age, can boost the model's performance, thus demonstrating the importance of meta-information for aiding pancreatic disease diagnosis.

Puyang Wang, Dazhou Guo, Dandan Zheng et al.

Intrathoracic airway segmentation in computed tomography (CT) is a prerequisite for various respiratory disease analyses such as chronic obstructive pulmonary disease (COPD), asthma and lung cancer. Unlike other organs with simpler shapes or topology, the airway's complex tree structure imposes an unbearable burden to generate the "ground truth" label (up to 7 or 3 hours of manual or semi-automatic annotation on each case). Most of the existing airway datasets are incompletely labeled/annotated, thus limiting the completeness of computer-segmented airway. In this paper, we propose a new anatomy-aware multi-class airway segmentation method enhanced by topology-guided iterative self-learning. Based on the natural airway anatomy, we formulate a simple yet highly effective anatomy-aware multi-class segmentation task to intuitively handle the severe intra-class imbalance of the airway. To solve the incomplete labeling issue, we propose a tailored self-iterative learning scheme to segment toward the complete airway tree. For generating pseudo-labels to achieve higher sensitivity , we introduce a novel breakage attention map and design a topology-guided pseudo-label refinement method by iteratively connecting breaking branches commonly existed from initial pseudo-labels. Extensive experiments have been conducted on four datasets including two public challenges. The proposed method ranked 1st in both EXACT'09 challenge using average score and ATM'22 challenge on weighted average score. In a public BAS dataset and a private lung cancer dataset, our method significantly improves previous leading approaches by extracting at least (absolute) 7.5% more detected tree length and 4.0% more tree branches, while maintaining similar precision.

Zhilin Zheng, Xu Fang, Jiawen Yao et al.

Lymph node (LN) metastasis status is one of the most critical prognostic and cancer staging factors for patients with resectable pancreatic ductal adenocarcinoma (PDAC), or in general, for any types of solid malignant tumors. Preoperative prediction of LN metastasis from non-invasive CT imaging is highly desired, as it might be straightforwardly used to guide the following neoadjuvant treatment decision and surgical planning. Most studies only capture the tumor characteristics in CT imaging to implicitly infer LN metastasis and very few work exploit direct LN's CT imaging information. To the best of our knowledge, this is the first work to propose a fully-automated LN segmentation and identification network to directly facilitate the LN metastasis status prediction task. Nevertheless LN segmentation/detection is very challenging since LN can be easily confused with other hard negative anatomic structures (e.g., vessels) from radiological images. We explore the anatomical spatial context priors of pancreatic LN locations by generating a guiding attention map from related organs and vessels to assist segmentation and infer LN status. As such, LN segmentation is impelled to focus on regions that are anatomically adjacent or plausible with respect to the specific organs and vessels. The metastasized LN identification network is trained to classify the segmented LN instances into positives or negatives by reusing the segmentation network as a pre-trained backbone and padding a new classification head. More importantly, we develop a LN metastasis status prediction network that combines the patient-wise aggregation results of LN segmentation/identification and deep imaging features extracted from the tumor region. Extensive quantitative nested five-fold cross-validation is conducted on a discovery dataset of 749 patients with PDAC.

Qing Wu, Xuanyu Tian, Chenhe Du et al.

Implicit neural representations (INRs) have emerged as a powerful paradigm for medical imaging via physics-informed unsupervised learning. Classical INRs optimize an entire network from scratch for each subject, leading to inefficient training and suboptimal imaging quality. Recent initialization-based approaches attempt to inject population priors into pre-trained networks, yet they rely on high-quality images and often suffer from catastrophic forgetting during fine-tuning. We present DisINR, a novel INR framework that explicitly disentangles shared and subject-specific representations. DisINR introduces a shared encoder-decoder pair and subject-specific encoders, whose features are jointly decoded for image reconstruction. By integrating differentiable forward models, it pre-trains the shared modules directly from limited raw measurements, removing the need for pre-acquired high-quality images. During test-time adaptation, only the subject-specific encoder is optimized, while the shared pair remains frozen, effectively preserving learned priors. Extensive evaluations on three representative medical imaging tasks show that DisINR significantly outperforms state-of-the-art INRs in both reconstruction accuracy and efficiency.

Ke Yan, Dakai Jin, Dazhou Guo et al.

Finding abnormal lymph nodes in radiological images is highly important for various medical tasks such as cancer metastasis staging and radiotherapy planning. Lymph nodes (LNs) are small glands scattered throughout the body. They are grouped or defined to various LN stations according to their anatomical locations. The CT imaging appearance and context of LNs in different stations vary significantly, posing challenges for automated detection, especially for pathological LNs. Motivated by this observation, we propose a novel end-to-end framework to improve LN detection performance by leveraging their station information. We design a multi-head detector and make each head focus on differentiating the LN and non-LN structures of certain stations. Pseudo station labels are generated by an LN station classifier as a form of multi-task learning during training, so we do not need another explicit LN station prediction model during inference. Our algorithm is evaluated on 82 patients with lung cancer and 91 patients with esophageal cancer. The proposed implicit station stratification method improves the detection sensitivity of thoracic lymph nodes from 65.1% to 71.4% and from 80.3% to 85.5% at 2 false positives per patient on the two datasets, respectively, which significantly outperforms various existing state-of-the-art baseline techniques such as nnUNet, nnDetection and LENS.

Yan-Jie Zhou, Wei Liu, Yuan Gao et al.

Skin diseases are among the most prevalent health issues, and accurate computer-aided diagnosis methods are of importance for both dermatologists and patients. However, most of the existing methods overlook the essential domain knowledge required for skin disease diagnosis. A novel multi-task model, namely DermImitFormer, is proposed to fill this gap by imitating dermatologists' diagnostic procedures and strategies. Through multi-task learning, the model simultaneously predicts body parts and lesion attributes in addition to the disease itself, enhancing diagnosis accuracy and improving diagnosis interpretability. The designed lesion selection module mimics dermatologists' zoom-in action, effectively highlighting the local lesion features from noisy backgrounds. Additionally, the presented cross-interaction module explicitly models the complicated diagnostic reasoning between body parts, lesion attributes, and diseases. To provide a more robust evaluation of the proposed method, a large-scale clinical image dataset of skin diseases with significantly more cases than existing datasets has been established. Extensive experiments on three different datasets consistently demonstrate the state-of-the-art recognition performance of the proposed approach.

Heng Guo, Jianfeng Zhang, Jiaxing Huang et al.

Segment anything model (SAM) demonstrates strong generalization ability on natural image segmentation. However, its direct adaptation in medical image segmentation tasks shows significant performance drops. It also requires an excessive number of prompt points to obtain a reasonable accuracy. Although quite a few studies explore adapting SAM into medical image volumes, the efficiency of 2D adaptation methods is unsatisfactory and 3D adaptation methods are only capable of segmenting specific organs/tumors. In this work, we propose a comprehensive and scalable 3D SAM model for whole-body CT segmentation, named CT-SAM3D. Instead of adapting SAM, we propose a 3D promptable segmentation model using a (nearly) fully labeled CT dataset. To train CT-SAM3D effectively, ensuring the model's accurate responses to higher-dimensional spatial prompts is crucial, and 3D patch-wise training is required due to GPU memory constraints. Therefore, we propose two key technical developments: 1) a progressively and spatially aligned prompt encoding method to effectively encode click prompts in local 3D space; and 2) a cross-patch prompt scheme to capture more 3D spatial context, which is beneficial for reducing the editing workloads when interactively prompting on large organs. CT-SAM3D is trained using a curated dataset of 1204 CT scans containing 107 whole-body anatomies and extensively validated using five datasets, achieving significantly better results against all previous SAM-derived models. Code, data, and our 3D interactive segmentation tool with quasi-real-time responses are available at https://github.com/alibaba-damo-academy/ct-sam3d.

Ethan H. Nguyen, Haichun Yang, Ruining Deng et al.

Box representation has been extensively used for object detection in computer vision. Such representation is efficacious but not necessarily optimized for biomedical objects (e.g., glomeruli), which play an essential role in renal pathology. In this paper, we propose a simple circle representation for medical object detection and introduce CircleNet, an anchor-free detection framework. Compared with the conventional bounding box representation, the proposed bounding circle representation innovates in three-fold: (1) it is optimized for ball-shaped biomedical objects; (2) The circle representation reduced the degree of freedom compared with box representation; (3) It is naturally more rotation invariant. When detecting glomeruli and nuclei on pathological images, the proposed circle representation achieved superior detection performance and be more rotation-invariant, compared with the bounding box. The code has been made publicly available: https://github.com/hrlblab/CircleNet

Jieneng Chen, Yongyi Lu, Qihang Yu et al.

Medical image segmentation is an essential prerequisite for developing healthcare systems, especially for disease diagnosis and treatment planning. On various medical image segmentation tasks, the u-shaped architecture, also known as U-Net, has become the de-facto standard and achieved tremendous success. However, due to the intrinsic locality of convolution operations, U-Net generally demonstrates limitations in explicitly modeling long-range dependency. Transformers, designed for sequence-to-sequence prediction, have emerged as alternative architectures with innate global self-attention mechanisms, but can result in limited localization abilities due to insufficient low-level details. In this paper, we propose TransUNet, which merits both Transformers and U-Net, as a strong alternative for medical image segmentation. On one hand, the Transformer encodes tokenized image patches from a convolution neural network (CNN) feature map as the input sequence for extracting global contexts. On the other hand, the decoder upsamples the encoded features which are then combined with the high-resolution CNN feature maps to enable precise localization. We argue that Transformers can serve as strong encoders for medical image segmentation tasks, with the combination of U-Net to enhance finer details by recovering localized spatial information. TransUNet achieves superior performances to various competing methods on different medical applications including multi-organ segmentation and cardiac segmentation. Code and models are available at https://github.com/Beckschen/TransUNet.

Ke Yan, Jinzheng Cai, Youjing Zheng et al.

Large-scale datasets with high-quality labels are desired for training accurate deep learning models. However, due to the annotation cost, datasets in medical imaging are often either partially-labeled or small. For example, DeepLesion is such a large-scale CT image dataset with lesions of various types, but it also has many unlabeled lesions (missing annotations). When training a lesion detector on a partially-labeled dataset, the missing annotations will generate incorrect negative signals and degrade the performance. Besides DeepLesion, there are several small single-type datasets, such as LUNA for lung nodules and LiTS for liver tumors. These datasets have heterogeneous label scopes, i.e., different lesion types are labeled in different datasets with other types ignored. In this work, we aim to develop a universal lesion detection algorithm to detect a variety of lesions. The problem of heterogeneous and partial labels is tackled. First, we build a simple yet effective lesion detection framework named Lesion ENSemble (LENS). LENS can efficiently learn from multiple heterogeneous lesion datasets in a multi-task fashion and leverage their synergy by proposal fusion. Next, we propose strategies to mine missing annotations from partially-labeled datasets by exploiting clinical prior knowledge and cross-dataset knowledge transfer. Finally, we train our framework on four public lesion datasets and evaluate it on 800 manually-labeled sub-volumes in DeepLesion. Our method brings a relative improvement of 49% compared to the current state-of-the-art approach in the metric of average sensitivity. We have publicly released our manual 3D annotations of DeepLesion in https://github.com/viggin/DeepLesion_manual_test_set.

Mengyang Zhao, Aadarsh Jha, Quan Liu et al.

Recently, single-stage embedding based deep learning algorithms gain increasing attention in cell segmentation and tracking. Compared with the traditional "segment-then-associate" two-stage approach, a single-stage algorithm not only simultaneously achieves consistent instance cell segmentation and tracking but also gains superior performance when distinguishing ambiguous pixels on boundaries and overlaps. However, the deployment of an embedding based algorithm is restricted by slow inference speed (e.g., around 1-2 mins per frame). In this study, we propose a novel Faster Mean-shift algorithm, which tackles the computational bottleneck of embedding based cell segmentation and tracking. Different from previous GPU-accelerated fast mean-shift algorithms, a new online seed optimization policy (OSOP) is introduced to adaptively determine the minimal number of seeds, accelerate computation, and save GPU memory. With both embedding simulation and empirical validation via the four cohorts from the ISBI cell tracking challenge, the proposed Faster Mean-shift algorithm achieved 7-10 times speedup compared to the state-of-the-art embedding based cell instance segmentation and tracking algorithm. Our Faster Mean-shift algorithm also achieved the highest computational speed compared to other GPU benchmarks with optimized memory consumption. The Faster Mean-shift is a plug-and-play model, which can be employed on other pixel embedding based clustering inference for medical image analysis. (Plug-and-play model is publicly available: https://github.com/masqm/Faster-Mean-Shift)

Wei Fang, Yuxing Tang, Heng Guo et al.

In the realm of medical 3D data, such as CT and MRI images, prevalent anisotropic resolution is characterized by high intra-slice but diminished inter-slice resolution. The lowered resolution between adjacent slices poses challenges, hindering optimal viewing experiences and impeding the development of robust downstream analysis algorithms. Various volumetric super-resolution algorithms aim to surmount these challenges, enhancing inter-slice resolution and overall 3D medical imaging quality. However, existing approaches confront inherent challenges: 1) often tailored to specific upsampling factors, lacking flexibility for diverse clinical scenarios; 2) newly generated slices frequently suffer from over-smoothing, degrading fine details, and leading to inter-slice inconsistency. In response, this study presents CycleINR, a novel enhanced Implicit Neural Representation model for 3D medical data volumetric super-resolution. Leveraging the continuity of the learned implicit function, the CycleINR model can achieve results with arbitrary up-sampling rates, eliminating the need for separate training. Additionally, we enhance the grid sampling in CycleINR with a local attention mechanism and mitigate over-smoothing by integrating cycle-consistent loss. We introduce a new metric, Slice-wise Noise Level Inconsistency (SNLI), to quantitatively assess inter-slice noise level inconsistency. The effectiveness of our approach is demonstrated through image quality evaluations on an in-house dataset and a downstream task analysis on the Medical Segmentation Decathlon liver tumor dataset.

Tony C. W. Mok, Zi Li, Yunhao Bai et al.

Establishing dense anatomical correspondence across distinct imaging modalities is a foundational yet challenging procedure for numerous medical image analysis studies and image-guided radiotherapy. Existing multi-modality image registration algorithms rely on statistical-based similarity measures or local structural image representations. However, the former is sensitive to locally varying noise, while the latter is not discriminative enough to cope with complex anatomical structures in multimodal scans, causing ambiguity in determining the anatomical correspondence across scans with different modalities. In this paper, we propose a modality-agnostic structural representation learning method, which leverages Deep Neighbourhood Self-similarity (DNS) and anatomy-aware contrastive learning to learn discriminative and contrast-invariance deep structural image representations (DSIR) without the need for anatomical delineations or pre-aligned training images. We evaluate our method on multiphase CT, abdomen MR-CT, and brain MR T1w-T2w registration. Comprehensive results demonstrate that our method is superior to the conventional local structural representation and statistical-based similarity measures in terms of discriminability and accuracy.

Weiwei Cao, Jianpeng Zhang, Yingda Xia et al.

Radiologists highly desire fully automated versatile AI for medical imaging interpretation. However, the lack of extensively annotated large-scale multi-disease datasets has hindered the achievement of this goal. In this paper, we explore the feasibility of leveraging language as a naturally high-quality supervision for chest CT imaging. In light of the limited availability of image-report pairs, we bootstrap the understanding of 3D chest CT images by distilling chest-related diagnostic knowledge from an extensively pre-trained 2D X-ray expert model. Specifically, we propose a language-guided retrieval method to match each 3D CT image with its semantically closest 2D X-ray image, and perform pair-wise and semantic relation knowledge distillation. Subsequently, we use contrastive learning to align images and reports within the same patient while distinguishing them from the other patients. However, the challenge arises when patients have similar semantic diagnoses, such as healthy patients, potentially confusing if treated as negatives. We introduce a robust contrastive learning that identifies and corrects these false negatives. We train our model with over 12,000 pairs of chest CT images and radiology reports. Extensive experiments across multiple scenarios, including zero-shot learning, report generation, and fine-tuning processes, demonstrate the model's feasibility in interpreting chest CT images.

Tianxiang Chen, Zhentao Tan, Tao Gong et al.

How to effectively interact audio with vision has garnered considerable interest within the multi-modality research field. Recently, a novel audio-visual segmentation (AVS) task has been proposed, aiming to segment the sounding objects in video frames under the guidance of audio cues. However, most existing AVS methods are hindered by a modality imbalance where the visual features tend to dominate those of the audio modality, due to a unidirectional and insufficient integration of audio cues. This imbalance skews the feature representation towards the visual aspect, impeding the learning of joint audio-visual representations and potentially causing segmentation inaccuracies. To address this issue, we propose AVSAC. Our approach features a Bidirectional Audio-Visual Decoder (BAVD) with integrated bidirectional bridges, enhancing audio cues and fostering continuous interplay between audio and visual modalities. This bidirectional interaction narrows the modality imbalance, facilitating more effective learning of integrated audio-visual representations. Additionally, we present a strategy for audio-visual frame-wise synchrony as fine-grained guidance of BAVD. This strategy enhances the share of auditory components in visual features, contributing to a more balanced audio-visual representation learning. Extensive experiments show that our method attains new benchmarks in AVS performance.

Jingyang Lin, Yingda Xia, Jianpeng Zhang et al.

Medical Vision-Language Pretraining (Med-VLP) establishes a connection between visual content from medical images and the relevant textual descriptions. Existing Med-VLP methods primarily focus on 2D images depicting a single body part, notably chest X-rays. In this paper, we extend the scope of Med-VLP to encompass 3D images, specifically targeting full-body scenarios, by using a multimodal dataset of CT images and reports. Compared with the 2D counterpart, 3D VLP is required to effectively capture essential semantics from significantly sparser representation in 3D imaging. In this paper, we introduce CT-GLIP (Grounded Language-Image Pretraining with CT scans), a novel method that constructs organ-level image-text pairs to enhance multimodal contrastive learning, aligning grounded visual features with precise diagnostic text. Additionally, we developed an abnormality dictionary to augment contrastive learning with diverse contrastive pairs. Our method, trained on a multimodal CT dataset comprising 44,011 organ-level vision-text pairs from 17,702 patients across 104 organs, demonstrates it can identify organs and abnormalities in a zero-shot manner using natural languages. The performance of CT-GLIP is validated on a separate test set of 1,130 patients, focusing on the 16 most frequent abnormalities across 7 organs. The experimental results show our model's superior performance over the standard CLIP framework across zero-shot and fine-tuning scenarios, using both CNN and ViT architectures.

Quan Liu, Jiawen Yao, Lisha Yao et al.

Colorectal cancer (CRC) micro-satellite instability (MSI) prediction on histopathology images is a challenging weakly supervised learning task that involves multi-instance learning on gigapixel images. To date, radiology images have proven to have CRC MSI information and efficient patient imaging techniques. Different data modalities integration offers the opportunity to increase the accuracy and robustness of MSI prediction. Despite the progress in representation learning from the whole slide images (WSI) and exploring the potential of making use of radiology data, CRC MSI prediction remains a challenge to fuse the information from multiple data modalities (e.g., pathology WSI and radiology CT image). In this paper, we propose $M^{2}$Fusion: a Bayesian-based multimodal multi-level fusion pipeline for CRC MSI. The proposed fusion model $M^{2}$Fusion is capable of discovering more novel patterns within and across modalities that are beneficial for predicting MSI than using a single modality alone, as well as other fusion methods. The contribution of the paper is three-fold: (1) $M^{2}$Fusion is the first pipeline of multi-level fusion on pathology WSI and 3D radiology CT image for MSI prediction; (2) CT images are the first time integrated into multimodal fusion for CRC MSI prediction; (3) feature-level fusion strategy is evaluated on both Transformer-based and CNN-based method. Our approach is validated on cross-validation of 352 cases and outperforms either feature-level (0.8177 vs. 0.7908) or decision-level fusion strategy (0.8177 vs. 0.7289) on AUC score.

Guangyu Guo, Jiawen Yao, Yingda Xia et al.

The absence of adequately sufficient expert-level tumor annotations hinders the effectiveness of supervised learning based opportunistic cancer screening on medical imaging. Clinical reports (that are rich in descriptive textual details) can offer a "free lunch'' supervision information and provide tumor location as a type of weak label to cope with screening tasks, thus saving human labeling workloads, if properly leveraged. However, predicting cancer only using such weak labels can be very changeling since tumors are usually presented in small anatomical regions compared to the whole 3D medical scans. Weakly semi-supervised learning (WSSL) utilizes a limited set of voxel-level tumor annotations and incorporates alongside a substantial number of medical images that have only off-the-shelf clinical reports, which may strike a good balance between minimizing expert annotation workload and optimizing screening efficacy. In this paper, we propose a novel text-guided learning method to achieve highly accurate cancer detection results. Through integrating diagnostic and tumor location text prompts into the text encoder of a vision-language model (VLM), optimization of weakly supervised learning can be effectively performed in the latent space of VLM, thereby enhancing the stability of training. Our approach can leverage clinical knowledge by large-scale pre-trained VLM to enhance generalization ability, and produce reliable pseudo tumor masks to improve cancer detection. Our extensive quantitative experimental results on a large-scale cancer dataset, including 1,651 unique patients, validate that our approach can reduce human annotation efforts by at least 70% while maintaining comparable cancer detection accuracy to competing fully supervised methods (AUC value 0.961 versus 0.966).

Yirui Wang, Qinji Yu, Ke Yan et al.

Lymph node (LN) assessment is a critical, indispensable yet very challenging task in the routine clinical workflow of radiology and oncology. Accurate LN analysis is essential for cancer diagnosis, staging, and treatment planning. Finding scatteredly distributed, low-contrast clinically relevant LNs in 3D CT is difficult even for experienced physicians under high inter-observer variations. Previous automatic LN detection works typically yield limited recall and high false positives (FPs) due to adjacent anatomies with similar image intensities, shapes, or textures (vessels, muscles, esophagus, etc). In this work, we propose a new LN DEtection TRansformer, named LN-DETR, to achieve more accurate performance. By enhancing the 2D backbone with a multi-scale 2.5D feature fusion to incorporate 3D context explicitly, more importantly, we make two main contributions to improve the representation quality of LN queries. 1) Considering that LN boundaries are often unclear, an IoU prediction head and a location debiased query selection are proposed to select LN queries of higher localization accuracy as the decoder query's initialization. 2) To reduce FPs, query contrastive learning is employed to explicitly reinforce LN queries towards their best-matched ground-truth queries over unmatched query predictions. Trained and tested on 3D CT scans of 1067 patients (with 10,000+ labeled LNs) via combining seven LN datasets from different body parts (neck, chest, and abdomen) and pathologies/cancers, our method significantly improves the performance of previous leading methods by > 4-5% average recall at the same FP rates in both internal and external testing. We further evaluate on the universal lesion detection task using NIH DeepLesion benchmark, and our method achieves the top performance of 88.46% averaged recall across 0.5 to 4 FPs per image, compared with other leading reported results.

Jiacheng Hao, Xiaoming Zhang, Wei Liu et al.

Focal liver lesions (FLL) are common clinical findings during physical examination. Early diagnosis and intervention of liver malignancies are crucial to improving patient survival. Although the current 3D segmentation paradigm can accurately detect lesions, it faces limitations in distinguishing between malignant and benign liver lesions, primarily due to its inability to differentiate subtle variations between different lesions. Furthermore, existing methods predominantly rely on specialized imaging modalities such as multi-phase contrast-enhanced CT and magnetic resonance imaging, whereas non-contrast CT (NCCT) is more prevalent in routine abdominal imaging. To address these limitations, we propose PLUS, a plug-and-play framework that enhances FLL analysis on NCCT images for arbitrary 3D segmentation models. In extensive experiments involving 8,651 patients, PLUS demonstrated a significant improvement with existing methods, improving the lesion-level F1 score by 5.66%, the malignant patient-level F1 score by 6.26%, and the benign patient-level F1 score by 4.03%. Our results demonstrate the potential of PLUS to improve malignant FLL screening using widely available NCCT imaging substantially.

Jiaxing Huang, Heng Guo, Le Lu et al.

Osteoporosis, characterized by reduced bone mineral density (BMD) and compromised bone microstructure, increases fracture risk in aging populations. While dual-energy X-ray absorptiometry (DXA) is the clinical standard for BMD assessment, its limited accessibility hinders diagnosis in resource-limited regions. Opportunistic computed tomography (CT) analysis has emerged as a promising alternative for osteoporosis diagnosis using existing imaging data. Current approaches, however, face three limitations: (1) underutilization of unlabeled vertebral data, (2) systematic bias from device-specific DXA discrepancies, and (3) insufficient integration of clinical knowledge such as spatial BMD distribution patterns. To address these, we propose a unified deep learning framework with three innovations. First, a self-supervised learning method using radiomic representations to leverage unlabeled CT data and preserve bone texture. Second, a Mixture of Experts (MoE) architecture with learned gating mechanisms to enhance cross-device adaptability. Third, a multi-task learning framework integrating osteoporosis diagnosis, BMD regression, and vertebra location prediction. Validated across three clinical sites and an external hospital, our approach demonstrates superior generalizability and accuracy over existing methods for opportunistic osteoporosis screening and diagnosis.

Jiaheng Zhou, Yanfeng Zhou, Wei Fang et al.

Ultrasound videos are an important form of clinical imaging data, and deep learning-based automated analysis can improve diagnostic accuracy and clinical efficiency. However, the scarcity of labeled data and the inherent challenges of video analysis have impeded the advancement of related methods. In this work, we introduce E-ViM$^3$, a data-efficient Vision Mamba network that preserves the 3D structure of video data, enhancing long-range dependencies and inductive biases to better model space-time correlations. With our design of Enclosure Global Tokens (EGT), the model captures and aggregates global features more effectively than competing methods. To further improve data efficiency, we employ masked video modeling for self-supervised pre-training, with the proposed Spatial-Temporal Chained (STC) masking strategy designed to adapt to various video scenarios. Experiments demonstrate that E-ViM$^3$ performs as the state-of-the-art in two high-level semantic analysis tasks across four datasets of varying sizes: EchoNet-Dynamic, CAMUS, MICCAI-BUV, and WHBUS. Furthermore, our model achieves competitive performance with limited labels, highlighting its potential impact on real-world clinical applications.

Zijiang Yang, Zhongwei Qiu, Tiancheng Lin et al.

It is clinically crucial and potentially very beneficial to be able to analyze and model directly the spatial distributions of cells in histopathology whole slide images (WSI). However, most existing WSI datasets lack cell-level annotations, owing to the extremely high cost over giga-pixel images. Thus, it remains an open question whether deep learning models can directly and effectively analyze WSIs from the semantic aspect of cell distributions. In this work, we construct a large-scale WSI dataset with more than 5 billion cell-level annotations, termed WSI-Cell5B, and a novel hierarchical Cell Cloud Transformer (CCFormer) to tackle these challenges. WSI-Cell5B is based on 6,998 WSIs of 11 cancers from The Cancer Genome Atlas Program, and all WSIs are annotated per cell by coordinates and types. To the best of our knowledge, WSI-Cell5B is the first WSI-level large-scale dataset integrating cell-level annotations. On the other hand, CCFormer formulates the collection of cells in each WSI as a cell cloud and models cell spatial distribution. Specifically, Neighboring Information Embedding (NIE) is proposed to characterize the distribution of cells within the neighborhood of each cell, and a novel Hierarchical Spatial Perception (HSP) module is proposed to learn the spatial relationship among cells in a bottom-up manner. The clinical analysis indicates that WSI-Cell5B can be used to design clinical evaluation metrics based on counting cells that effectively assess the survival risk of patients. Extensive experiments on survival prediction and cancer staging show that learning from cell spatial distribution alone can already achieve state-of-the-art (SOTA) performance, i.e., CCFormer strongly outperforms other competing methods.

Zi Li, Ying Chen, Zeli Chen et al.

In the radiation therapy of nasopharyngeal carcinoma (NPC), clinicians typically delineate the gross tumor volume (GTV) using non-contrast planning computed tomography to ensure accurate radiation dose delivery. However, the low contrast between tumors and adjacent normal tissues necessitates that radiation oncologists manually delineate the tumors, often relying on diagnostic MRI for guidance. % In this study, we propose a novel approach to directly segment NPC gross tumors on non-contrast planning CT images, circumventing potential registration errors when aligning MRI or MRI-derived tumor masks to planning CT. To address the low contrast issues between tumors and adjacent normal structures in planning CT, we introduce a 3D Semantic Asymmetry Tumor segmentation (SATs) method. Specifically, we posit that a healthy nasopharyngeal region is characteristically bilaterally symmetric, whereas the emergence of nasopharyngeal carcinoma disrupts this symmetry. Then, we propose a Siamese contrastive learning segmentation framework that minimizes the voxel-wise distance between original and flipped areas without tumor and encourages a larger distance between original and flipped areas with tumor. Thus, our approach enhances the sensitivity of features to semantic asymmetries. % Extensive experiments demonstrate that the proposed SATs achieves the leading NPC GTV segmentation performance in both internal and external testing, \emph{e.g.}, with at least 2\% absolute Dice score improvement and 12\% average distance error reduction when compared to other state-of-the-art methods in the external testing.

Fakai Wang, Kang Zheng, Le Lu et al.

Osteoporosis is a common chronic metabolic bone disease often under-diagnosed and under-treated due to the limited access to bone mineral density (BMD) examinations, e.g. via Dual-energy X-ray Absorptiometry (DXA). This paper proposes a method to predict BMD from Chest X-ray (CXR), one of the most commonly accessible and low-cost medical imaging examinations. Our method first automatically detects Regions of Interest (ROIs) of local CXR bone structures. Then a multi-ROI deep model with transformer encoder is developed to exploit both local and global information in the chest X-ray image for accurate BMD estimation. Our method is evaluated on 13719 CXR patient cases with ground truth BMD measured by the gold standard DXA. The model predicted BMD has a strong correlation with the ground truth (Pearson correlation coefficient 0.894 on lumbar 1). When applied in osteoporosis screening, it achieves a high classification performance (average AUC of 0.968). As the first effort of using CXR scans to predict the BMD, the proposed algorithm holds strong potential for early osteoporosis screening and public health promotion.

Kang Zheng, Yirui Wang, Chen-I Hsieh et al.

Knee osteoarthritis (OA) is a common degenerate joint disorder that affects a large population of elderly people worldwide. Accurate radiographic assessment of knee OA severity plays a critical role in chronic patient management. Current clinically-adopted knee OA grading systems are observer subjective and suffer from inter-rater disagreements. In this work, we propose a computer-aided diagnosis approach to provide more accurate and consistent assessments of both composite and fine-grained OA grades simultaneously. A novel semi-supervised learning method is presented to exploit the underlying coherence in the composite and fine-grained OA grades by learning from unlabeled data. By representing the grade coherence using the log-probability of a pre-trained Gaussian Mixture Model, we formulate an incoherence loss to incorporate unlabeled data in training. The proposed method also describes a keypoint-based pooling network, where deep image features are pooled from the disease-targeted keypoints (extracted along the knee joint) to provide more aligned and pathologically informative feature representations, for accurate OA grade assessments. The proposed method is comprehensively evaluated on the public Osteoarthritis Initiative (OAI) data, a multi-center ten-year observational study on 4,796 subjects. Experimental results demonstrate that our method leads to significant improvements over previous strong whole image-based deep classification network baselines (like ResNet-50).

Dazhou Guo, Jia Ge, Xianghua Ye et al.

Accurate organ at risk (OAR) segmentation is critical to reduce the radiotherapy post-treatment complications. Consensus guidelines recommend a set of more than 40 OARs in the head and neck (H&N) region, however, due to the predictable prohibitive labor-cost of this task, most institutions choose a substantially simplified protocol by delineating a smaller subset of OARs and neglecting the dose distributions associated with other OARs. In this work we propose a novel, automated and highly effective stratified OAR segmentation (SOARS) system using deep learning to precisely delineate a comprehensive set of 42 H&N OARs. SOARS stratifies 42 OARs into anchor, mid-level, and small & hard subcategories, with specifically derived neural network architectures for each category by neural architecture search (NAS) principles. We built SOARS models using 176 training patients in an internal institution and independently evaluated on 1327 external patients across six different institutions. It consistently outperformed other state-of-the-art methods by at least 3-5% in Dice score for each institutional evaluation (up to 36% relative error reduction in other metrics). More importantly, extensive multi-user studies evidently demonstrated that 98% of the SOARS predictions need only very minor or no revisions for direct clinical acceptance (saving 90% radiation oncologists workload), and their segmentation and dosimetric accuracy are within or smaller than the inter-user variation. These findings confirmed the strong clinical applicability of SOARS for the OAR delineation process in H&N cancer radiotherapy workflows, with improved efficiency, comprehensiveness, and quality.

Peng Wang, Yuhsuan Wu, Bolin Lai et al.

Objectives: to propose a fully-automatic computer-aided diagnosis (CAD) solution for liver lesion characterization, with uncertainty estimation. Methods: we enrolled 400 patients who had either liver resection or a biopsy and was diagnosed with either hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, or secondary metastasis, from 2006 to 2019. Each patient was scanned with T1WI, T2WI, T1WI venous phase (T2WI-V), T1WI arterial phase (T1WI-A), and DWI MRI sequences. We propose a fully-automatic deep CAD pipeline that localizes lesions from 3D MRI studies using key-slice parsing and provides a confidence measure for its diagnoses. We evaluate using five-fold cross validation and compare performance against three radiologists, including a senior hepatology radiologist, a junior hepatology radiologist and an abdominal radiologist. Results: the proposed CAD solution achieves a mean F1 score of 0.62, outperforming the abdominal radiologist (0.47), matching the junior hepatology radiologist (0.61), and underperforming the senior hepatology radiologist (0.68). The CAD system can informatively assess its diagnostic confidence, i.e., when only evaluating on the 70% most confident cases the mean f1 score and sensitivity at 80% specificity for HCC vs. others are boosted from 0.62 to 0.71 and 0.84 to 0.92, respectively. Conclusion: the proposed fully-automatic CAD solution can provide good diagnostic performance with informative confidence assessments in finding and discriminating liver lesions from MRI studies.

Bowen Li, Dar-In Tai, Ke Yan et al.

Background & Aims: Hepatic steatosis is a major cause of chronic liver disease. 2D ultrasound is the most widely used non-invasive tool for screening and monitoring, but associated diagnoses are highly subjective. We developed a scalable deep learning (DL) algorithm for quantitative scoring of liver steatosis from 2D ultrasound images. Approach & Results: Using retrospectively collected multi-view ultrasound data from 3,310 patients, 19,513 studies, and 228,075 images, we trained a DL algorithm to diagnose steatosis stages (healthy, mild, moderate, or severe) from ultrasound diagnoses. Performance was validated on two multi-scanner unblinded and blinded (initially to DL developer) histology-proven cohorts (147 and 112 patients) with histopathology fatty cell percentage diagnoses, and a subset with FibroScan diagnoses. We also quantified reliability across scanners and viewpoints. Results were evaluated using Bland-Altman and receiver operating characteristic (ROC) analysis. The DL algorithm demonstrates repeatable measurements with a moderate number of images (3 for each viewpoint) and high agreement across 3 premium ultrasound scanners. High diagnostic performance was observed across all viewpoints: area under the curves of the ROC to classify >=mild, >=moderate, =severe steatosis grades were 0.85, 0.90, and 0.93, respectively. The DL algorithm outperformed or performed at least comparably to FibroScan with statistically significant improvements for all levels on the unblinded histology-proven cohort, and for =severe steatosis on the blinded histology-proven cohort. Conclusions: The DL algorithm provides a reliable quantitative steatosis assessment across view and scanners on two multi-scanner cohorts. Diagnostic performance was high with comparable or better performance than FibroScan.

Xianghua Ye, Dazhou Guo, Chen-kan Tseng et al.

Background: The current clinical workflow for esophageal gross tumor volume (GTV) contouring relies on manual delineation of high labor-costs and interuser variability. Purpose: To validate the clinical applicability of a deep learning (DL) multi-modality esophageal GTV contouring model, developed at 1 institution whereas tested at multiple ones. Methods and Materials: We collected 606 esophageal cancer patients from four institutions. 252 institution-1 patients had a treatment planning-CT (pCT) and a pair of diagnostic FDG-PETCT; 354 patients from other 3 institutions had only pCT. A two-streamed DL model for GTV segmentation was developed using pCT and PETCT scans of a 148 patient institution-1 subset. This built model had the flexibility of segmenting GTVs via only pCT or pCT+PETCT combined. For independent evaluation, the rest 104 institution-1 patients behaved as unseen internal testing, and 354 institutions 2-4 patients were used for external testing. We evaluated manual revision degrees by human experts to assess the contour-editing effort. The performance of the deep model was compared against 4 radiation oncologists in a multiuser study with 20 random external patients. Contouring accuracy and time were recorded for the pre-and post-DL assisted delineation process. Results: Our model achieved high segmentation accuracy in internal testing (mean Dice score: 0.81 using pCT and 0.83 using pCT+PET) and generalized well to external evaluation (mean DSC: 0.80). Expert assessment showed that the predicted contours of 88% patients need only minor or no revision. In multi-user evaluation, with the assistance of a deep model, inter-observer variation and required contouring time were reduced by 37.6% and 48.0%, respectively. Conclusions: Deep learning predicted GTV contours were in close agreement with the ground truth and could be adopted clinically with mostly minor or no changes.

Fengze Liu, Ke Yan, Adam Harrison et al.

In this work, we introduce a fast and accurate method for unsupervised 3D medical image registration. This work is built on top of a recent algorithm SAM, which is capable of computing dense anatomical/semantic correspondences between two images at the pixel level. Our method is named SAME, which breaks down image registration into three steps: affine transformation, coarse deformation, and deep deformable registration. Using SAM embeddings, we enhance these steps by finding more coherent correspondences, and providing features and a loss function with better semantic guidance. We collect a multi-phase chest computed tomography dataset with 35 annotated organs for each patient and conduct inter-subject registration for quantitative evaluation. Results show that SAME outperforms widely-used traditional registration techniques (Elastix FFD, ANTs SyN) and learning based VoxelMorph method by at least 4.7% and 2.7% in Dice scores for two separate tasks of within-contrast-phase and across-contrast-phase registration, respectively. SAME achieves the comparable performance to the best traditional registration method, DEEDS (from our evaluation), while being orders of magnitude faster (from 45 seconds to 1.2 seconds).