Investigating and Improving Latent Density Segmentation Models for Aleatoric Uncertainty Quantification in Medical Imaging

Medical image segmentation supports clinical workflows by precisely delineating anatomical structures and lesions. However, medical image datasets medical image datasets suffer from acquisition noise and annotation ambiguity, causing pervasive data uncertainty that substantially undermines model robustness. Existing research focuses primarily on model architectural improvements and predictive reliability estimation, while systematic exploration of the intrinsic data uncertainty remains insufficient. To address this gap, this work proposes leveraging the universal representation capabilities of visual foundation models to estimate inherent data uncertainty. Specifically, we analyze the feature diversity of the model's decoded representations and quantify their singular value energy to define the semantic perception scale for each class, thereby measuring sample difficulty and aleatoric uncertainty. Based on this foundation, we design two uncertainty-driven application strategies: (1) the aleatoric uncertainty-aware data filtering mechanism to eliminate potentially noisy samples and enhance model learning quality; (2) the dynamic uncertainty-aware optimization strategy that adaptively adjusts class-specific loss weights during training based on the semantic perception scale, combined with a label denoising mechanism to improve training stability. Experimental results on five public datasets encompassing CT and MRI modalities and involving multi-organ and tumor segmentation tasks demonstrate that our method achieves significant and robust performance improvements across various mainstream network architectures, revealing the broad application potential of aleatoric uncertainty in medical image understanding and segmentation tasks.

Ambiguous Medical Image Segmentation (AMIS) is significant to address the challenges of inherent uncertainties from image ambiguities, noise, and subjective annotations. Existing conditional variational autoencoder (cVAE)-based methods effectively capture uncertainty but face limitations including redundancy in high-dimensional latent spaces and limited expressiveness of single posterior networks. To overcome these issues, we introduce a novel PCA-Enhanced Probabilistic U-Net (PEP U-Net). Our method effectively incorporates Principal Component Analysis (PCA) for dimensionality reduction in the posterior network to mitigate redundancy and improve computational efficiency. Additionally, we further employ an inverse PCA operation to reconstruct critical information, enhancing the latent space's representational capacity. Compared to conventional generative models, our method preserves the ability to generate diverse segmentation hypotheses while achieving a superior balance between segmentation accuracy and predictive variability, thereby advancing the performance of generative modeling in medical image segmentation.

Reliable uncertainty estimation is critical for medical image segmentation, where automated contours feed downstream quantification and clinical decision support. Many strong uncertainty methods require repeated inference, while efficient single-forward-pass alternatives often provide weaker failure ranking or rely on restrictive feature-space assumptions. We present $\textbf{SegWithU}$, a post-hoc framework that augments a frozen pretrained segmentation backbone with a lightweight uncertainty head. SegWithU taps intermediate backbone features and models uncertainty as perturbation energy in a compact probe space using rank-1 posterior probes. It produces two voxel-wise uncertainty maps: a calibration-oriented map for probability tempering and a ranking-oriented map for error detection and selective prediction. Across ACDC, BraTS2024, and LiTS, SegWithU is the strongest and most consistent single-forward-pass baseline, achieving AUROC/AURC of $0.9838/2.4885$, $0.9946/0.2660$, and $0.9925/0.8193$, respectively, while preserving segmentation quality. These results suggest that perturbation-based uncertainty modeling is an effective and practical route to reliability-aware medical segmentation. Source code is available at https://github.com/ProjectNeura/SegWithU.