Medical image analysis depends on accurate segmentation and controllable synthesis, but both tasks face severe spatial imbalance: lesions occupy small regions against large backgrounds. We study adaptive spatial weighting as a task-level design principle and instantiate it in two adapters. LAW learns per-pixel loss weights for mask-conditioned diffusion by modulating a ratio prior with a feature-dependent delta map, with normalization, clamping, and Dice regularization for stability. ORDER improves lightweight segmentation by adding selective bidirectional skip attention with stage-wise confidence gating. On held-out diffusion test sets, LAW lowers FID from 158.13±0.15 to 108.43±0.71 on Polyps, from 144.13±0.31 to 89.51±0.96 on KiTS19, and from 139.22±0.38 to 112.58±0.68 on BRISC, while improving held-out mask-recovery Dice from 0.681±0.013 to 0.825±0.003 on Polyps. When the resulting images are added to nnUNet training, downstream Polyps mDice rises from 71.7±0.4 to 74.1±0.8. On the cleaned Polyps segmentation protocol, the reported ORDER configuration reaches 76.3±1.9 mDice and 67.2±2.0 mIoU at 42K parameters and 0.11 GFLOPs, versus 70.3±1.5 mDice and 59.9±1.7 mIoU for matched MK-UNet. On BRISC under the same training recipe, ORDER reaches 77.4±0.8 mDice and 68.1±0.7 mIoU. These results position adaptive spatial weighting as a practical design idea for both medical diffusion and efficient segmentation.
Clinical cardiac imaging pipelines currently deploy separate models for each dataset and modality, incurring redundant training costs and precluding knowledge sharing across anatomically related tasks. Consolidating semi-supervised learning, unsupervised domain adaptation, and domain generalisation into one model is therefore a practical necessity, yet naive joint training exposes a fundamental barrier: conflicting label semantics between datasets collapse LA Dice from 90.31% to 83.38%, while gradient imbalance across tasks of unequal complexity suppresses the weaker tasks throughout training. We present UniT-Diff, a unified diffusion segmentation framework that resolves these conflicts through three targeted mechanisms. An 11-channel task-specific output space physically partitions label categories, eliminating cross-task gradient sign reversal by construction. SNR-Adaptive Task Conditioning (SATC) scales the task token by the log signal-to-noise ratio of the current diffusion timestep, suppressing domain-specific bias during coarse denoising and restoring full task guidance as the signal clears. Task-Type-Aware Conditional Dropout (TTACD) permanently removes the task token for domain-generalisation inputs, routing them through a shared neutral pathway that draws on cross-dataset cardiac anatomy rather than source-vendor statistics. Under a single parameter set, UniT-Diff surpasses independently trained task-specific baselines on all three benchmarks simultaneously: +0.87% on LA, +1.77% on MMWHS, and +0.88% on MNMS.
We address adaptive computation in 3D medical image segmentation: instead of designing another backbone, we ask how much spectral mixing each network stage needs and let optimization answer. We derive FHEAT, a two-parameter operator family, from the discrete cosine transform (DCT) solution of a fractional heat equation. A fractional order alpha and a diffusion strength D govern the operator, and at D=0 it is exactly the identity. Reparametrized by the semigroup time tau = D*alpha, same-resolution instances compose exactly, so any distribution of diffusion across same-resolution stages amounts to a single Sobolev-type regularizer of learned strength. This identity limit lets the optimizer of each layer, not the designer, decide whether global mixing is needed and how sharp it should be. We instantiate FHEAT in a lightweight U-shaped architecture (Light-UNETR) paired with a Kolmogorov-Arnold mixer (KAN3D) with adaptive rational activations, yielding FHEAT-Seg. At 5% to 20% label rates on three public benchmarks, training produces gradient-driven spectral sparsification: seven of the eight stage-level operators drive D to zero, and the survivor saturates at the sharpest low-pass (alpha ~ 0.9) in the decoder layer feeding the semi-supervised attention map. The retired layers become exact identity shortcuts at inference, cutting FLOPs from 4.29G to 0.90G (a 79% drop) at 0.975M parameters. Under a standard semi-supervised protocol, FHEAT-Seg reaches Dice scores of 90.47% (left atrium), 78.79% (Pancreas-CT), and 81.90% (BraTS 2019), ahead of five semi-supervised methods and the Light-UNETR baseline. The large variant also surpasses Light-UNETR-L under full supervision (Dice 93.09%, 85.11%, and 87.19%) with 2.851M parameters and 55.75G FLOPs. These results suggest that the allocation of spectral computation is a learnable property of optimization dynamics, not a manual design commitment.
Large networks and ensembles often lead medical image segmentation challenges, but their storage and inference demands complicate deployment. We present LightMedSeg-ISLES, a 1.26-million-parameter pipeline for T1-weighted stroke lesion segmentation in ISLES'26. On a 146-case held-out cohort, flip test-time augmentation produces 0.618 mean Dice and 0.599 lesion-wise F1. A 102.35-million-parameter nnU-Net ResEnc-L produces 0.634 Dice and 0.544 lesion-wise F1 after size filtering. LightMedSeg therefore retains 97.5% of nnU-Net's Dice with 81.4× fewer parameters while improving lesion-wise F1 by 0.055. Its four-pass TTA operating point requires 4.7× fewer FLOPs per standardized patch than nnU-Net. It also slightly exceeds filtered UNETR++ and nnFormer. Longer training and stronger augmentation add 0.0358 Dice without increasing capacity, establishing a strong single-checkpoint alternative to much larger models.