PolarMAE: Efficient Fetal Ultrasound Pre-training via Semantic Screening and Polar-Guided Masking

Maternal-fetal US is the primary imaging modality for monitoring fetal development, yet accurate automated segmentation remains challenging due to the scarcity of pixel-level annotations. To address this issue, we propose DACL, a semi-supervised framework for robust fetal US image segmentation. DACL jointly trains a deployment-oriented lightweight convolutional network (1.47\thinsp\mathrm{M} parameters) and a Transformer-based network, leveraging labeled data for supervised learning and unlabeled data via CPS. To enhance prediction stability, we introduce a dual-agreement consistency loss that couples pixel-wise probabilistic divergence with entropy-guided confidence alignment. Unlike conventional CPS methods that enforce agreement only at the prediction level, DACL explicitly regularizes both distributional alignment and uncertainty, thereby suppressing unreliable pseudo-labels and enabling stable cross-architecture pseudo-label learning under extreme annotation scarcity. Furthermore, an interpolation-based consistency strategy using mixup is applied to unlabeled samples to enhance robustness. Under 5% labeled data, DACL improves Dice by up to 2.77% and reduces HD95 by up to 14.69 mm compared with the strongest recent semi-supervised methods, demonstrating significant improvements in boundary accuracy on both fetal head and abdomen datasets. These results demonstrate the effectiveness of agreement-based consistency learning for annotation-efficient fetal US segmentation. Our code is on GitHub.

Ultrasound is widely used in obstetric care due to its safety, accessibility, and real-time imaging. However, interpretation remains operator-dependent and susceptible to noise and artifacts. Deep learning models have shown strong performance to solve these problem, but they typically require large annotated datasets that are difficult to obtain in clinical ultrasound. Foundation models (FMs) offer an alternative, using a large number of ultrasound images to learn transferable representations that can generalize with limited labeled data. This work presents a comprehensive benchmark of ultrasound-specific FMs for fetal plane classification. We evaluated four ultrasound FMs (USFM, MOFO, UltraSAM, FetalCLIP) against two CNN baselines (ResNet50, EfficientNet-V2) and a ViT (DINOv3) pretrained on natural images. We trained all models under two complementary settings: full fine-tuning and linear probing with a frozen encoder. All models were trained using 5-fold patient-level cross-validation on a Spanish fetal ultrasound dataset and tested on both in-domain data and an external African cohort to assess cross-population generalization. We found that FetalCLIP achieved the best results in the linear probing setting (F1 = 0.9261 for in-domain, F1 = 0.9731 for out-of-domain), while USFM performed best in the full fine-tuning setting (F1 = 0.9476 for in-domain, F1 = 0.9515 for out-of-domain). MOFO and UltraSAM degraded most in both settings, underperforming natural image pretrained models in some cases. These findings highlight how the choice of pretrained model strongly affects fetal plane classification performance, since different pretraining objectives lead to different levels of transferability.

Prenatal anomaly classification and localization is of critical importance for fetal health and pregnancy management. Although ultrasound (US) is the primary modality for prenatal screening, accurate diagnosis remains challenging due to the low prevalence and high heterogeneity of anomalies. Existing deep learning methods for prenatal tasks rely on large-scale annotated datasets, which are difficult to obtain in practice. Although few-shot learning alleviates data scarcity, it typically requires fine-tuning for new categories, limiting its practicality in resource-limited clinical settings. To address these challenges, we propose a training-free framework for multi-class prenatal US anomaly classification and localization that operates with only a few reference images per class, representing the first exploration of this setting. Our framework comprises three key components: (1) a memory bank with multi-granular prototypes that explicitly models both class-level semantics and anomaly characteristics; (2) a prototype-driven soft merging mechanism that aggregates discriminative features to detect the anomaly region; and (3) a class-aware refinement strategy that leverages prototype consistency to improve category prediction. Extensively validated on a multi-center prenatal US dataset containing 1,149 cases, with a total of 2,357 images and 9 categories, our proposed method outperforms the competitors.