Prototype Memory-Guided Training-Free Anomaly Classification and Localization in Prenatal Ultrasound

Life-limiting congenital anomalies require accurate prenatal diagnosis for appropriate clinical decision-making. Prenatal ultrasound (US) examinations involve multiple anatomical planes, and diagnosis depends on identifying anatomical planes and selecting diagnostically relevant planes for each anomaly. Existing automated methods either rely on plane-level annotations or aggregate heterogeneous images without explicitly modeling these diagnostic capabilities. We propose AnomExpert, a prototype-driven framework for prenatal US anomaly diagnosis using only case-level supervision. AnomExpert introduces learnable plane prototypes to organize unordered images into latent representations corresponding to anatomical planes without requiring plane annotations. A disease-aware sparse selection mechanism further selects diagnostically relevant planes for each anomaly. Experiments on a multi-center dataset of 3,654 cases show that AnomExpert consistently outperforms nine representative multi-instance learning methods. Using a ViT-small backbone, it achieves 86.9% accuracy and 84.2% F1-score while maintaining parameter efficiency. These findings indicate that modeling anatomical plane identification and disease-specific plane selection improves weakly supervised multi-plane prenatal US anomaly classification. The code is available at https://github.com/TIanCat/AnomExpert.

A large number of infants with congenital anomalies are born each year globally, especially in areas with underdeveloped medical resources. Currently, fetal ultrasound screening is the most common modality for early pregnancy anatomy detection. This modality can detect anomalies earlier and provide opportune treatment advice. However, the lack of an ultrasound dataset on early fetal gestation has slowed down the development of automated assisted diagnosis. In this work, we present a benchmark dataset for Fetal Ultrasound Screening in Early Pregnancy to facilitate intelligent ultrasound examination and assisted diagnosis called FUSEP. Our dataset consists of two ultrasound views recommended by the international guideline, i.e., Crown-rump Length (CRL) and Nuchal Translucency (NT) views in three hospitals, totaling 4,017 ultrasound images, with 45,820 box-level expert-level annotations. Our dataset and baseline present the following three contributions: 1) Our medical experts annotated a total of 14 key anatomical structures in two views using a box-level format; 2) Our data is collected extensively from different sonographers, devices, scanning angles, hospitals, etc; 3) We report the performance of the semi-supervised learning, fully supervised learning, unsupervised domain adaptation (UDA), and source-free UDA in ultrasound images multi-object detection. To the best of our knowledge, this is the first publicly available dataset and benchmark for fetal early pregnancy ultrasound screening. We believe that FUSEP and benchmark can contribute to the medical community in the development of multiple tasks such as standard plane recognition, quality control on ultrasound images, automated assisted diagnostics in early fetal pregnancy, medical multi-object detection, domain adaptation for object detection, etc.

Intelligent fetal ultrasound (US) interpretation is crucial for prenatal diagnosis, but high annotation costs and operator-induced variance make unsupervised pre-training a highly promising paradigm. However, existing pre-training methods largely ignore US-specific characteristics -- severe data redundancy, fan-shaped locality, and polar coordinate beamforming -- limiting their effectiveness in downstream tasks. To address this, we propose PolarMAE, a novel and efficient pre-training framework tailored for US images. Specifically, to mitigate continuous scanning redundancy, we introduce a Progressive Visual-Semantic Screening (PVSS) that adaptively extracts high-value samples, significantly boosting pre-training efficiency. Furthermore, we design an Acoustic-Bounded Region Constraint (ABRC) to accommodate US locality, forcing the model to focus strictly on valid acoustic regions rather than invalid dark backgrounds. Finally, leveraging the beamforming prior and local details, we propose a Polar-Texture Collaborative Masking (PTCM), enabling the model to capture underlying radial imaging patterns and critical tissue structures. Extensive experiments across diverse datasets and downstream interpretation tasks demonstrate that our method achieves state-of-the-art performance with strong pre-training scalability and efficiency.