A Unified 2D Framework for DeepLesion Detection, Segmentation and Short Report Generation
Authors: Ruida Cheng, Tejas S. Mathai, Benjamin Hou, Qingqing Zhu, Zhiyong Lu, Matthew McAuliffe, Ronald M. Summers
Abstract
In previous work, we integrated large language models (LLMs) into the lesion segmentation model based on the ULS23 DeepLesion dataset, using short-form findings from the reports. In this study, we developed a unified 2D lesion analysis framework that integrates LLM-based reasoning, lesion bounding box detection, segmentation, and radiology report generation from the original DeepLesion dataset. In the testing phase, we achieved relatively high lesion bounding box detection accuracy with mAP50 of 70.1%, mAP50-95 of 46.4%; Lesion segmentation performance with a Dice score of 62.6%; short report generation accuracy with BLEU_1 score of 64.3%, BLEU_4 score of 49.6%, METEOR of 34.7%, and ROUGE_L of 60.1%. In this work, we address the challenging issue of segmentation in the original DeepLesion dataset and achieve a 28.5% Dice score improvement over the nnUNet lesion segmentation model. We also integrated spatial and anatomical context into the DeepLesion short report generation. We released the implementation, dataset, and models on Github. https://github.com/ruida/2D_DeepLesion_Foundation
Medical image segmentation is more clinically valuable when it supports diagnosis rather than merely producing lesion masks. However, diagnostically relevant lesion cues are often subtle and localized, while existing models may be distracted by background tissues, acoustic artifacts, and irrelevant visual correlations. To address this problem, we propose Rad-VLSM, a two-stage cross-modal framework for semantics-assisted lesion focusing, robust segmentation, and visually grounded diagnosis. In the first stage, a BLIP-2-based vision-language alignment module identifies lesion-related candidate regions under semantic guidance and converts them into box prompts. In the second stage, these prompts are fed into a SAM-based multitask network, where a multi-candidate region aggregation strategy improves prompt stability and guides lesion segmentation. The predicted masks are then used as spatial priors for diagnosis, and a visual-radiomics fusion head integrates lesion-aware visual features with selected radiomics descriptors. By using semantic information for localization rather than direct prediction, Rad-VLSM reduces text-to-diagnosis dependence and grounds diagnosis in lesion-level evidence. Experiments on a private clinical breast ultrasound dataset and public benchmarks show that Rad-VLSM achieves strong segmentation and diagnostic performance with favorable generalization.
Accurate lesion segmentation in PET/CT is critical for oncology, yet remains challenging because physiologic tracer uptake and artifacts can mimic malignant signal. We present RADIANT-PET, a reasoning-augmented framework that couples a high-sensitivity voxel-level segmentation model with lesion-level large language model (LLM) adjudication. Candidate uptake regions are generated with a deliberately permissive segmentation stage, then converted into structured textual descriptions that summarize uptake intensity, morphology, and regional and global anatomical context. An LLM classifies each candidate as true lesion vs. false positive, optionally leveraging the radiology report as additional clinical context. To strengthen lesion-level reasoning, we further optimize a local LLM via reinforcement learning using Group Relative Policy Optimization, rewarding correct lesion classification and anatomically concordant site assignment. Across AutoPET and an OSU test cohort, RADIANT-PET consistently outperforms strong image-only baselines, with the largest improvements observed when radiology reports are provided. Overall, these results demonstrate that LLM-based lesion-level reasoning adds a novel reasoning layer beyond conventional segmentation, suppressing physiologic false positives and aligning voxel-level predictions with clinical interpretation. The project repository is available at: https://github.com/jwang-580/RADIANT-PET.
Recent segmentation models have demonstrated promising efficiency by aggressively reducing parameter counts and computational complexity. However, these models often struggle to accurately delineate fine lesion boundaries and texture patterns essential for early skin cancer diagnosis and treatment planning. In this paper, we propose MambaLiteUNet, a compact yet robust segmentation framework that integrates Mamba state space modeling into a U-Net architecture, along with three key modules: Adaptive Multi-Branch Mamba Feature Fusion (AMF), Local-Global Feature Mixing (LGFM), and Cross-Gated Attention (CGA). These modules are designed to enhance local-global feature interaction, preserve spatial details, and improve the quality of skip connections. MambaLiteUNet achieves an average IoU of 87.12% and average Dice score of 93.09% across ISIC2017, ISIC2018, HAM10000, and PH2 benchmarks, outperforming state-of-the-art models. Compared to U-Net, our model improves average IoU and Dice by 7.72 and 4.61 points, respectively, while reducing parameters by 93.6% and GFLOPs by 97.6%. Additionally, in domain generalization with six unseen lesion categories, MambaLiteUNet achieves 77.61% IoU and 87.23% Dice, performing best among all evaluated models. Our extensive experiments demonstrate that MambaLiteUNet achieves a strong balance between accuracy and efficiency, making it a competitive and practical solution for dermatological image segmentation. Our code is publicly available at: https://github.com/maklachur/MambaLiteUNet.