LISynSeg: Data-Centric Label-to-Image Synthesis for Cross-Modality Whole-Heart Segmentation

Purpose: Developing generalizable medical image segmentation models is challenging because imaging data are distributed across institutions and differ in modality and acquisition protocol. Federated learning (FL) enables collaborative training without centralizing raw medical images, but cross-modality domain shifts between computed tomography (CT) and magnetic resonance imaging (MRI) can substantially reduce model performance. This study investigates augmentation-driven cross-modality FL for abdominal organ and whole-heart segmentation. Methods: We evaluate convolution-based spatial augmentation, frequency-domain argumentation, domain-specific normalization, and global intensity nonlinear (GIN) augmentation for multimodal segmentation. Abdominal organ segmentation and whole-heart segmentation are first evaluated using a 2D U-Net framework. For whole-heart segmentation, we additionally perform native 3D experiments using a self-configuring nnU-Net architecture on the CARE-WHS 2026 dataset, enabling evaluation of whether the observed cross-modality FL behavior persists when moving from slice-based 2D segmentation to volumetric 3D segmentation. Results: GIN provides the most consistent cross-modality performance among the evaluated approaches in the original 2D experiments. For pancreas segmentation, the Dice similarity coefficient (DSC) improved from 0.073 to 0.437 when CT data were incorporated through federated cross-modality training. In 3D whole-heart segmentation, FedGIN improved mean DSC over FedAvg from 0.8696 to 0.8901 on the unseen CT center and from 0.7160 to 0.7956 on the unseen MRI center. Relative to centralized GIN training, FedGIN retained 92.4% of performance on unseen CT data and achieved comparable performance on unseen MRI data (0.7956 versus 0.7937).

Comprehensive quantification of cardiac structures from computed tomography (CT) remains limited not by data availability but by the scalability of measurements, which makes routine use impractical. Here we present a unified framework for comprehensive cardiac CT segmentation and phenotyping that combines a human-in-the-loop annotation pipeline, a cardiac CT augmentation technique, and a self-supervised foundation model pre-trained on 60,000 unlabeled cardiac CT scans. Using this approach, we assembled the largest and most comprehensive expert-annotated cardiac CT segmentation dataset to date, comprising 1598 cases and 14 distinct cardiac structures (1000 for training, 598 for the external test set). Across five external datasets, the framework segmented all structures more accurately and comprehensively than existing open-source tools. Self-supervised pre-training improved labeling efficiency, with the most significant gains observed during external evaluation in the low-data regime. Benchmarking across convolutional, transformer, and state-space architectures showed comparable performance, indicating that data quality and pre-training, rather than architecture, drove accuracy. The framework was scaled to population-level phenotyping, with segmented anatomy that carries functionally relevant information about ventricular function and disease severity beyond demographic variables. By openly releasing the largest dataset with human labels, code, model weights, a CT augmentation library, and software, this work provides a reproducible foundation for opportunistic cardiac phenotyping from routinely acquired CT scans.

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.