LASSNet: Level-Aware Availability-Conditioned Spatial-Semantic Fusion for Brain Tumor Segmentation with Missing MRI Modalities

Existing brain tumor segmentation methods usually utilize multiple Magnetic Resonance Imaging (MRI) modalities in brain tumor images for segmentation, which can achieve better segmentation performance. However, in clinical applications, some modalities are often missing due to resource constraints, resulting in significant performance degradation for methods that rely on complete modality segmentation. In this paper, we propose a Multimodal feature distillation with Mamba-Transformer hybrid network (MMTSeg) for accurate brain tumor segmentation with missing modalities. We first employ a Multimodal Feature Distillation (MFD) module to distill feature-level multimodal knowledge into different unimodalities to extract complete modality information. We further develop an Unimodal Feature Enhancement (UFE) module to model the semantic relationship between global and local information. Finally, we built a Cross-Modal Fusion (CMF) module to explicitly align the global correlations across modalities, even when some modalities are missing. Complementary features within and across modalities are refined by the Mamba-Transformer hybrid architectures in both the UFE and CMF modules, dynamically capturing long-range dependencies and global semantic information for complex spatial contexts. A boundary-wise loss function is employed as the segmentation loss of the proposed MMTSeg to minimize boundary discrepancies for a distance-based metric. Our ablation study demonstrates the importance of the proposed feature enhancement and fusion modules in the proposed network and the Transformer with Mamba block for improving the performance of brain tumor segmentation with missing modalities. Extensive experiments on the BraTS 2018 and BraTS 2020 datasets demonstrate that the proposed MMTSeg framework outperforms state-of-the-art methods when modalities are missing.

Multimodal MRI offers complementary information for brain tumor segmentation, but clinical scans often lack one or more modalities, which degrades segmentation performance. In this paper, we propose UniME (Uni-Encoder Meets Multi-Encoders), a two-stage heterogeneous method for brain tumor segmentation with missing modalities that reconciles the trade-offs among fine-grained structure capture, cross-modal complementarity modeling, and exploitation of available modalities. The idea is to decouple representation learning from segmentation via a two-stage heterogeneous architecture. Stage 1 pretrains a single ViT Uni-Encoder with masked image modeling to establish a unified representation robust to missing modalities. Stage 2 adds modality-specific CNN Multi-Encoders to extract high-resolution, multi-scale, fine-grained features. We fuse these features with the global representation to produce precise segmentations. Experiments on BraTS 2023 and BraTS 2024 show that UniME outperforms previous methods under incomplete multi-modal scenarios. The code is available at https://github.com/Hooorace-S/UniME

Accurate brain tumor segmentation using multi-parametric MRI is critical for effective treatment planning. However, in clinical settings, complete acquisition of all MRI sequences is not always possible. The absence of certain MRI modalities results in substantial performance degradation in existing segmentation methods, which typically rely on naive feature concatenation or direct fusion strategies. To address this limitation, we propose a novel segmentation model D3Seg which is designed to maintain stable performance under missing-modality settings. D3Seg introduces Multi-hop Modality Graph Fusion (MMGF) to model higher-order inter-modality dependencies, a lightweight diffusion-based imputation mechanism to compensate for missing T1ce and FLAIR feature representations in latent space, and probability-space decision refinement to mitigate dominant-class overconfidence and improve delineation of underrepresented tumor subregions. We evaluate the proposed D3Seg model on BraTS 2023 Glioma as the primary benchmark and further test it on a subset of the external BraTS 2023 Meningioma cohort to assess generalization across tumor pathologies. The results are compared with the state-of-the-art models under different missing-modality conditions. The proposed model achieves approximately 1.5-2.0% Dice improvement on enhancing tumor (ET) and around 1.0% on tumor core (TC) across multiple missing-modality configurations compared to the current state-of-the-art model on BraTS Glioma dataset. Cross-cohort evaluation on BraTS Meningioma dataset demonstrates the generalizability of the proposed model, showing consistent improvements in the challenging TC and ET regions, with approximately 1.5-3.0% and 1.5-6.5% gains respectively across several missing-modality configurations.