3D Medical Image Segmentation

Reliable liver segmentation in contrast-enhanced MRI is essential for quantitative hepatic assessment, treatment planning, and longitudinal disease monitoring. However, limited annotated data and scanner- or vendor-dependent intensity variations can cause overfitting and poor generalization to unseen acquisition domains. Moreover, simultaneously achieving robust global localization and precise boundary delineation remains challenging, while predictions may contain isolated false-positive regions outside the main liver component. To address these challenges, we propose CIRSeg, a coarse-to-fine, intensity-robust liver segmentation framework based on nnU-Netv2. CIRSeg combines 3D CutMix with stochastic intensity transfer using either Nyul augmentation or histogram matching to improve robustness to heterogeneous MRI intensities. Its cascaded architecture decouples low-resolution anatomical localization from full-resolution boundary refinement. At inference, source-free test-time adaptation based on confidence-filtered predictions and probability-prior regularization further improves robustness to out-of-distribution inputs. As a final deterministic post-processing step, largest connected component filtering removes isolated false-positive regions. On the CARE 2026 test set, CIRSeg achieves Dice scores of 97.13% and 97.93% on the in-domain and unseen-domain subsets, with corresponding HD95 values of 20.18 mm and 11.30 mm, respectively. These results demonstrate consistently accurate segmentation across both in-domain and unseen acquisition settings. The code is available at https://github.com/jingkunchen/MICCAI_CARE_2026

Reliable volumetric segmentation is critical for clinical diagnostics, yet foundation models such as MedSAM remain deterministic and lack calibrated uncertainty under distribution shift. Existing conformal prediction methods offer statistical guarantees but are frequently applied in 2D and assume symmetric error distributions, so they do not capture the class-specific biases that arise in 3D multi-class segmentation. We propose Class-Aware Asymmetric Weighted Conformal Prediction (CA-WCP), which combines latent-space density-ratio weighting for covariate shift with directional quantiles for the lower and upper volume bounds, and scales each bound by a class-specific asymmetry factor derived from validation-set false-positive and false-negative rates. We prove that CA-WCP retains the weighted-exchangeability marginal coverage guarantee for every class, and we evaluate it on 3D brain tumor segmentation (BraTS 2020) and on a synthetic multi-organ CT benchmark constructed under covariate shift. On both benchmarks the 95% Clopper--Pearson interval for the observed coverage of CA-WCP contains the nominal 90% level for every semantic class, while interval width is reduced by 8--14% relative to symmetric weighted conformal prediction. We further encode the calibrated intervals into structured prompts for a multimodal large language model to produce uncertainty-conditioned radiology reports, linking distribution-shift-aware uncertainty quantification to interpretable clinical communication.

Accurate segmentation of axons in 3D microscopy data is important for analyzing white-matter organization, but dense ground truth labels are expensive to obtain. Existing supervised axon segmentation methods rely on target-domain annotations and can be brittle when tissue type, species, modality, or acquisition conditions change. We present AxonSynth, a domain-randomized synthetic-data framework for training 3D axon segmentation models without manually annotated real training volumes. AxonSynth generates dense synthetic axon labels with orientation priors that reflect realistic fiber configurations and renders them with randomized density, contrast, bias fields, blur, and noise. A three-class 3D U-Net is trained to predict background, axon sheath and intra-axonal space. We evaluate zero-shot transfer on 10 held-out light-sheet microscopy (LSM) patches from macaque and human brain samples labeled with one of three axonal markers, comparing against calibrated thresholding and Frangi filtering using overlap, corrected detection, false-positive, and topology metrics. On macaque samples, AxonSynth achieved the best corrected Dice and corrected precision (0.826 and 0.851), compared with 0.765 and 0.754 for thresholding and 0.685 and 0.762 for Frangi. On human samples, corrected Dice was comparable to thresholding (0.857 vs. 0.868), while component-count error decreased from 22,504 to 3,377. Across all held-out patches, AxonSynth reduced component-count error in 10/10 patches and Euler-characteristic error in 8/10. These results show that synthetic-label domain randomization can reduce dependence on manual axon annotation while supporting synthetic-to-real 3D segmentation.

We address adaptive computation in 3D medical image segmentation: instead of designing another backbone, we ask how much spectral mixing each network stage needs and let optimization answer. We derive FHEAT, a two-parameter operator family, from the discrete cosine transform (DCT) solution of a fractional heat equation. A fractional order alpha and a diffusion strength D govern the operator, and at D=0 it is exactly the identity. Reparametrized by the semigroup time tau = D*alpha, same-resolution instances compose exactly, so any distribution of diffusion across same-resolution stages amounts to a single Sobolev-type regularizer of learned strength. This identity limit lets the optimizer of each layer, not the designer, decide whether global mixing is needed and how sharp it should be. We instantiate FHEAT in a lightweight U-shaped architecture (Light-UNETR) paired with a Kolmogorov-Arnold mixer (KAN3D) with adaptive rational activations, yielding FHEAT-Seg. At 5% to 20% label rates on three public benchmarks, training produces gradient-driven spectral sparsification: seven of the eight stage-level operators drive D to zero, and the survivor saturates at the sharpest low-pass (alpha ~ 0.9) in the decoder layer feeding the semi-supervised attention map. The retired layers become exact identity shortcuts at inference, cutting FLOPs from 4.29G to 0.90G (a 79% drop) at 0.975M parameters. Under a standard semi-supervised protocol, FHEAT-Seg reaches Dice scores of 90.47% (left atrium), 78.79% (Pancreas-CT), and 81.90% (BraTS 2019), ahead of five semi-supervised methods and the Light-UNETR baseline. The large variant also surpasses Light-UNETR-L under full supervision (Dice 93.09%, 85.11%, and 87.19%) with 2.851M parameters and 55.75G FLOPs. These results suggest that the allocation of spectral computation is a learnable property of optimization dynamics, not a manual design commitment.

Interactive segmentation of 3D medical images supports quantitative analysis of anatomical structures and disease while allowing users to specify and refine their targets. Despite substantial progress by nnInteractive and VISTA3D, reliable segmentation across diverse clinical targets remains challenging, particularly for complex anatomical structures and the heterogeneous, long-tailed spectrum of pathology. We present SAMI3D-DW V1 (hereafter SAMI3D-DW), an interactive 3D segmentation model trained on Deepwise's large-scale proprietary medical image datasets. We evaluate the model under simulated user interactions on a CT/MR benchmark comprising 4,326 cases from 219 source datasets, spanning 107 anatomical and pathological categories, organized by a medical taxonomy and evaluated with a category-balanced DSC score. SAMI3D-DW achieves the highest category-macro Dice among evaluated methods in both interaction modes. With one point, it scores 0.5756 versus 0.5316 for nnInteractive, the strongest baseline, rising to 0.7771 versus 0.7495 with five points. With bounding-box initialization, the scores are 0.7129 versus 0.6530. After five corrective clicks, SAMI3D-DW reaches 0.8004 versus 0.7868. For radiologists and clinicians, SAMI3D-DW enables segmentation of complex anatomical structures, including intracranial vessel trees on CT and MR angiography, with a few clicks. In a preliminary in-house comparison involving neurofibromatosis type 1 (NF1), SAMI3D-DW-assisted tumor annotation took minutes per case and approximately one-fifteenth of the time required for manual annotation, highlighting its potential to support volumetric treatment-response assessment.

Brain metastases are the most common intracranial malignancy, occurring in roughly 30% of patients with primary solid tumors and carrying a median survival near 5.9 months. Automated segmentation is critical for treatment planning and volumetric monitoring, but metastases are frequently small, numerous, and heterogeneous in size within a single patient. We compare a plain nnU-Net baseline, a Residual Encoder Large (ResEncL) variant, region-based training, and a Primus transformer model for BraTS-METS 2026 Task 1, using patient-grouped cross-validation to prevent leakage from the longitudinal UCSD subset. Primus (label-based) is our strongest individual model by aggregate DSC/NSD, achieving 0.710/0.761 (ET), 0.742/0.785 (TC), 0.683/0.689 (WT), and 0.531/0.436 (RC). ResEncL trails Primus on aggregate DSC/NSD but achieves substantially higher lesion-wise F1 (e.g. ET: 0.452 vs. 0.052); a probability-averaging ensemble of the two only partially preserves ResEncL's F1 advantage (ET lesion-wise F1: 0.064). We further report three postprocessing and label-reconstruction pitfalls we believe generalize beyond this challenge. Code is available at https://github.com/mahdiislam79/BraTS_METS_2026.

Medical image segmentation models typically rely on large amounts of densely annotated volumetric data, limiting their scalability across tasks and imaging modalities. This work addresses the challenge of predicting entire 3D anatomical structures from extreme annotation sparsity. An annotation-efficient student-teacher framework is proposed for automatic 3D medical segmentation that requires only a set of point prompts on a single 2D slice per volume, as input. A foundation model serves as an offline teacher, utilizing the provided point prompts from the selected slice to full-volume pseudo-annotations alongside their corresponding spatial confidence scores prior to student training. To mitigate the error propagation of noisy pseudo-annotations, a task-specific 3D student network is trained using a confidence-aware optimization strategy. By leveraging the teacher's pre-computed confidence scores, this strategy explicitly excludes statically uncertain regions of the pseudo-annotations from the loss calculation, while simultaneously emphasizing regions with higher confidence. Evaluated on 3D cardiac MRI datasets, our framework outperforms state-of-the-art semi-supervised methods, improving segmentation performance by up to 43.6%. Furthermore, it drastically reduces the manual annotation burden to just a few positive point prompts per volume, while improving surface boundary precision by up to 14.7% over the teacher and successfully recovering up to 34.1% of the performance gap toward the fully supervised upper bound.

Automated quality assessment, enhancement, and segmentation of multiple structures in $0.064\,\mathrm{T}$ ultra-low-field pediatric MRI are limited by a low signal-to-noise ratio, weak anatomical boundaries, and frequent artifacts. We present a unified framework for the LISA 2026 Challenge that performs all three tasks together within one inference pipeline. A network with two coupled streams, built on a 3D U-Net, first reconstructs an enhanced uLF volume and then combines the original and enhanced images for subcortical segmentation. To improve boundary stability, we add an auxiliary class covering brain tissue outside the target structures, derived from whole brain masks. A head conditioned on an artifact graph predicts the seven artifact ratings from reconstruction residuals and frozen segmentation features. We address the scarcity of dense annotations using diffeomorphic registration from atlas to target for label propagation and to regularize anatomical reconstruction. We report validation results across all three tasks.

Medical image segmentation supports quantitative clinical analysis and computer-aided diagnosis. Recent methods for medical image segmentation have improved both local feature representation and volumetric context modeling. However, existing methods still strug- gle to efficiently model cross-slice relations in anisotropic volumet- ric images, limiting segmentation consistency and accuracy. This pa- per proposes G^2RA-Net, a medical image segmentation framework that combines graph-based cross-slice relation modeling with atten- tion gating. Graph-Based Slice Relationship Modeling (GSRM) cap- tures anatomical dependencies across consecutive slices by repre- senting each slice as a graph node and propagating semantic con- text through graph message passing. The Cross-Slice Attention Gate (CSAG) then selects relevant neighboring context and emphasizes target anatomical regions through attention-guided feature modula- tion. Experiments on brain MRI and abdominal CT datasets demon- strate that G^2RA-Net outperforms representative methods in seg- mentation accuracy and boundary quality. Ablation studies further validate the proposed design.

Pediatric brain tumors are a leading cause of cancer-related mortality in children, and their small, rare, and often low-contrast subregions make accurate manual delineation challenging. Reliable automated segmentation is therefore needed to support diagnosis, treatment planning, and response assessment. Accordingly, we introduce NeuroTS-Net, a three-dimensional encoder-decoder convolutional neural network architecture for multi-class semantic segmentation that incorporates a dual-scale raw-detail stream, adaptive low-resolution context selection, and detail-preserving multipath downsampling. These components preserve fine intensity and boundary information while efficiently modeling broader tumor context. NeuroTS-Net was trained on the BraTS 2026 pediatric dataset without external data or pretrained weights and evaluated against nnU-Net and MedNeXt under the same experimental protocol. NeuroTS-Net outperformed the baseline methods, achieving whole-tumor and tumor-core Dice scores of 0.938 and 0.937 on the internal validation set and 0.927 and 0.926 on the official challenge validation set. The code is open-sourced at: https://github.com/maenstru56/NeuroTS.

Annotating large radiology datasets is bottlenecked by the manual effort of delineating structures slice-by-slice in 3D volumes. Interactive methods reduce this effort but stay interaction-inefficient: slice-wise methods (including many foundation models) ignore inter-slice continuity, while 3D and video-based methods propagate a prompt with a \emph{fixed} propagator that never adapts to the target volume, so it drifts on low-contrast or pathological structures and must be re-prompted. We present IMVS, a human-in-the-loop annotation framework that composes three components into a closed loop rather than a new segmentation primitive: a lightweight 2D Slice Mask Adapter (SMA) fine-tuned online from user scribbles, a frozen Volume Mask Tracker (VMT) that propagates corrected masks across adjacent slices, and a soft teacher--student alignment that limits forgetting. The SMA is backbone-agnostic (UNet++, DeepLabV3, TransUNet). Across 8 public CT/MRI datasets, IMVS matches strong interactive baselines in quality while sharply cutting annotation effort: $14.4\times$ faster than a proficient copy-based manual workflow ($22.3\times$ over naive manual), $4.6\times$ over slice-wise and $1.9\times$ over 3D interactive methods. MedSAM2 and ScribblePrompt stay competitive or stronger on well-delineated organs; IMVS's advantage is largest on challenging targets and on interaction efficiency. Source code and Demo Video: https://github.com/AbhilakshSinghReen/imvs.

Brain tumor segmentation remains difficult because enhancing tumor (ET) has low contrast and overlaps surrounding tissue, while scanner and site variation causes domain shift. We propose DE-GAN, a contrast-enhancing conditional GAN that combines input-adaptive dynamic convolutions, style-aware feature mixing, and coordinate encoding to synthesize slice-adaptive FLAIR images. A label-guided, class-conditional target separates tumor-core (TC) and ET intensities while preserving anatomy. The generated FLAIR is concatenated with the original MR modalities and used to train a 3D U-Net. Across BraTS 2015, 2018, and 2019, DE-GAN improves segmentation over the baseline and static EnhGAN replacement on most reported TC/ET metrics, with the largest gains from retaining both original and enhanced FLAIR. Code and pretrained models are available at https://github.com/zkhansuri-ui/DE-GAN.

BraTS-GoAT evaluates tumor segmentation across heterogeneous populations. We trained a conventional 3D nnU-Net on 1,351 labeled cases using five-fold cross-validation and 1,000 epochs per fold. The final predictor averaged all folds and applied test-time mirroring. On pooled official validation, global DSC values were 0.7805, 0.8288, and 0.8854 for enhancing tumor (ET), tumor core (TC), and whole tumor (WT). Under matched fold-0 inference, mean regional Dice decreased from 0.9058 on source out-of-fold (OOF) cases to 0.8310 on pooled validation (difference--0.0747). Mirroring gave small single-fold gains but no clear ensemble benefit; a residual-encoder alternative reached 0.8282 mean Dice. In labeled OOF predictions, failure cases had substantially smaller reference ET volumes; after adjustment for ET and WT volume, lower Dice remained associated with more disconnected ET components and a smaller fraction of ET contained in the largest component.

Single Ventricle Physiology (SVP) is a rare subtype of congenital heart disease characterized by the presence of a single functional cardiac ventricle with atypical anatomic configurations that challenge conventional image segmentation approaches. The scarcity of clinical data and the morphological diversity across SVP subtypes make the development of robust segmentation methods particularly difficult. To address these limitations, we propose a cardiac MRI segmentation framework focused on ventricular chambers and myocardium segmentation tailored for SVP. First, we introduce a data augmentation pipeline that generates synthetic 3D cardiac meshes using SDF4CHD and corresponding synthetic cardiac MRI through generative modeling. Second, we introduce SV-Cine, a diagnosis-conditioned adaptation of the foundation model CineMA that incorporates patient-level diagnostic information through Feature-wise Linear Modulation layers, enabling diagnosis-aware feature adaptation during segmentation. We evaluated the framework on an internal cohort with varying SVP subtypes. SV-Cine achieved median Dice scores of 0.89 (IQR: 0.80--0.91) for the left ventricle and 0.72 (IQR: 0.54--0.84) for the right ventricle, outperforming the strongest baseline, nnU-Net, by 0.39 Dice points on right ventricle segmentation. It also yields a median ejection fraction error of 5.55 percentage points (IQR: 3.41--7.69) for the dominant ventricle. Compared with the internal cohort, LV and myocardium segmentation performance was lower for the external cohort; whereas RV Dice scores were comparable for both cohorts. Our findings suggest that a pretrained foundation model can be adapted for highly specialized downstream tasks through usage of diagnosis priors while leveraging anatomic knowledge learned from large-scale MRI datasets during pretraining.

Robust medical image segmentation across imaging modalities is challenging because of large differences in appearance and intensity distributions. Models trained on a single modality often show substantial performance drops when applied to unseen domains. In this work, we develop a unified 3D pancreas segmentation framework that applies domain-adversarial learning to 4,604 heterogeneous CT and MRI scans to learn anatomical representations. A shared nnU-Net encoder-decoder is trained for whole-pancreas segmentation, with a latent domain discriminator encouraging CT-MRI feature alignment. The learned encoder is subsequently transferred to pancreatic head-body-tail segmentation using limited MRI-only subregion annotations. An average Dice score of 87.31% on the in-distribution test set and Dice scores ranging from 84.20% to 88.09% across external OOD datasets were achieved in whole pancreas segmentation. Dice scores of 80.53% on MRI and 83.05% on CT were achieved for downstream subregion segmentation, without using CT subregion annotations. These results demonstrate that a unified anatomical representation can support both cross-modality pancreas segmentation and label-efficient downstream transfer.

Pseudo-labeling is a strong paradigm for semi-supervised medical image segmentation, yet its effectiveness is highly sensitive to confidence thresholding. In abdominal multi-organ segmentation, a fixed global threshold is particularly suboptimal because organ classes differ substantially in size, appearance, and learning difficulty. In this work, we propose ThreshGuide, a class-aware threshold adaptation framework that uses labeled data to guide pseudo-label selection on unlabeled data. Built upon a standard teacher-student architecture, the teacher model evaluates labeled samples during training to estimate class-aware threshold targets by maximizing an error-aware F\b{eta} criterion that balances precision and coverage. These targets are then smoothed with an exponential moving average (EMA) and used to filter unlabeled voxels in a class-dependent manner. Experiments on FLARE2022 and AMOS2022 show that ThreshGuide performs competitively overall, yielding clear improvements specifically on hard-to-learn organs.

Detecting brain metastases in magnetic resonance imaging (MRI) remains challenging because lesions vary widely in size and appearance, with very small metastases occupying only a minute fraction of a three-dimensional input. We investigate whether combining different spatial fields of view (FOVs) improves lesion detection in multimodal MRI and present a scale-aware 3D deep-learning framework. The method uses independently trained $96^3$ and $64^3$ 3D U-Nets whose whole-volume probability maps are combined by weighted late fusion. This design allows us to study the effect of spatial context separately from image resolution and modality choice. On a 97-patient development cohort, cross-FOV fusion improved lesion-level precision and F1 while substantially reducing false positives relative to the individual models. A same-FOV ensemble control showed that these gains were not explained solely by averaging independently trained networks, supporting a contribution from complementary spatial context. An exploratory cross-FOV agreement filter reduced false positives but did not improve overall F1. These results support cross-FOV probability fusion as a simple and computationally practical strategy for improving the precision-false-positive trade-off in 3D brain-metastasis detection.

Delineating lung tumours on computed tomography (CT) takes a considerable share of the time spent on radiotherapy planning, and a contour proposed by a model can be refined interactively by the clinician. Promptable foundation models such as SAM 3 support this workflow by writing each correction into a session memory that conditions the remaining slices, while the model weights stay fixed. On 690 test cases from five public CT cohorts, fine-tuning SAM 3 on lung tumours raises the Dice obtained from a single point prompt from 0.298 to 0.757, and seven rounds of corrections raise it further to 0.765, but under memory conditioning alone the accuracy on slices the annotator has not touched stops improving after six rounds. We therefore treat each correction as a training signal and propose LeCor, which performs test-time training on a small set of case adapters that are reset for every case and meta-learned such that a single gradient step driven by a click improves the slices that were not clicked. On the 133 test cases that span at least eight slices, LeCor raises the Dice reached after seven correction rounds from 0.787 with the fine-tuned model to 0.827, reduces the number of cases that never reach a Dice of 0.80 from 47 to 27, and reaches in three correction rounds the accuracy that the fine-tuned model attains in seven.

Pancreatic tumor segmentation in 3D CT volumes is challenged by extreme scale variability across both the pancreas and tumor, and highly irregular tumor morphology. While recent advances have pushed segmentation performance, existing methods do not explicitly address these challenges and come at the cost of excessive computational complexity, limiting their practicality in resource-constrained clinical environments. We propose TRIUNE-Net, a lightweight unified architecture that harmonizes scale, shape, and efficiency through three synergistic innovations. A multi-scale context aggregation module with stage-adaptive dilated convolutions enables the model to reason across the broad range of anatomical scales present in both organs. A serial linear-deformable attention mechanism combines large effective receptive fields with shapeadaptive deformable convolutions to capture irregular, non-convex tumor morphologies. Finally, an information-preserving downsampling module replaces conventional max pooling entirely, retaining all spatial information while adding negligible parameters, preventing small tumors from being discarded before they can be recognized. On both the MSD Pancreas and NVD Pancreas datasets, TRIUNE-Net achieves state-of-theart results with only 5.86 M parameters and no external pre-training, outperforming all baselines across all key tumor metrics. Specifically, it surpasses the next-best model by 0.45% in tumor Dice, 6.0 points in F1 score, 6.6 points in sensitivity, and 3.4 points in precision, simultaneously reflecting its ability to suppress both missed tumors and false alarms in clinically realistic conditions. Our code is available at: https://github.com/abdora-ai/TRIUNE-Net

Uncertainty arising from inter-observer variability in medical image segmentation plays an important role in developing treatment plans. Research in this area is inhibited by the lack of multiple annotations for large-scale medical datasets, especially for volumetric data, which suffers from additional scaling and computational complexity challenges. Flow matching has emerged as a powerful framework for generative modelling and has also been demonstrated to maintain strong performance when working with latent representations of images. In this work, we introduce a latent-to-latent flow technique for stochastic segmentation of medical volumes via encoded representations of both the image and label space. We evaluate our method on two challenging applications covering delineation uncertainty for radiotherapy planning and multiple organ structure segmentation, improving efficiency up to 14x compared with full resolution models while maintaining clinically relevant performance.

Accurate 3D abnormality segmentation in chest CT requires dense spatial supervision, but obtaining expert voxel-level labels is costly. Radiology reports, however, are routinely generated during clinical interpretation and contain instance-specific descriptions that can provide additional guidance without new dense annotation. Existing vision-language grounding methods typically require report-derived findings at inference, making localization dependent on paired text and limiting each forward pass to a queried finding. We propose Instance-Guided Report Anchoring (IGRA), a model-agnostic module that preserves the correspondence between each annotated abnormality instance and the report finding that describes it. IGRA pools each instance representation and anchors it to the corresponding finding embedding during training; all text-related components are discarded at inference. We further reformulate free-text grounding on ReXGroundingCT as multi-label volumetric segmentation by merging same-category instances, allowing all abnormality categories to be predicted in one image-only forward pass. IGRA improves Dice by 22.5% over the strongest image-only baseline (30.93 vs. 25.25) and is comparable to VoxTell on the single-finding subset (30.29 vs. 30.43). Applied unchanged to four standard 3D segmentation backbones, IGRA improves Dice and hit rate across all architectures. Zero-shot evaluation on LIDC-IDRI, PleThora, and a private in-house dataset further shows consistent gains over image-only baselines.

The clinical management of gynecological diseases often relies on medical imaging for diagnosis, treatment planning, and follow-up. Segmentation in this setting is challenging because successive tasks may differ in imaging modality, target anatomy, pathology, and annotation structure. Continual learning allows models to adapt to new tasks without simultaneous access to previous datasets. However, when successive tasks differ substantially, learning a new task can degrade performance on earlier ones, a problem known as catastrophic forgetting. Understanding where adaptation disrupts previous knowledge can help guide the design of more targeted continual-learning strategies. We investigate how forgetting changes as different parts of an encoder--decoder network are allowed to adapt. We progressively expand the trainable region of a 3D nnU-Net backbone from the bottleneck toward input- and output-proximal blocks. Under a shared learning rate, adaptation near the bottleneck largely preserves previous-task performance but provides limited current-task learning, whereas broader adaptation improves current-task performance but sharply increases forgetting. This trade-off persists even when the average change in trainable backbone parameters is approximately comparable. Assigning different learning rates to different blocks substantially reduces forgetting when part of the backbone is trainable, although this changes both the size and location of the updates. Forgetting still increases as more blocks are trained and remains severe when the full backbone is updated. These results show that forgetting depends not only on how much the model changes, but also on which parts of the model are allowed to change.

Dense voxel-level annotation remains a major bottleneck in 3D medical image segmentation. Single-slice propagation methods such as Sli2Vol reduce this burden by propagating one annotated seed slice through a volume using label-free registration. However, axial-only propagation accumulates errors with distance from the seed, especially in surface-distance metrics, because it ignores coronal and sagittal evidence and therefore underuses the 3D information available in CT/MRI volumes. To better leverage volumetric geometry, we study how key training and inference choices affect slice-propagation models, including single-axis versus multi-axis label-free registration, single-seed versus multi-seed propagation, and orthogonal seed configurations. Instead of propagating from a single axial seed, we use three orthogonal seeds---one axial, one coronal, and one sagittal---and fuse their propagated labels with a simple label-free rule. Our results show that the training paradigm has limited impact: an axially trained network applied to off-axis seeds captures nearly all the improvement, while explicit three-axis training adds little. Instead, performance is driven by inference-time seed geometry, especially orthogonality rather than the number of annotated slices, as a budget-matched three-axial control provides no benefit and can even degrade performance. On a multi-organ CT cohort, orthogonal seeding with the axial Sli2Vol backbone improves Dice by 21.9%, Normalized Surface Dice by 25.5%, and reduces Average Hausdorff Distance by 53.5% over the single-axis baseline.

Background: Accurate segmentation of the Left Anterior Descending (LAD) artery in 3D free-breathing, non-contrast CT is critical for cardiac dose sparing in thoracic radiotherapy. The LAD is extremely small, has poor soft-tissue contrast, and varies substantially across patients; even manual contours show limited inter-observer agreement, underscoring the ambiguity of the vessel boundaries. Purpose: To develop a transformer-based framework that improves LAD delineation in low-contrast, imbalanced CT through local-global context modeling and uncertainty-guided optimization. Methods: We propose NA-UNETR, a 3D transformer-based segmentation model whose Neighborhood Attention (NA) and Dilated NA (DiNA) blocks jointly capture fine structural detail and long-range context. Given the scarcity of annotated LAD data, the model is pretrained on 1,000 CTA volumes of general coronary anatomy and fine-tuned with LoRA-based parameter-efficient adaptation on 20 free-breathing institutional CT scans. A composite Dice-Focal and Hausdorff loss, dynamically balanced via homoscedastic uncertainty, improves overlap and boundary accuracy. Results: NA-UNETR reached 45.64% Dice, 38.16 mm HD95, and 10.01 mm ASD, improving Dice by 3.10 percentage points over nnU-Net and reducing HD95 by 2.96 mm relative to Swin UNETR, with the strongest boundary accuracy among all models and improved centerline stability. On ImageCAS it achieved 79.49% Dice, 8.89 mm HD95, and 1.02 mm ASD. Ablations confirmed that residual blocks, variable kernels, and uncertainty-weighted loss each contributed. Conclusions: NA-UNETR balances local precision and global context for thin, low-contrast LAD structures, offering a computationally efficient framework for substructure-level cardiac segmentation in radiotherapy planning.

Accurate 3D neuron segmentation in fluorescence microscopy is critical for neuroscience. However, the sparse and elongated morphology of neurons poses significant challenges to existing segmentation methods. These methods struggle to preserve both local details and global topology, leading to fragmented results. To address this, we propose NeuroRefiner, a multi-agent system that formalizes the human expert workflow involving iterative global observation and local editing. Specifically, NeuroRefiner comprises three collaborative agents dedicated to diagnosing topological errors, generating correction instructions, and validating refinement quality. To facilitate agent instruction-guided segmentation refinement, we propose TopoRefineNet, a dedicated 3D U-Net-based tool that leverages cross-modality feature fusion to generate refined masks. Through multi-round agent reasoning and voxel-level editing, NeuroRefiner produces topologically more accurate segmentations with enhanced interpretability. Experiments on the BigNeuron, CWMBS, and ZBFWB datasets demonstrate that NeuroRefiner outperforms state-of-the-art methods, notably achieving a 3.02% improvement in F1 score on the challenging ZBFWB dataset.

Accurate 3D medical image segmentation requires the integration of long-range anatomical context with fine boundary detail. Existing methods often model global and local features in separate modules or feature levels and perform channel recalibration independently. This may cause semantic mismatch between global context and local boundaries, insufficient channel relationship modeling, weak spatial-channel interaction, and redundant representations. We propose CDGC-Net, a 3D medical image segmentation network that combines cooperative dual-scale spatial attention with grouped hierarchical channel modeling. With-in each CDGC block, Cooperative Dual-Scale Self-Attention (CDSA) assigns attention heads to parallel local-window and global-sparse branches. The two branches capture fine spatial details and long-range anatomical context at the same feature level. Their outputs are concatenated into an $N\times C$ spatial representation and directly passed to Grouped Hierarchical Channel Attention (GHCA). GHCA organizes the channels into $r$ groups and models both within-group and cross-group dependencies. CDSA and GHCA reuse a shared key projection to maintain a consistent feature reference. Residual feature alignment subsequently integrates the refined features with the original representation. On the Synapse, ACDC, BraTS, and LA datasets, CDGC-Net achieved mean DSC values of 86.96%, 92.91%, 82.56%, and 93.52%, respectively, exceeding the next-highest reported values by 0.39, 0.47, 0.17, and 0.32 percentage points. CDGC-Net contains 25.83M parameters and 28.62G FLOPs for an input size of $64\times128\times128$, reducing these quantities by 39.87% and 40.30%, respectively, relative to UNETR++. These results indicate a favorable trade-off between segmentation accuracy and computational complexity.

Accurate aneurysm segmentation in 3D rotational angiography (3DRA) is hindered by extreme class imbalance, morphological similarity to vessels, and absent large-scale 3D pretraining. 2D vision foundation models encode dense structural priors from 1.7 billion images, yet naïve slice-wise transfer fragments anatomical continuity and destabilises optimisation. We propose DINO-3DRA, a dual-path framework achieving effective cross-dimensional semantic transfer by injecting frozen DINOv3 features into a 3D U-Net backbone via Room-Lite spatial mixing and calibrated residual fusion. On multi-centre 3DRA data, DINO-3DRA achieves state-of-the-art aneurysm segmentation (Dice: 0.758; HD95: 2.75 mm; +13% over nnU-Net) with only 5.72M trainable parameters. Ablation studies confirm that gains arise from structured cross-dimensional transfer rather than loss design alone, with bridged foundation features improving anatomical continuity between aneurysms and parent vessels. Without fine-tuning on CADA and SHINY-ICARUS, DINO-3DRA eliminates all catastrophic failure cases observed in baseline architectures, demonstrating robust generalisation across heterogeneous imaging protocols.

Radiology foundation models learn transferable representations that can be adapted to new tasks by training only small layers on top of a frozen encoder. Dense prediction tasks such as 3D segmentation are, however, underrepresented in their evaluation, and, with the encoder kept frozen, pre-trained models still fall short of nnU-Net, the state-of-the-art reference trained from scratch. To close this gap we extend convolutional MAE pre-training with a robust reconstruction objective, a feature regularizer, and a local-global similarity objective. Using this method, we propose Curia-MAE, a multi-modal, multi-anatomy MAE model pre-trained on 300,000 CT and MRI images covering a large number of anatomical sites. On eight anatomy- and lesion-focused segmentation benchmarks, Curia-MAE improves frozen-encoder performance over a strong MAE baseline, while remaining competitive under full finetuning and superior on lesion tasks, where labeled data is scarce. These results indicate that a single frozen encoder can be reused across diverse segmentation tasks, reducing the cost of adapting and deploying such models in clinical workflows. Curia-MAE pre-trained model weights are made publicly available at https://huggingface.co/raidium/Curia-MAE.

Background: Accurate glioma subregion delineation is important for radiotherapy planning and longitudinal monitoring, but manual contour correction is time-consuming. Models such as nnU-Net may generalize imperfectly and lack clinician-directed text correction. Purpose: We investigated adapting a three-dimensional (3D) vision-language foundation model for text-guided brain tumor segmentation refinement. Methods: We developed a lightweight VoxTell-based framework. Pretrained VoxTell generated initial masks. Oracle prompts derived from segmentation errors encoded target, action, location, imaging evidence, edit size, and preservation constraints. Frozen Qwen/VoxTell prompt embeddings were injected through trainable projections into its multiscale decoder conditioning; other weights remained frozen. Training, validation, and testing used 901, 100, and 250 BraTS-GLI cases. Cross-dataset transfer was evaluated on 100 meningioma, metastasis, pediatric tumor, and UPENN-GBM cases. Results: On the internal test set using post-contrast T1-weighted input, correct instructions improved subregion Dice similarity coefficient (DSC; enhancing tumor, edema, and necrotic/non-enhancing core) from $0.774\pm0.158$ to $0.796\pm0.137$. They outperformed blank prompts ($0.762\pm0.155$; Holm-adjusted $p<0.001$, $d_z=0.71$) and contradictory prompts ($0.770\pm0.163$; $p<0.001$, $d_z=0.48$). In cross-dataset testing, correct instructions improved DSC from $0.527\pm0.287$ to $0.550\pm0.278$ and outperformed contradictory instructions ($0.504\pm0.275$; $p<0.001$, $d_z=0.43$). Conclusion: A 3D vision-language foundation model can perform instruction-guided refinement of glioma subregion segmentations. Sensitivity to correct, blank, and contradictory prompts suggests text-dependent contour editing rather than nonspecific post-processing, supporting further evaluation as a clinician-in-the-loop tool.

Confocal microscopy of optically cleared and swelled tissue resolves complex biological structures in 3D, but such acquisitions are highly anisotropic: along the under-sampled axial direction the structure can appear discontinuous, hampering reconstruction and automated quantitative analysis. The usual remedy upsamples the axial dimension to an isotropic volume before training a segmentation model, which requires dense annotations in the upsampled space, a prohibitive labeling burden. We present an end-to-end, GPU-accelerated framework that overcomes this without additional annotations. The model is trained on the native acquisition volume; random rotation of training patches leverages the well-resolved lateral plane to supply the missing axial information, and a z-axis continuity loss keeps neighboring slices consistent. We adapt both a convolutional (3D U-Net) and a transformer (SwinUNETR) backbone, aggregate overlapping patches by Gaussian consensus, and compute point-spread-function-corrected membrane thickness by ray-surface intersection on the GPU. We apply the method to the glomerular basement membrane (GBM), a thin, highly convoluted part of the kidney's filtration barrier that grows more irregular in disease. Segmentation accuracy matches inter-expert agreement. Continuity-aware training improves reconstruction smoothness and suppresses a periodic terracing artifact at minimal accuracy cost. We quantify GBM thickness across the reconstructed 3D surface and capture disease-related thickening, enabling fully automated anisotropic 3D morphometry of biological structures without dense volumetric labels or image restoration.