3D Medical Image Segmentation

Overview

This field develops methods that label anatomical structures and disease in 3D CT, MRI, PET, and other scans, supporting diagnosis, treatment planning, and quantitative analysis. U-Net and nnU-Net remain common baselines, alongside Transformer and state-space models; newer work also uses anatomical and topological constraints, foundation models with prompts, and efficient ways to process volumes. To reduce dependence on costly voxel-level labels, researchers use self-supervised pretraining, synthetic data, semi-supervised learning, and interactive correction, evaluating methods on tasks such as BraTS, BTCV, and ACDC. A central challenge is that strong scores on familiar datasets may not hold across hospitals, scanners, or modalities, while thin structures, uncertain boundaries, and limited compute make reliable clinical deployment difficult.

Latest papers

213 papers14 papers in the last four weeks, down 53% on the four weeks before. 0.1% of all new papers.

Apr 27, 2026

Instance Awareness of Multi-class Semantic Segmentation Loss Functions

Instance-sensitive losses for semantic segmentation such as blob loss and CC loss were designed to address instance imbalance, ensuring small lesions generate the same gradient as large ones, but operate only on single-class segmentation. In multi-class settings, class imbalance poses an additional problem: rare classes with few instances receive a disproportionately small share of the training signal. We show that extending instance-sensitive losses to multi-class segmentation via a one-vs-rest class decomposition repurposes them to also address class imbalance, as uniform averaging over classes ensures each class contributes equally regardless of frequency. We further show that inverse-size weighting, which destabilizes training when applied globally due to weight imbalances across rare and common classes, becomes effective when integrated within the per-component loss, confining the reweighting to each component's spatial context. On the BraTS-METS 2025 dataset (260 test cases), multi-class CC loss improves foreground Dice (0.64 +/- 0.26 vs. 0.59 +/- 0.27 baseline) and rare-class Dice, while maintaining Panoptic Quality at DSC threshold 0.5. Multi-class blob loss achieves the best Panoptic Quality at threshold 0.5 (0.40 +/- 0.24 vs. 0.38 +/- 0.25 baseline) and recognition quality (0.53 +/- 0.29 vs. 0.49 +/- 0.30). Integrating inverse-size weighting within the per-component loss increases rare-class Dice to 0.44 +/- 0.36 at the cost of reduced detection quality.
Apr 25, 2026

Learning from Noisy Prompts: Saliency-Guided Prompt Distillation for Robust Segmentation with SAM

Segmentation is central to clinical diagnosis and monitoring, yet the reliability of modern foundation models in medical imaging still depends on the availability of precise prompts. The Segment Anything Model (SAM) offers powerful zero-shot capabilities, although it collapses under the weak, generic, and noisy prompts that dominate real clinical workflows. In practice, annotations such as centerline points are coarse and ambiguous, often drifting across neighboring anatomy and misguiding SAM toward inconsistent or incomplete masks. We introduce SPD, a Saliency-Guided Prompt Distillation framework that converts these unreliable cues into robust guidance. SPD first learns data-driven anatomical priors through a lightweight saliency head to obtain confident localization maps. These priors then drive Contextual Prompt Distillation, which validates and enriches noisy prompts using cues from anatomically adjacent slices, producing a consensus prompt set that matches the behavior of expert reasoning. A Pairwise Slice Consistency objective further enforces local anatomical coherence during segmentation. Experiments on four challenging MRI and CT benchmarks demonstrate that SPD consistently outperforms existing SAM adaptations and supervised baselines, delivering large gains in both region-based and boundary-based metrics. SPD provides a practical and principled path toward reliable foundation model deployment in clinical environments where only imperfect prompts are available.
Apr 22, 2026

MAE-Based Self-Supervised Pretraining for Data-Efficient Medical Image Segmentation Using nnFormer

Transformer architectures, including nnFormer,have demonstrated promising results in volumetric medical image segmentation by being able to capture long-range spatial interactions. Although they have high performance, these models need large quantities of labeled training data and are also likely to overfit and become training unstable. This is a serious practical problem because it is not only time-consuming but also expensive to obtain medical images that are annotated by experts. Moreover, fully supervised traditional training pipelines do not take advantage of the available large amounts of unlabeled medical imaging data that can be easily obtained in the clinics. We have solved these drawbacks by advancing the efficiency of the nnFormer with a self-supervised pretraining framework, which is based on the Masked Autoencoders (MAE). In this method, the model is pretrained on unlabeled volumetric medical images to reconstruct randomly masked parts of the input. This allows the encoder to learn meaningful anatomical and structural representations . The encoder is then further fine-tuned on a labeled dataset on the downstream segmentation task. Conducted Experiment shows that the offered method leads to a higher segmentation performance on the count of Dice score, a quicker convergence rate on the course of the fine-tuning procedure, and a superior generalization on the basis of limited labeled data . These findings validate that self-supervised learning combined with transformer-based segmentation models is an appropriate approach to the problem of data shortage in medical image analysis.
Apr 20, 2026

CrossPan: A Comprehensive Benchmark for Cross-Sequence Pancreas MRI Segmentation and Generalization

Automatic pancreas segmentation is fundamental to abdominal MRI analysis, yet deep learning models trained on one MRI sequence often fail catastrophically when applied to another-a challenge that has received little systematic investigation. We introduce CrossPan, a multi-institutional benchmark comprising 1,386 3D scans across three routinely acquired sequences (T1-weighted, T2-weighted, and Out-of-Phase) from eight centers. Our experiments reveal three key findings. First, cross-sequence domain shifts are far more severe than cross-center variability: models achieving Dice scores above 0.85 in-domain collapse to near-zero (<0.02) when transferred across sequences. Second, state-of-the-art domain generalization methods provide negligible benefit under these physics-driven contrast inversions, whereas foundation models like MedSAM2 maintain moderate zero-shot performance through contrast-invariant shape priors. Third, semi-supervised learning offers gains only under stable intensity distributions and becomes unstable on sequences with high intra-organ variability. These results establish cross-sequence generalization-not model architecture or center diversity-as the primary barrier to clinically deployable pancreas MRI segmentation. Dataset and code are available at https://crosspan.netlify.app/.
Apr 20, 2026

Align then Refine: Text-Guided 3D Prostate Lesion Segmentation

Automated 3D segmentation of prostate lesions from biparametric MRI (bp-MRI) is essential for reliable algorithmic analysis, but achieving high precision remains challenging. Volumetric methods must combine multiple modalities while ensuring anatomical consistency, but current models struggle to integrate cross-modal information reliably. While vision-language models (VLMs) are replacing the currently used architectural designs, they still lack the fine-grained, lesion-level semantics required for effective localized guidance. To address these limitations, we propose a new multi-encoder U-Net architecture incorporating three key innovations: (1) an alignment loss that enhances foreground text-image similarity to inject lesion semantics; (2) a heatmap loss that calibrates the similarity map and suppresses spurious background activations; and (3) a final-stage, confidence-gated multi-head cross-attention refiner that performs localized boundary edits in high-confidence regions. A phase-scheduled training regime stabilizes the optimization of these components. Our method consistently outperforms prior approaches, establishing a new state-of-the-art on the PI-CAI dataset through enhanced multi-modal fusion and localized text guidance. Our code is available at https://github.com/NUBagciLab/Prostate-Lesion-Segmentation.
Apr 20, 2026

AI Approach for MRI-only Full-Spine Vertebral Segmentation and 3D Reconstruction in Paediatric Scoliosis

MRI is preferred over CT in paediatric imaging because it avoids ionising radiation, but its use in spine deformity assessment is largely limited by the lack of automated, high-resolution 3D bony reconstruction, which continues to rely on CT. MRI-based 3D reconstruction remains impractical due to manual workflows and the scarcity of labelled full-spine datasets. This study introduces an AI framework that enables fully automated thoracolumbar spine (T1-L5) segmentation and 3D reconstruction from MRI alone. Historical low-dose CT scans from adolescent idiopathic scoliosis (AIS) patients were converted into MRI-like images using a GAN and combined with existing labelled thoracic MRI data to train a U-Net-based model. The resulting algorithm accurately generated continuous thoracolumbar 3D reconstructions, improved segmentation accuracy (88% Dice score), and reduced processing time from approximately 1 hour to under one minute, while preserving AIS-specific deformity features. This approach enables radiation-free 3D deformity assessment from MRI, supporting clinical evaluation, surgical planning, and navigation in paediatric spine care.
Apr 19, 2026

SGP-SAM: Self-Gated Prompting for Transferring 3D Segment Anything Models to Lesion Segmentation

Large segmentation foundation models such as the Segment Anything Model (SAM) have reshaped promptable segmentation in natural images, and recent efforts have extended these models to medical images and volumetric settings. However, directly transferring a 3D SAM-style model to lesion segmentation remains challenging due to (i) weak spatial representational capacity for small, irregular targets in intermediate features, and (ii) extreme foreground-background imbalance in 3D volumes.We propose SGP-SAM, a self-gated prompting framework for efficient and effective transfer to 3D lesion segmentation. Our key component, the Self-Gated Prompting Module (SGPM), performs conditional multi-scale spatial enhancement: a lightweight multi-channel gating unit predicts whether the current features require additional multi-scale fusion, and only then activates a Multi-Scale Feature Fusion Block to enrich spatial context. To further address small-lesion learning, we design a Zoom Loss that up-weights lesion-focused supervision by combining Dice and a voxel-balanced focal term.Experiments on MSD Liver Tumor and MSD Brain Tumor (enhancing tumor) show consistent gains over strong transfer baselines based on SAM-Med3D. On MSD Liver Tumor, SGP-SAM improves mDice by 7.3% over fine-tuning.
Apr 15, 2026

A 3D SAM-Based Progressive Prompting Framework for Multi-Task Segmentation of Radiotherapy-induced Normal Tissue Injuries in Limited-Data Settings

Radiotherapy-induced normal tissue injury is a clinically important complication, and accurate segmentation of injury regions from medical images could facilitate disease assessment, treatment planning, and longitudinal monitoring. However, automatic segmentation of these lesions remains largely unexplored because of limited voxel-level annotations and substantial heterogeneity across injury types, lesion size, and imaging modality. To address this gap, we curate a dedicated head-and-neck radiotherapy-induced normal tissue injury dataset covering three manifestations: osteoradionecrosis (ORN), cerebral edema (CE), and cerebral radiation necrosis (CRN). We further propose a 3D SAM-based progressive prompting framework for multi-task segmentation in limited-data settings. The framework progressively incorporates three complementary prompts: text prompts for task-aware adaptation, dose-guided box prompts for coarse localization, and click prompts for iterative refinement. A small-target focus loss is introduced to improve local prediction and boundary delineation for small and sparse lesions. Experiments on ORN, CE, and CRN demonstrate that the proposed method achieves reliable segmentation performance across diverse injury types and outperforms state-of-the-art methods.
Apr 13, 2026

A Workflow to Efficiently Generate Dense Tissue Ground Truth Masks for Digital Breast Tomosynthesis

Digital breast tomosynthesis (DBT) is now the standard of care for breast cancer screening in the USA. Accurate segmentation of fibroglandular tissue in DBT images is essential for personalized risk estimation, but algorithm development is limited by scarce human-delineated training data. In this study we introduce a time- and labor-saving framework to generate a human-annotated binary segmentation mask for dense tissue in DBT. Our framework enables a user to outline a rough region of interest (ROI) enclosing dense tissue on the central reconstructed slice of a DBT volume and select a segmentation threshold to generate the dense tissue mask. The algorithm then projects the ROI to the remaining slices and iteratively adjusts slice-specific thresholds to maintain consistent dense tissue delineation across the DBT volume. By requiring annotation only on the central slice, the framework substantially reduces annotation time and labor. We used 44 DBT volumes from the DBTex dataset for evaluation. Inter-reader agreement was assessed by computing patient-wise Dice similarity coefficients between segmentation masks produced by two radiologists, yielding a median of 0.84. Accuracy of the proposed method was evaluated by having a radiologist manually segment the 20th and 80th percentile slices from each volume (CC and MLO views; 176 slices total) and calculate Dice scores between the manual and proposed segmentations, yielding a median of 0.83.
Apr 13, 2026

Efficient KernelSHAP Explanations for Patch-based 3D Medical Image Segmentation

Perturbation-based explainability methods such as KernelSHAP provide model-agnostic attributions but are typically impractical for patch-based 3D medical image segmentation due to the large number of coalition evaluations and the high cost of sliding-window inference. We present an efficient KernelSHAP framework for volumetric CT segmentation that restricts computation to a user-defined region of interest and its receptive-field support, and accelerates inference via patch logit caching, reusing baseline predictions for unaffected patches while preserving nnU-Net's fusion scheme. To enable clinically meaningful attributions, we compare three automatically generated feature abstractions within the receptive-field crop: whole-organ units, regular FCC supervoxels, and hybrid organ-aware supervoxels, and we study multiple aggregation/value functions targeting stabilizing evidence (TP/Dice/Soft Dice) or false-positive behavior. Experiments on whole-body CT segmentations show that caching substantially reduces redundant computation (with computational savings ranging from 15% to 30%) and that faithfulness and interpretability exhibit clear trade-offs: regular supervoxels often maximize perturbation-based metrics but lack anatomical alignment, whereas organ-aware units yield more clinically interpretable explanations and are particularly effective for highlighting false-positive drivers under normalized metrics.
Apr 13, 2026

RADA: Region-Aware Dual-encoder Auxiliary learning for Barely-supervised Medical Image Segmentation

Deep learning has greatly advanced medical image segmentation, but its success relies heavily on fully supervised learning, which requires dense annotations that are costly and time-consuming for 3D volumetric scans. Barely-supervised learning reduces annotation burden by using only a few labeled slices per volume. Existing methods typically propagate sparse annotations to unlabeled slices through geometric continuity to generate pseudo-labels, but this strategy lacks semantic understanding, often resulting in low-quality pseudo-labels. Furthermore, medical image segmentation is inherently a pixel-level visual understanding task, where accuracy fundamentally depends on the quality of local, fine-grained visual features. Inspired by this, we propose RADA, a novel Region-Aware Dual-encoder Auxiliary learning pipeline which introduces a dual-encoder framework pre-trained on Alpha-CLIP to extract fine-grained, region-specific visual features from the original images and limited annotations. The framework combines image-level fine-grained visual features with text-level semantic guidance, providing region-aware semantic supervision that bridges image-level semantics and pixel-level segmentation. Integrated into a triple-view training framework, RADA achieves SOTA performance under extremely sparse annotation settings on LA2018, KiTS19 and LiTS, demonstrating robust generalization across diverse datasets.
Apr 9, 2026

Weakly-Supervised Lung Nodule Segmentation via Training-Free Guidance of 3D Rectified Flow

Dense annotations, such as segmentation masks, are expensive and time-consuming to obtain, especially for 3D medical images where expert voxel-wise labeling is required. Weakly supervised approaches aim to address this limitation, but often rely on attribution-based methods that struggle to accurately capture small structures such as lung nodules. In this paper, we propose a weakly-supervised segmentation method for lung nodules by combining pretrained state-of-the-art rectified flow and predictor models in a plug-and-play manner. Our approach uses training-free guidance of a 3D rectified flow model, requiring only fine-tuning of the predictor using image-level labels and no retraining of the generative model. The proposed method produces improved-quality segmentations for two separate predictors, consistently detecting lung nodules of varying size and shapes. Experiments on LUNA16 demonstrate improvements over baseline methods, highlighting the potential of generative foundation models as tools for weakly supervised 3D medical image segmentation.
Apr 9, 2026

T-Gated Adapter: A Lightweight Temporal Adapter for Vision-Language Medical Segmentation

Medical image segmentation traditionally relies on fully supervised 3D architectures that demand a large amount of dense, voxel-level annotations from clinical experts which is a prohibitively expensive process. Vision Language Models (VLMs) offer a powerful alternative by leveraging broad visual semantic representations learned from billions of images. However, when applied independently to 2D slices of a 3D scan, these models often produce noisy and anatomically implausible segmentations that violate the inherent continuity of anatomical structures. We propose a temporal adapter that addresses this by injecting adjacent-slice context directly into the model's visual token representations. The adapter comprises a temporal transformer attending across a fixed context window at the token level, a spatial context block refining within-slice representations, and an adaptive gate balancing temporal and single-slice features. Training on 30 labeled volumes from the FLARE22 dataset, our method achieves a mean Dice of 0.704 across 13 abdominal organs with a gain of +0.206 over the baseline VLM trained with no temporal context. Zero-shot evaluation on BTCV and AMOS22 datasets yields consistent improvements of +0.210 and +0.230, with the average cross-domain performance drop reducing from 38.0% to 24.9%. Furthermore, in a cross-modality evaluation on AMOS22 MRI with neither model receiving any MRI supervision, our method achieves a mean Dice of 0.366, outperforming a fully supervised 3D baseline (DynUNet, 0.224) trained exclusively on CT, suggesting that CLIP's visual semantic representations generalize more gracefully across imaging modalities than convolutional features.
Apr 9, 2026

Benchmarking Deep Learning for Future Liver Remnant Segmentation in Colorectal Liver Metastasis

Accurate segmentation of the future liver remnant (FLR) is critical for surgical planning in colorectal liver metastases (CRLM) to prevent fatal post-hepatectomy liver failure. However, this segmentation task is technically challenging due to complex resection boundaries, convoluted hepatic vasculature and diffuse metastatic lesions. A primary bottleneck in developing automated AI tools has been the lack of high-fidelity, validated data. We address this gap by manually refining all 197 volumes from the public CRLM-CT-Seg dataset, creating the first open-source, validated benchmark for this task. We then establish the first segmentation baselines, comparing cascaded (Liver->CRLM->FLR) and end-to-end (E2E) strategies using nnU-Net, SwinUNETR, and STU-Net. We find a cascaded nnU-Net achieves the best final FLR segmentation Dice (0.767), while the pretrained STU-Net provides superior CRLM segmentation (0.620 Dice) and is significantly more robust to cascaded errors. This work provides the first validated benchmark and a reproducible framework to accelerate research in AI-assisted surgical planning.
Apr 8, 2026

GPAFormer: Graph-guided Patch Aggregation Transformer for Efficient 3D Medical Image Segmentation

Deep learning has been widely applied to 3D medical image segmentation tasks. However, due to the diversity of imaging modalities, the high-dimensional nature of the data, and the heterogeneity of anatomical structures, achieving both segmentation accuracy and computational efficiency in multi-organ segmentation remains a challenge. This study proposed GPAFormer, a lightweight network architecture specifically designed for 3D medical image segmentation, emphasizing efficiency while keeping high accuracy. GPAFormer incorporated two core modules: the multi-scale attention-guided stacked aggregation (MASA) and the mutual-aware patch graph aggregator (MPGA). MASA utilized three parallel paths with different receptive fields, combined through planar aggregation, to enhance the network's capability in handling structures of varying sizes. MPGA employed a graph-guided approach to dynamically aggregate regions with similar feature distributions based on inter-patch feature similarity and spatial adjacency, thereby improving the discrimination of both internal and boundary structures of organs. Experiments were performed on public whole-body CT and MRI datasets including BTCV, Synapse, ACDC, and BraTS. Compared to the existed 3D segmentation networkd, GPAFormer using only 1.81 M parameters achieved overall highest DSC on BTCV (75.70%), Synapse (81.20%), ACDC (89.32%), and BraTS (82.74%). Using consumer level GPU, the inference time for one validation case of BTCV spent less than one second. The results demonstrated that GPAFormer balanced accuracy and efficiency in multi-organ, multi-modality 3D segmentation tasks across various clinical scenarios especially for resource-constrained and time-sensitive clinical environments.
Apr 7, 2026

Geometrical Cross-Attention and Nonvoid Voxelization for Efficient 3D Medical Image Segmentation

Accurate segmentation of 3D medical scans is crucial for clinical diagnostics and treatment planning, yet existing methods often fail to achieve both high accuracy and computational efficiency across diverse anatomies and imaging modalities. To address these challenges, we propose GCNV-Net, a novel 3D medical segmentation framework that integrates a Tri-directional Dynamic Nonvoid Voxel Transformer (3DNVT), a Geometrical Cross-Attention module (GCA), and Nonvoid Voxelization. The 3DNVT dynamically partitions relevant voxels along the three orthogonal anatomical planes, namely the transverse, sagittal, and coronal planes, enabling effective modeling of complex 3D spatial dependencies. The GCA mechanism explicitly incorporates geometric positional information during multi-scale feature fusion, significantly enhancing fine-grained anatomical segmentation accuracy. Meanwhile, Nonvoid Voxelization processes only informative regions, greatly reducing redundant computation without compromising segmentation quality, and achieves a 56.13% reduction in FLOPs and a 68.49% reduction in inference latency compared to conventional voxelization. We evaluate GCNV-Net on multiple widely used benchmarks: BraTS2021, ACDC, MSD Prostate, MSD Pancreas, and AMOS2022. Our method achieves state-of-the-art segmentation performance across all datasets, outperforming the best existing methods by 0.65% on Dice, 0.63% on IoU, 1% on NSD, and relatively 14.5% on HD95. All results demonstrate that GCNV-Net effectively balances accuracy and efficiency, and its robustness across diverse organs, disease conditions, and imaging modalities highlights strong potential for clinical deployment.
Apr 2, 2026

Why Invariance is Not Enough for Biomedical Domain Generalization and How to Fix It

We present MaskGen, a theoretically grounded and deliberately simple approach for domain generalization in 3D biomedical image segmentation. Modern segmentation models degrade sharply under shifts in modality, disease severity, clinical sites, and more, limiting their reliable adoption. Existing generalization methods address this using extreme augmentations, hand-engineered domain statistics mixing, or architectural redesigns that add significant implementation overhead while yielding inconsistent performance across biomedical settings. MaskGen instead presents a principled learning strategy with marginal overhead that utilizes both source-domain image intensities and domain-stable foundation model representations to train robust segmentation models. As a result, MaskGen achieves strong gains in both fully supervised and few-shot segmentation across broad clinical shifts in biomedical studies. Unlike prior approaches, MaskGen is architecture- and loss-agnostic, compatible with standard augmentation pipelines, easy to implement, and tackles arbitrary anatomical regions. Its implementation is freely available at https://github.com/sebodiaz/MaskGen.
Apr 1, 2026

Multicentric thrombus segmentation using an attention-based recurrent network with gradual modality dropout

Detecting and delineating tiny targets in 3D brain scans is a central yet under-addressed challenge in medical imaging.In ischemic stroke, for instance, the culprit thrombus is small, low-contrast, and variably expressed across modalities(e.g., susceptibility-weighted T2 blooming, diffusion restriction on DWI/ADC), while real-world multi-center dataintroduce domain shifts, anisotropy, and frequent missing sequences. We introduce a methodology that couples an attention-based recurrent segmentation network (UpAttLLSTM), a training schedule that progressively increases the difficulty of hetero-modal learning, with gradual modality dropout, UpAttLLSTM aggregates context across slices via recurrent units (2.5D) and uses attention gates to fuse complementary cues across available sequences, making it robust to anisotropy and class imbalance. Gradual modality dropout systematically simulates site heterogeneity,noise, and missing modalities during training, acting as both augmentation and regularization to improve multi-center generalization. On a monocentric cohort, our approach detects thrombi in >90% of cases with a Dice score of 0.65. In a multi-center setting with missing modalities, it achieves-80% detection with a Dice score around 0.35. Beyond stroke, the proposed methodology directly transfers to other small-lesion tasks in 3D medical imaging where targets are scarce, subtle, and modality-dependent
Apr 1, 2026

Automated Detection of Multiple Sclerosis Lesions on 7-tesla MRI Using U-net and Transformer-based Segmentation

Ultra-high field 7-tesla (7T) MRI improves visualization of multiple sclerosis (MS) white matter lesions (WML) but differs sufficiently in contrast and artifacts from 1.5-3T imaging - suggesting that widely used automated segmentation tools may not translate directly. We analyzed 7T FLAIR scans and generated reference WML masks from Lesion Segmentation Tool (LST) outputs followed by expert manual revision. As external comparators, we applied LST-LPA and the more recent LST-AI ensemble, both originally developed on lower-field data. We then trained 3D UNETR and SegFormer transformer-based models on 7T FLAIR at multiple resolutions (0.5x0.5x0.5^3, 1.0x1.0x1.0^3, and 1.5x1.5x2.0^3) and evaluated all methods using voxel-wise and lesion-wise metrics from the BraTS 2023 framework. On the held-out test set at native 0.5x0.5x0.5^3 resolution, 7T-trained transformers achieved competitive overlap with LST-AI while recovering additional small lesions that were missed by classical methods, at the cost of some boundary variability and occasional artifact-related false positives. On a held-out 7 T test set, our best transformer model (SegFormer) achieved a voxel-wise Dice of 0.61 and lesion-wise Dice of 0.20, improving on the classical LST-LPA tool (Dice 0.39, lesion-wise Dice 0.02). Performance decreased for models trained on downsampled images, underscoring the value of native 7T resolution for small-lesion detection. By releasing our 7T-trained models, we aim to provide a reproducible, ready-to-use resource for automated lesion quantification in ultra-high field MS research (https://github.com/maynord/7T-MS-lesion-segmentation).
Mar 31, 2026

FOSCU: Feasibility of Synthetic MRI Generation via Duo-Diffusion Models for Enhancement of 3D U-Nets in Hepatic Segmentation

Medical image segmentation faces fundamental challenges including restricted access, costly annotation, and data shortage to clinical datasets through Picture Archiving and Communication Systems (PACS). These systemic barriers significantly impede the development of robust segmentation algorithms. To address these challenges, we propose FOSCU, which integrates Duo-Diffusion, a 3D latent diffusion model with ControlNet that simultaneously generates high-resolution, anatomically realistic synthetic MRI volumes and corresponding segmentation labels, and an enhanced 3D U-Net training pipeline. Duo-Diffusion employs segmentation-conditioned diffusion to ensure spatial consistency and precise anatomical detail in the generated data. Experimental evaluation on 720 abdominal MRI scans shows that models trained with combined real and synthetic data yield a mean Dice score gain of 0.67% over those using only real data, and achieve a 36.4% reduction in Fréchet Inception Distance (FID), reflecting enhanced image fidelity.
Mar 26, 2026

C2W-Tune: Cavity-to -Wall Transfer Learning for Thin Atrial Wall Segmentation in 3D LGE-MRI

Accurate segmentation of the left atrial (LA) wall in 3D late gadolinium-enhanced MRI (LGE-MRI) is essential for wall thickness mapping and fibrosis quantification, yet it remains challenging due to the wall's thin geometry, complex anatomy, and low contrast. We propose C2W-Tune, a two-stage cavity-to-wall transfer framework that leverages a high-accuracy LA cavity model as an anatomical prior to improve thin-wall delineation. Using a 3D U-Net with a ResNeXt encoder and instance normalization, Stage 1 pre-trains the network to segment the LA cavity, learning robust atrial representations. Stage 2 transfers these weights and adapts the network to LA wall segmentation using a progressive layer-unfreezing schedule to preserve cavity features while enabling wall-specific refinement. On the 2018 LA Segmentation Challenge dataset, C2W-Tune outperformed an architecture-matched baseline trained from scratch. The wall Dice score increased from 0.623 to 0.814, surface Dice at 1 mm increased from 0.553 to 0.731, 95th-percentile Hausdorff distance (HD95) decreased from 2.95 mm to 2.55 mm, and average symmetric surface distance (ASSD) decreased from 0.71 mm to 0.63 mm. Under reduced supervision using 70 training volumes sampled from the same training set, C2W-Tune achieved a Dice of 0.78, remaining competitive with recent multi-class bi-atrial benchmarks, typically 0.6-0.7. These results show that anatomically grounded task transfer with controlled fine-tuning improves accuracy for thin LA wall segmentation in 3D LGE-MRI.
Mar 26, 2026

Few-Shot Left Atrial Wall Segmentation in 3D LGE MRI via Meta-Learning

Segmenting the left atrial (LA) wall from late gadolinium enhancement magnetic resonance imaging (LGE-MRI) is challenging because of its thin geometry, low contrast, and limited expert annotations. We propose a model-agnostic meta-learning (MAML) framework with a 3D residual U-Net backbone for K-shot (K = 5, 10, 20) LA wall segmentation. The framework is meta-trained on LA wall tasks together with auxiliary LA and right atrial (RA) cavity tasks and uses a boundary-aware composite loss to improve thin-structure delineation. We evaluated MAML on a held-out clean test set and assessed its robustness under an unseen synthetic domain shift and on a local cohort. On the held-out clean test set, MAML outperformed the K-shot fine-tuning baseline at 5-shot, achieving Dice coefficient (DSC) = 0.54 versus 0.48 and Hausdorff distance (HD95) = 4.60 versus 6.40 mm. At 20-shot, MAML approached the fully supervised model trained from scratch, with DSC = 0.59 versus 0.61. Under unseen shifts, performance decreased relative to clean testing but improved consistently as K increased. At 5-shot, MAML achieved DSC = 0.52 and HD95 = 5.02 mm under the unseen synthetic shift, and DSC = 0.50 and HD95 = 5.43 mm on the local cohort. These results suggest that meta-learning can improve thin-wall delineation in low-shot adaptation and may reduce the annotation burden for atrial remodeling assessment.
Mar 24, 2026

Harnessing Lightweight Transformer with Contextual Synergic Enhancement for Efficient 3D Medical Image Segmentation

Transformers have shown remarkable performance in 3D medical image segmentation, but their high computational requirements and need for large amounts of labeled data limit their applicability. To address these challenges, we consider two crucial aspects: model efficiency and data efficiency. Specifically, we propose Light-UNETR, a lightweight transformer designed to achieve model efficiency. Light-UNETR features a Lightweight Dimension Reductive Attention (LIDR) module, which reduces spatial and channel dimensions while capturing both global and local features via multi-branch attention. Additionally, we introduce a Compact Gated Linear Unit (CGLU) to selectively control channel interaction with minimal parameters. Furthermore, we introduce a Contextual Synergic Enhancement (CSE) learning strategy, which aims to boost the data efficiency of Transformers. It first leverages the extrinsic contextual information to support the learning of unlabeled data with Attention-Guided Replacement, then applies Spatial Masking Consistency that utilizes intrinsic contextual information to enhance the spatial context reasoning for unlabeled data. Extensive experiments on various benchmarks demonstrate the superiority of our approach in both performance and efficiency. For example, with only 10% labeled data on the Left Atrial Segmentation dataset, our method surpasses BCP by 1.43% Jaccard while drastically reducing the FLOPs by 90.8% and parameters by 85.8%. Code is released at https://github.com/CUHK-AIM-Group/Light-UNETR.
Mar 24, 2026

FDIF: Formula-Driven supervised Learning with Implicit Functions for 3D Medical Image Segmentation

Deep learning-based 3D medical image segmentation methods relies on large-scale labeled datasets, yet acquiring such data is difficult due to privacy constraints and the high cost of expert annotation. Formula-Driven Supervised Learning (FDSL) offers an appealing alternative by generating training data and labels directly from mathematical formulas. However, existing voxel-based approaches are limited in geometric expressiveness and cannot synthesize realistic textures. We introduce Formula-Driven supervised learning with Implicit Functions (FDIF), a framework that enables scalable pre-training without using any real data and medical expert annotations. FDIF introduces an implicit-function representation based on signed distance functions (SDFs), enabling compact modeling of complex geometries while exploiting the surface representation of SDFs to support controllable synthesis of both geometric and intensity textures. Across three medical image segmentation benchmarks (AMOS, ACDC, and KiTS) and three architectures (SwinUNETR, nnUNet ResEnc-L, and nnUNet Primus-M), FDIF consistently improves over a formula-driven method, and achieves performance comparable to self-supervised approaches pre-trained on large-scale real datasets. We further show that FDIF pre-training also benefits 3D classification tasks, highlighting implicit-function-based formula supervision as a promising paradigm for data-free representation learning. Code is available at https://github.com/yamanoko/FDIF.
Mar 24, 2026

Automatic Segmentation of 3D CT scans with SAM2 using a zero-shot approach

Foundation models for image segmentation have shown strong generalization in natural images, yet their applicability to 3D medical imaging remains limited. In this work, we study the zero-shot use of Segment Anything Model 2 (SAM2) for automatic segmentation of volumetric CT data, without any fine-tuning or domain-specific training. We analyze how SAM2 should be applied to CT volumes and identify its main limitation: the lack of inherent volumetric awareness. To address this, we propose a set of inference-alone architectural and procedural modifications that adapt SAM2's video-based memory mechanism to 3D data by treating CT slices as ordered sequences. We conduct a systematic ablation study on a subset of 500 CT scans from the TotalSegmentator dataset to evaluate prompt strategies, memory propagation schemes and multi-pass refinement. Based on these findings, we select the best-performing configuration and report final results on a bigger sample of the TotalSegmentator dataset comprising 2,500 CT scans. Our results show that, even with frozen weights, SAM2 can produce coherent 3D segmentations when its inference pipeline is carefully structured, demonstrating the feasibility of a fully zero-shot approach for volumetric medical image segmentation.
Mar 24, 2026

NeuroSeg Meets DINOv3: Transferring 2D Self-Supervised Visual Priors to 3D Neuron Segmentation via DINOv3 Initialization

2D visual foundation models, such as DINOv3, a self-supervised model trained on large-scale natural images, have demonstrated strong zero-shot generalization, capturing both rich global context and fine-grained structural cues. However, an analogous 3D foundation model for downstream volumetric neuroimaging remains lacking, largely due to the challenges of 3D image acquisition and the scarcity of high-quality annotations. To address this gap, we propose to adapt the 2D visual representations learned by DINOv3 to a 3D biomedical segmentation model, enabling more data-efficient and morphologically faithful neuronal reconstruction. Specifically, we design an inflation-based adaptation strategy that inflates 2D filters into 3D operators, preserving semantic priors from DINOv3 while adapting to 3D neuronal volume patches. In addition, we introduce a topology-aware skeleton loss to explicitly enforce structural fidelity of graph-based neuronal arbor reconstruction. Extensive experiments on four neuronal imaging datasets, including two from BigNeuron and two public datasets, NeuroFly and CWMBS, demonstrate consistent improvements in reconstruction accuracy over SoTA methods, with average gains of 2.9% in Entire Structure Average, 2.8% in Different Structure Average, and 3.8% in Percentage of Different Structure. Code: https://github.com/yy0007/NeurINO.
Mar 23, 2026

SegMaFormer: A Hybrid State-Space and Transformer Model for Efficient Segmentation

The advent of Transformer and Mamba-based architectures has significantly advanced 3D medical image segmentation by enabling global contextual modeling, a capability traditionally limited in Convolutional Neural Networks (CNNs). However, state-of-the-art Transformer models often entail substantial computational complexity and parameter counts, which is particularly prohibitive for volumetric data and further exacerbated by the limited availability of annotated medical imaging datasets. To address these limitations, this work introduces SegMaFormer, a lightweight hybrid architecture that synergizes Mamba and Transformer modules within a hierarchical volumetric encoder for efficient long-range dependency modeling. The model strategically employs Mamba-based layers in early, high-resolution stages to reduce computational overhead while capturing essential spatial context, and reserves self-attention mechanisms for later, lower-resolution stages to refine feature representation. This design is augmented with generalized rotary position embeddings to enhance spatial awareness. Despite its compact structure, SegMaFormer achieves competitive performance on three public benchmarks (Synapse, BraTS, and ACDC), matching the Dice coefficient of significantly larger models. Empirically, our approach reduces parameters by up to 75x and substantially decreases FLOPs compared to current state-of-the-art models, establishing an efficient and high-performing solution for 3D medical image segmentation.
Mar 23, 2026

Multi-View Deformable Convolution Meets Visual Mamba for Coronary Artery Segmentation

Accurate segmentation of coronary arteries from computed tomography angiography (CTA) images is of paramount clinical importance for the diagnosis and treatment planning of cardiovascular diseases. However, coronary artery segmentation remains challenging due to the inherent multi-branching and slender tubular morphology of the vasculature, compounded by severe class imbalance between foreground vessels and background tissue. Conventional convolutional neural network (CNN)-based approaches struggle to capture long-range dependencies among spatially distant vascular structures, while Vision Transformer (ViT)-based methods incur prohibitive computational overhead that hinders deployment in resource-constrained clinical settings. Motivated by the recent success of state space models (SSMs) in efficiently modeling long-range sequential dependencies with linear complexity, we propose MDSVM-UNet, a novel two-stage coronary artery segmentation framework that synergistically integrates multidirectional snake convolution (MDSConv) with residual visual Mamba (RVM). In the encoding stage, we introduce MDSConv, a deformable convolution module that learns adaptive offsets along three orthogonal anatomical planes -- sagittal, coronal, and axial -- thereby enabling comprehensive multi-view feature fusion that faithfully captures the elongated and tortuous geometry of coronary vessels. In the decoding stage, we design an RVM-based upsampling decoder block that leverages selective state space mechanisms to model inter-slice long-range dependencies while preserving linear computational complexity. Furthermore, we propose a progressive two-stage segmentation strategy: the first stage performs coarse whole-image segmentation to guide intelligent block extraction, while the second stage conducts fine-grained block-level segmentation to recover vascular details and suppress false positives..
Mar 23, 2026

PGR-Net: Prior-Guided ROI Reasoning Network for Brain Tumor MRI Segmentation

Brain tumor MRI segmentation is essential for clinical diagnosis and treatment planning, enabling accurate lesion detection and radiotherapy target delineation. However, tumor lesions occupy only a small fraction of the volumetric space, resulting in severe spatial sparsity, while existing segmentation networks often overlook clinically observed spatial priors of tumor occurrence, leading to redundant feature computation over extensive background regions. To address this issue, we propose PGR-Net (Prior-Guided ROI Reasoning Network) - an explicit ROI-aware framework that incorporates a data-driven spatial prior set to capture the distribution and scale characteristics of tumor lesions, providing global guidance for more stable segmentation. Leveraging these priors, PGR-Net introduces a hierarchical Top-K ROI decision mechanism that progressively selects the most confident lesion candidate regions across encoder layers to improve localization precision. We further develop the WinGS-ROI (Windowed Gaussian-Spatial Decay ROI) module, which uses multi-window Gaussian templates with a spatial decay function to produce center-enhanced guidance maps, thus directing feature learning throughout the network. With these ROI features, a windowed RetNet backbone is adopted to enhance localization reliability. Experiments on BraTS-2019/2023 and MSD Task01 show that PGR-Net consistently outperforms existing approaches while using only 8.64M Params, achieving Dice scores of 89.02%, 91.82%, and 89.67% on the Whole Tumor region. Code is available at https://github.com/CNU-MedAI-Lab/PGR-Net.
Mar 20, 2026

Probing and Inducing Clinical Modality Grounding in Brain Tumor Segmentation

Multimodal MRI provides complementary information for brain tumor segmentation, but high accuracy alone does not reveal whether a model relies on clinically appropriate imaging evidence. Radiologists use different sequences for different findings, such as T1ce for enhancing tumor and FLAIR for peritumoral edema. Yet most 3D segmentation networks fuse MRI sequences through fixed connections, regardless of patient, region, or depth. We frame multimodal segmentation as grounded multimodal reasoning and introduce (i) a model agnostic probing framework combining per region modality ablation, Dominant Sensitivity Enhancement (DSE), and gate trajectory analysis to reveal sequence reliance, and (ii) evidence that adaptive Hyper-Connections (HC) induce clinically aligned modality reliance without modality supervision. Across nnU Net, SwinUNETR, and VT-UNet on BraTS 2021, most HC configurations increase reliance on clinically appropriate sequences. This interpretable pattern recurs across all three backbones, suggesting it arises from adaptive connections rather than a single architecture. HC also improves segmentation accuracy at negligible parameter cost. On validation, the best HC configuration increases mean Dice by 0.43 to 0.81 percentage points across the three backbones. On the held-out test set, it reduces mean HD95 by 1.17 to 1.78 mm (approximately 20 to 27 percent) for nnU-Net and VT UNet, adding at most 0.53 percent parameters. Our framework offers an inspectable measure of clinical grounding and extends naturally to multimodal medical foundation models.