Cross-Modality Medical Image Segmentation
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2 papers in the last four weeks, against 1 the four weeks before. 0.0% of all new papers.
Latest papers 42
Multi-structure segmentation of the uterus is important for computer-assisted screening, diagnosis, and treatment planning of uterine diseases, where ultrasound and MRI provide complementary clinical information. However, developing a unified model across these modalities is challenging due to their substantially different image appearances, anatomical contexts, spatial resolutions, and label spaces. Moreover, existing datasets often define different segmentation targets, making joint learning challenging and potentially leading to negative transfer across heterogeneous tasks. To this end, we propose a Topology-informed Prompt-conditioned Universal Segmentation (TPUS) framework for segmenting multiple uterine structures across ultrasound and MRI. TPUS introduces a graph-based multi-dataset backbone comprising modality-specific stems and a modality-shared graph-based encoder-decoder to support modality-sensitive input adaptation, structural feature reasoning, and joint representation learning across heterogeneous uterine segmentation tasks. In addition, TPUS uses task-aware class prompts to condition the segmentation process for different datasets and label spaces, a dynamic convolutional adaptation module to generate task-specific output responses, and a topology-informed loss to encourage anatomically consistent predictions. Experiments on a uterine ultrasound dataset and a T2-weighted uterine myoma MRI dataset demonstrate that TPUS achieves Dice scores of 0.898 and 0.693 on the two held-out test sets, respectively, outperforming several generic and universal segmentation baselines. Source code can be accessed at https://github.com/YonghengSun1997/TPUS.
Unified CT and MRI Pancreas Segmentation for Label-Efficient Cross-Modality Subregion Transfer
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.
When Fusion Fails: Corruption-Aware Rebalanced Fusion for Multi-Modal Medical Image Segmentation
Multi-modal medical image segmentation leverages complementary diagnostic information, yet fusion can underperform single-modality baselines when spatially aligned inputs differ in quality. Here, "corruption" primarily denotes resolution-induced degradation rather than misalignment or complete modality absence, while synthetic noise is evaluated only as an auxiliary setting. We identify a critical optimization-inference inconsistency: degraded modalities can receive weak training updates yet substantially affect predictions, indicating active interference with fusion. We attribute this failure to resampling-induced feature corruption and optimization bias, where noisy features propagate through skip connections and encourage unreliable modality selection. We therefore propose CoReFuse-Med, a Corruption-aware Rebalanced Fusion framework that suppresses corruption during feature transmission and rebalances modality contributions during high-level fusion. Experiments on EPVS, BraTS, and WMH, including multiple Z-axis slice-retention ratios and an auxiliary noise test, demonstrate improved accuracy and robustness under modality-quality discrepancies. Our code is available at https://github.com/lrever/CoReFuse.
LISynSeg: Data-Centric Label-to-Image Synthesis for Cross-Modality Whole-Heart Segmentation
Whole-heart segmentation (WHS) in computed tomography (CT) and magnetic resonance imaging (MRI) is affected by acquisition shifts and heterogeneous cardiac annotations. Existing WHS systems combine architectural design, transfer learning, and generic spatial or intensity augmentation. We investigate whether changes to data augmentation and training supervision can improve cross-modality WHS while the segmentation architecture is held constant. We present LISynSeg, a data-centric approach that augments real-image nnU-Net training with label-to-image synthesis. Synthetic volumes are generated from cardiac label maps using contrast and acquisition perturbations calibrated to the training cohort, then mixed with real images to retain thoracic context absent from the labels (and thus the synthesized images). We model cardiac label variation through controlled changes in myocardial wall thickness and partial supervision of uncertain vessel endpoints. On the CARE Whole-Heart benchmark, synthetic-only training performs worse than the real-image nnU-Net baseline, whereas calibrated real-synthetic training improves cross-modality segmentation without changing the architecture; the improvement is larger for MRI than for CT. The results show that modifying the training data strategy can benefit model development for heterogeneous cardiac data. Code and trained weights will be released at https://github.com/MedICL-VU/Care26_LISynSeg.
DistMedVL: Distributional Vision-Language Alignment for Uncertainty-Aware Medical Image Segmentation
Cross-modal alignment of visual and textual representations is fundamental to multimodal medical image understanding, yet remains hindered by uncertainty in both modalities under real-world clinical conditions. Existing vision-language segmentation methods rely on deterministic cross-modal matching, which overlooks aleatoric uncertainty from ambiguous boundaries and epistemic uncertainty from limited training data, leading to fragile performance under domain shift. To address this issue, we propose DistMedVL, a probabilistic vision-language framework that introduces a lightweight Probabilistic Cross-Modal Adapter (PCM-Adapter) upon frozen encoders to explicitly model representational uncertainty. Specifically, the PCM-Adapter comprises two sequential modules for progressive probabilistic alignment. We first devise a Mahalanobis Alignment Module (MAM) that models textual tokens as Gaussian distributions and computes patch-text compatibility via Mahalanobis distance, yielding variance-conditioned matching that downweights unreliable feature dimensions. Moreover, we devise a Distribution Flow Module (DFM) that estimates modality-wise confidence parameters and performs vision-guided refinement of textual distributions, accommodating distributional variation across imaging modalities. Extensive experiments across eight medical segmentation benchmarks demonstrate that DistMedVL outperforms state-of-the-art methods with only 6.3M trainable parameters, exhibiting superior data efficiency, perturbation robustness and cross-dataset generalization.
Unsupervised Adversarial Domain Adaptation for Uterine layer Segmentation: From Labeled Cine to Unlabeled Dynamic EPI MRI
Uterine peristalsis is a key physiological phenomenon responsible for various functions across the menstrual cycle, intimately linked to uterine wall microstructure. Alterations in uterine motion and tissue properties are implicated in the etiology of gynecological diseases, yet these processes have been studied in isolation. We introduce a dynamic multi-echo gradient echo EPI framework for simultaneous characterization and correlation of uterine peristaltic activity and time-resolved T2* changes at 0.55T. Inherent susceptibility artifacts, reduced resolution, and burden of manual uterine layer annotation are addressed by an unsupervised adversarial domain adaptation framework, transferring segmentation knowledge from labeled cine MRI to unlabeled dynamic EPI. We implemented Unet-LSTM with multi-scale domain discriminators that exploits temporal layer dynamics. A Dice score of 0.88 and Jaccard index of 0.80 was achieved. Mean T2* values were 108ms, 76ms, and 124ms for the myometrium, junctional zone, and endometrium. A negative correlation between junctional zone area and T2* was observed in 14/39 cases, providing first insights into oxygenation patterns associated with junctional zone contraction and motion, demonstrating feasibility of assessing the interplay between contractility and dynamic T2* changes.
CRIL-U-Net: Compact Ratio-Interaction Learning for Focal Cortical Dysplasia Segmentation from T1w and FLAIR MRI
Focal cortical dysplasia (FCD) type II is an important structural cause of drug-resistant focal epilepsy, but its small size, heterogeneous appearance, and subtle MRI characteristics make automated segmentation challenging. Conventional multimodal networks commonly concatenate T1-weighted (T1w) and fluid-attenuated inversion recovery (FLAIR) images, requiring subsequent layers to learn useful cross-modal relationships implicitly. We propose CRIL-U-Net, a 3D U-Net incorporating a Compact Ratio-Interaction Learning module that combines local spatial features, voxel-wise cross-modal mixing, and bidirectional ratio-inspired interactions. CRIL-U-Net was compared with a conventional 3D U-Net and an input self-attention U-Net using five-fold cross-validation on 85 FCD subjects and 25 healthy controls. Each architecture was trained independently using Dice-binary cross-entropy (Dice-BCE) and Focal Tversky-Focal (FTF) losses. With FTF, CRIL-U-Net achieved the highest mean Dice score (0.196 +/- 0.262), compared with 0.136 +/- 0.224 for the U-Net and 0.135 +/- 0.214 for the attention comparator. It produced nonzero lesion overlap in 44 of 85 cases, compared with 36 for the U-Net. Under FTF, CRIL-U-Net significantly outperformed both comparison architectures after false-discovery-rate correction. These findings suggest that compact cross-modal representation learning can improve FCD segmentation within a controlled U-Net setting when combined with an imbalance-aware objective, although the remaining zero-overlap rate of 48.2% highlights the need for further validation and methodological development.
Registration-Grounded Spectral Fusion for Unregistered WLI/NBI Endoscopic Lesion Segmentation
White-light imaging (WLI) and narrow-band imaging (NBI) provide complementary views of endoscopic lesions, but their paired observations are often spatially misaligned due to viewpoint changes, tissue deformation, and sequential handheld acquisition. This makes direct WLI/NBI fusion prone to mixing non-corresponding regions and may even degrade segmentation around lesion boundaries. To address this problem, we propose a reliability-aware complex-domain fusion framework for paired-but-unregistered WLI/NBI lesion segmentation. The framework first establishes topology-regularized feature correspondence and further estimates where the cross-modal correspondence is reliable. Guided by this reliability, the model selectively fuses WLI and NBI features in a learnable complex representation. In this representation, WLI-derived cues mainly provide appearance-related magnitude responses, while NBI-derived cues provide structure-sensitive phase responses. Unlike conventional real-valued or symmetric multimodal fusion, the proposed method explicitly models the different roles of WLI and NBI and suppresses unreliable cross-modal interaction in locally mismatched regions. Experiments on paired WLI/NBI endoscopic datasets show that the proposed reliability-aware registration grounding and complex-domain fusion consistently improve lesion segmentation performance. Role-reversal and module ablation studies further validate the necessity of both the modality-role design and reliability-guided cross-modal interaction.
UnDA: Unpaired Domain Alignment for Cross-Modal Knowledge Transfer in Medical Imaging
Multimodal based approaches often outperform single modality approaches in downstream tasks as the different modalities provide complementary information, yet acquiring paired clinical data remains a significant challenge in real world scenarios. While cross-modal knowledge distillation addresses this, existing methods often struggle with large modality gaps and the propagation of noise from uncertain source-domain predictions. To overcome these challenges, we propose UnDA, an anchor-guided framework for unpaired cross-modal distillation. Our approach introduces a backbone-agnostic Alignment Module that extracts semantically structured class tokens via an attention based pooling mechanism. To ensure robust knowledge transfer, we propose Uncertainty-Weighted Optimal Transport (UCT-OT), which dynamically weights feature-level alignment based on prediction confidence, effectively suppressing noisy supervision. Furthermore, a per-class ProtoNCE objective maintains stable prototype memories to enforce global discriminability across unpaired batches. Evaluations on representative segmentation tasks under strictly unpaired settings show consistent improvements in accuracy and boundary precision in the target modality, demonstrating that meaningful structural knowledge can be transferred across heterogeneous data sources without paired datasets.
ASTRA-Net: Anatomy-Specific Transfer and Representation Alignment for Drug-Induced Sleep Endoscopy Segmentation
Quantitative drug-induced sleep endoscopy (DISE) requires reliable airway boundaries at specific anatomical levels. Pixel-level DISE annotations are scarce, and manual contouring limits the scalability of quantitative assessment. To address this limitation, we developed ASTRA-Net for known-plane DISE segmentation with limited real annotations. Stage 1 aligned intermediate ConvNeXt-Base representations from 14,250 unlabeled virtual endoscopy frames derived from computed tomography and real DISE frames. Virtual images were used only for feature alignment. Stage 2 fine-tuned four independent UNet++ decoders on 401 real annotated frames. Structured zero-mask supervision constrained incompatible plane outputs and invalid frames. Six alignment configurations used maximum mean discrepancy, domain adversarial learning, or both objectives. On a hold-out evaluation set of 100 frames, the five-model MMD-only segmentation ensemble achieved a mean Dice of 0.8927, with a 95% image-level bootstrap interval of 0.8631 to 0.9160. The mean intersection over union was 0.8239. A classification- enabled variant of the same alignment configuration reached a restricted four-plane top-1 accuracy of 0.92 on the same hold-out frames. These results indicate that ASTRA-Net can support frame-level, plane-specific DISE boundary delineation when real annotations are limited.
ViPSAM: Visual Prompting Medical Image Segmentation Using Segment Anything Model
In proton therapy planning, respiratory-gated non-contrast CT (NCCT) is commonly used for lesion segmentation; however, accurate delineation remains challenging due to low lesion-to-background contrast. Although learning-based methods have shown strong performance, they often struggle with non-contrast image segmentation. Inspired by clinical practice, where contrast-enhanced MRI is referenced to delineate lesions on NCCT, we propose ViPSAM, a visual prompting framework that leverages complementary cross-modality information. Built upon the Segment Anything Model (SAM), ViPSAM introduces a visual prompt encoder to extract guidance features from contrast-enhanced images and a visual-guided cross-attention module to integrate non-contrast and contrast-enhanced features, thereby enhancing lesion-relevant representations in low-contrast regions. The mask decoder is further adapted in a parameter-efficient manner to utilize visual prompts effectively. We evaluate the proposed method on liver lesion segmentation using NCCT acquired for proton therapy. Experimental results demonstrate that ViPSAM outperforms representative U-Net- and SAM-based methods, indicating that cross-modality visual prompting enables more robust and accurate segmentation in non-contrast images.
GLOW-FDG: Generalized cancer LesiOn Whole-body segmentation model for F-FDG-PET/CT
Whole-body fluorodeoxyglucose positron emission tomography combined with computed tomography is widely used in cancer care, but manual lesion delineation is slow, subjective, and difficult to scale. We present GLOW-FDG, an open-source artificial intelligence model for whole-body cancer lesion segmentation in fluorodeoxyglucose positron emission tomography and computed tomography. The model was trained on 1,563 scans spanning multiple cancer types and evaluated on 185 external scans from independent institutions. Across breast cancer, nonmetastatic and oligometastatic lung cancer, head and neck cancer, and metastatic melanoma, GLOW-FDG consistently outperformed publicly available benchmark models in lesion detection, while reducing false positives and maintaining strong segmentation accuracy. Quantification of total tumor burden and total lesion glycolysis was robust across cohorts, and performance approached the variability observed between expert radiation oncologists. These results support GLOW-FDG as a generalizable tool for automated cancer segmentation and quantitative imaging biomarker extraction in whole-body imaging.
PSP: Harnessing Position and Shape Priors for Cross-Domain Few-Shot Medical Image Segmentation
Few-Shot Medical Image Segmentation (FSMIS) offers a powerful solution to data scarcity but struggles to generalize across different imaging modalities. This performance collapse stems primarily from the drastic texture discrepancies between domains, which mislead models trained on source-specific intensity distributions. While existing methods attempt to align frequency or local texture features, they often fail to decouple semantic structure from domain-specific appearance. To address this, we identify a critical invariance: despite distinct imaging physics, the position and geometric shape of organs remain robustly consistent across modalities. Therefore, we propose a novel framework that harnesses Position and Shape Priors (PSP) for cross-domain FSMIS. Specifically, PSP first introduces a Position Coordinate Embedding (PCE) module to inject relative spatial coordinates for rapid organ localization. Subsequently, a Shape Prototype Modulation (SPM) module constructs domain-invariant structural prototypes via explicit shape priors, effectively filtering out texture noise. Furthermore, the Hybrid-Prototype Prediction (HPP) module adaptively calibrates the support prototype to the query feature distribution, mitigating feature misalignment. Extensive experiments on two public medical imaging datasets demonstrate that PSP significantly outperforms state-of-the-art methods.
Intracranial Aneurysm Classification and Segmentation via Tri-Axial ROI and Multi-Task Learning
Intracranial aneurysms are often asymptomatic until rupture, which carries high mortality. Rupture risk assessment and treatment planning depend on both aneurysm morphology and anatomical location, yet existing automated methods remain limited to binary detection without fine-grained anatomical classification or multi-class segmentation. We present a multi-task framework that simultaneously performs multi-label classification, multi-class aneurysm segmentation, and multi-class vessel segmentation across 13 anatomical locations and four imaging modalities (CTA, MRA, T2, T1-post). Our two-stage approach combines a fast 2D tri-axial Region of Interest (ROI) extraction method with a 3D multi-task nnU-Net backbone. A dual-decoder design mitigates the extreme volume imbalance between aneurysm and vessel classes, while cross-attention pooling and modality-specific auxiliary heads improve feature learning across heterogeneous inputs. Our two-fold ensemble achieved 2nd place in the RSNA 2025 Intracranial Aneurysm Detection challenge. Code, model weights, and a 3D Slicer plugin are publicly available.
C^2GR: Coupled Comprehensive Generative Replay for a Continually Learnable Universal Segmentation Model
Universal segmentation models exhibit significant potential for diverse tasks involving different imaging modalities and segmentation objectives. Task-Incremental Learning provides a privacy-preserving approach to continually evolve a universal model on tasks from sequentially-arriving medical departments. However, training the model solely on the incoming task induces forgetting on past tasks, since consecutive tasks exhibit concurrent shifts in image appearance and segmentation objective. To address this problem, we propose a novel Coupled Comprehensive Generative Replay (C^2GR) framework that simultaneously synthesizes image-mask pairs of previous tasks to mitigate forgetting under concurrent appearance and objective shifts. This requires preserving image-mask correspondence for structure-realistic generation and bridging asynchronous optimization of the generator and segmentor for segmentation-oriented generation. Specifically, we propose a Bayesian Joint Diffusion (BJD) method that formulates the correspondence as conditional distributions optimized via conditional denoising. Furthermore, we develop a Relation-aware Unified Prompt Synchronization (RUPS) scheme to simultaneously modulate the generator and segmentor via a shared task-relation-aware prompt for synchronizing their optimization. Experiments on 20 tasks spanning diverse modalities and objectives demonstrate that C^2GR exhibits only a 2.44% drop in overall performance compared to joint training with all task data, effectively alleviating forgetting from the concurrent shifts. Our code will be made publicly available at https://github.com/mar-cry/C2GR.
EnTrust: Modeling Inter-Modal Conflict for Trustworthy Multimodal Medical Image Analysis
Multimodal medical imaging fuses complementary anatomical and functional information, yet modalities frequently disagree in pathologically heterogeneous regions. Current segmentation models handle this in one of two inadequate ways: deterministic fusion that averages away disagreement, or post-hoc uncertainty estimation decoupled from the fusion process that produces it. Both obscure the clinically critical question: why is this prediction unreliable? We present EnTrust, a framework that treats inter-modal conflict as the primary source of predictive uncertainty. Our EnFuse module decomposes multimodal features into three disentangled components: shared anatomical consensus (F_c), modality-specific cues (F_{u,m}), and spatially localized conflict signals (F_{cf}), with independence enforced via a cross-covariance objective. This structured decomposition conditions SegDiff, a diffusion-based generative segmentation model whose sampled hypotheses diverge specifically in regions of modal disagreement. TrustMap then translates this hypothesis divergence into calibrated, pixel-wise uncertainty using ensemble entropy, conflict-guided perturbation probing, and a learned calibration head, enabling clinicians to understand not only where predictions are uncertain, but why. Across four benchmarks spanning brain, cardiac, lesion, and oncology domains, EnTrust achieves state-of-the-art segmentation accuracy while reducing calibration error by 40% compared to the strongest baseline. Notably, it outperforms 5x deep ensembles using a single model at roughly half the memory footprint. Code and checkpoints are available at https://github.com/GenMI-Lab/EnTrust.git.
Mutual Distillation of Dual-Foundation Models for Semi-Supervised PET/CT Segmentation
Organ segmentation from PET/CT is critical for quantitative analysis and radiotherapy planning in oncology. To ease the high annotation cost of PET/CT segmentation, semi-supervised learning (SSL) provides a practical and effective solution for developing deep models with limited labeled data. Recent developments in visual foundation models have demonstrated remarkable adaptability with improved efficiency. In this work, we propose a mutual distillation framework that seamlessly exploits both structural and functional foundation models, which act as modality-specific generalists for distilling knowledge from structural CT and metabolic PET imaging. By bridging the gap between the task-specific precision of student models and the segmentation priors of generalist foundation models, we propose \textbf{MuDuo}, a mutual distillation framework that synergistically leverages SAM-Med3D for CT and SegAnyPET for PET to distill their knowledge into a lightweight student network. Our approach eliminates the need for manual prompts while maximizing the utility of unlabeled data for automatic segmentation, achieving state-of-the-art performance on the AutoPET dataset with only 5 labeled cases. Our source code is available at https://github.com/Wu-beining/MuDuo.
One Click per Cell Type Suffices: Training-free Group Interaction for Cell Instance Segmentation
Cell instance segmentation models trained on cell-specific datasets suffer severe performance drops on out-of-distribution cell types, while interactive foundation models overcome this through per-instance prompting at a cost that is prohibitively expensive for histopathology images containing hundreds to thousands of densely packed instances. We introduce \textbf{Group Prompting}, a new paradigm that shifts interactive segmentation from per-instance to per-type , where a single click per cell type suffices to segment all instances of that type. Our key observation is that the frozen image encoder of the Segment Anything Model (SAM) already clusters same-type cells in its feature space before any prompt is given, and that this clustering holds across staining modalities without any training. Exploiting this property, we propose \textbf{Chain-of-Prompts (CoP)}, a training-free framework that recursively expands a single user click by (1) identifying reliable same-type locations through non-parametric gating of multi-scale encoder features, and (2) selecting the most spatially distant reliable point as the next prompt to maximize coverage. On eleven benchmarks, CoP generalizes to both unseen cell types and unseen imaging modalities without any adaptation: with one click per type it retains over 90% of per-instance performance on three cell-type-annotated datasets while surpassing fully-supervised methods, and with one click per image it retains over 95% on eight datasets spanning both H&E and non-H&E imaging. Project Page: https://shjo-april.github.io/Chain-of-Prompts/
An Open Multi-Center Whole-Body FDG PET/CT Foundation Model for Tumor Segmentation
The synergistic interpretation of anatomical information from computed tomography (CT) and metabolic information from positron emission tomography (PET) is important to oncologic imaging. However, existing deep learning methods for PET/CT remain largely task-specific, are often trained on single-center cohorts, or adopt dual-branch fusion schemes that delay cross-modal interaction and underutilize early spatial correspondence between PET and CT. To address these limitations, we present an open-source, multi-center, whole-body FDG PET/CT foundation model utilizing 4,997 harmonized scans from four public datasets. Our framework employs hierarchical UNet-shaped backbones with early channel-wise concatenation, enabling anatomical and metabolic features to interact from the first embedding layer onward. We further introduce a masked autoencoding objective based on zero-mean imputation, combined with a weighted global reconstruction loss. This design avoids non-physical intensity discontinuities at masked-region boundaries that arise from learnable mask tokens. On downstream AutoPET lesion segmentation, the proposed models demonstrate strong label efficiency: with only 10% of the labeled training data, they achieve performance comparable to models trained from scratch on the full dataset. Under extreme 5-shot linear probing, joint PET/CT pretraining also achieves higher Dice scores than separated-modality pretraining. This multi-center foundation model demonstrates label efficiency and cross-modality representation learning for PET/CT tumor segmentation. It provides a robust, open-source basis for advancing automated oncologic imaging, significantly reducing the need for large-scale manual annotations in clinical practice.
Benchmarking transferability of SSL pretraining to same and different modality segmentation tasks
Methods: Nine SSL methods spanning four pretext-task families were pretrained from scratch using the same 10{,}412 3D CT scans (1.89~M 2D axial slices) covering varied disease sites. The pretrained Swin Transformer encoder from each method was integrated into a SwinUNETR-style segmentation network (Swin encoder with a 3D CNN decoder and skip connections) and fine-tuned on nine public segmentation tasks of varying complexity, including large abdominal organs, head-and-neck structures, and tumors from CT and MRI. Performance was assessed using Dice similarity coefficient (DSC). Fine-tuning convergence speed, transferability across modalities (CT-to-MRI), and feature-reuse patterns between few- and many-shot fine tuning were further analyzed using centered kernel alignment. Results: Self-distilled masked image transformer (SMIT), which combines masked image modeling (MIM) with local and global self-distillation, achieved the highest overall segmentation accuracy across the nine tasks, the fastest fine-tuning convergence, and the smallest few-shot-to-many-shot performance gap, indicating the strongest data efficiency. SMIT also showed the most consistent feature-reuse patterns between few- and many-shot fine tuning. MIM-based SimMIM and self-distillation methods (DINO, iBOT) outperformed contrastive learning and rotation prediction, which rely on image-level global representations. Differences between SSL methods were largest in the few-shot setting and narrowed as the size of the labeled fine-tuning dataset increased, indicating that the choice of SSL pretraining matters most under limited annotation budgets.
Speech-Guided Multimodal Learning for Vocal Tract Segmentation in Real-Time MRI
Segmenting vocal tract articulators in real-time MRI (rtMRI) is a challenging dynamic image segmentation problem characterized by low contrast, rapid motion, and limited spatial resolution. However, while rtMRI acquisitions may provide synchronized acoustic signals, existing methods discard this information, and the few multimodal approaches that incorporate audio cannot be deployed when audio is unavailable. We propose a three-stage framework that leverages acoustic and phonological supervision during training while requiring only the rtMRI image at inference: phonological representations are converted into spatial bounding-box priors for articulator localization, visual and acoustic encoders are aligned via dual-level cross-modal contrastive pretraining, and the learned representations are fused through a cross-attention decoder, effectively transferring multimodal knowledge into a single-modality inference pipeline. Evaluated on 75-Speaker~Annot-16 and USC-TIMIT datasets, our method outperforms existing unimodal and multimodal methods, demonstrating that multimodal supervision provides transferable benefits for precise and clinically deployable vocal tract segmentation.
Rad-VLSM: A Cross-Modal Framework with Semantics-Assisted Prompting for Medical Segmentation and Diagnosis
Medical image segmentation is more clinically valuable when it supports diagnosis rather than merely producing lesion masks. However, diagnostically relevant lesion cues are often subtle and localized, while existing models may be distracted by background tissues, acoustic artifacts, and irrelevant visual correlations. To address this problem, we propose Rad-VLSM, a two-stage cross-modal framework for semantics-assisted lesion focusing, robust segmentation, and visually grounded diagnosis. In the first stage, a BLIP-2-based vision-language alignment module identifies lesion-related candidate regions under semantic guidance and converts them into box prompts. In the second stage, these prompts are fed into a SAM-based multitask network, where a multi-candidate region aggregation strategy improves prompt stability and guides lesion segmentation. The predicted masks are then used as spatial priors for diagnosis, and a visual-radiomics fusion head integrates lesion-aware visual features with selected radiomics descriptors. By using semantic information for localization rather than direct prediction, Rad-VLSM reduces text-to-diagnosis dependence and grounds diagnosis in lesion-level evidence. Experiments on a private clinical breast ultrasound dataset and public benchmarks show that Rad-VLSM achieves strong segmentation and diagnostic performance with favorable generalization.
Degradation-Aware Blur-Segmentation of Brain Tumor
Multimodal 3D MRI brain tumor segmentation is a pivotal step in radiotherapy target delineation, surgical planning and post-treatment assessment. Existing methods often assume artifact-free MRI images. However, inevitable patient motion during scanning introduces artifacts and blur that degrade boundary and texture features, leading to poor segmentation performance. To bridge this gap, we introduce Degradation-Aware Blur-Segmentation Net (DABSeg), a synchronous deblurring 3D multimodal MRI segmentation network that unifies blur removal and accurate segmentation. Specifically, we propose a feature-domain motion-deblurring stem to compensate for blur and rebalance intensity. Concurrently, the backbone network embeds a blur-aware cross-modal cross-attention module and multi-scale residual aggregation to yield effective modality complementarity. Notably, we optimize a joint loss that combines weighted Dice with a clear-reference reconstruction term, where imbalanced weights are applied to small targets to boost learning intensity and predictive stability for small lesions and border regions. Systematic comparisons and ablation experiments on the BraTS2020 dataset under both clear and degenerative conditions consistently demonstrate that DABSeg surpasses state-of-the-art methods in tumor Dice score and boundary precision. These results validate the effectiveness of degenerative-aware cross-task collaborative learning in improving the robustness and clinical utility of multi-modal 3D brain tumor segmentation under realistic degenerative conditions. The source code is available at https://github.com/YuchunWang24/DABSeg_ICPR
Geometry-aware Prototype Learning for Cross-domain Few-shot Medical Image Segmentation
Cross-domain few-shot medical image segmentation (CD-FSMIS) requires a model to generalise simultaneously to novel anatomical categories and unseen imaging domains from only a handful of annotated examples. Existing prototypical approaches inevitably entangle anatomical structure with domain-specific appearance variations, and thus lack a stable reference for reliable matching under domain shift. We observe that the geometric structure of human anatomy constitutes a reliable, domain-transferable prior that has been overlooked. Building on this insight, we propose GeoProto, a geometry-aware CD-FSMIS framework that enriches prototypical matching with explicit structural priors. The core component, Geometry-Aware Prototype Enrichment (GAPE), augments each local appearance prototype with a learned geometric offset encoding its ordinal position within the organ's interior topology. This offset is derived from an auxiliary Ordinal Shape Branch (OSB) trained under an ordinally consistent objective that enforces monotonic variation of geometric embeddings across interior strata, requiring no annotation beyond standard segmentation masks. Extensive experiments across seven datasets spanning three evaluation settings (cross-modality, cross-sequence, and cross-context) demonstrate that GeoProto achieves state-of-the-art performance.
GenMed: A Pairwise Generative Reformulation of Medical Diagnostic Tasks
Data-driven medical AI is traditionally formulated as a discriminative mapping from input to output via a learned function , which does not generalize well across heterogeneous data and modalities encountered in real-world clinical settings. In this work, we propose a fundamentally different, generative paradigm. We model the joint distribution using diffusion models and reframe inference as a test-time output optimization problem. By guiding the generative process to match observed inputs, our framework enables flexible, gradient-based conditioning at inference time without architectural changes or retraining, effectively supporting arbitrary and previously unseen combinations of observations. Extensive experiments demonstrate strong performance across standard and cross-modality medical image segmentation, few-shot segmentation with only 2 or 4 training samples, degraded-input segmentation, shape completion from sparse and partial observations, and zero-shot application to demonstrate generality. To support these evaluations, we curated and released a large-scale text-shape dataset derived from MedShapeNet. Our results highlight the versatility of generative joint modeling as a foundation for reusable, task-agnostic medical AI systems.
Cross-Source Supervision for Bone Infection Segmentation in Dual-Modality PET-CT
Early and accurate diagnosis and lesion localization of bone infections are crucial for clinical treatment. PET-CT integrates anatomical information from CT with metabolic information from PET, making it an important imaging modality for diagnosing bone infections. However, accurate lesion segmentation remains challenging due to indistinct lesion boundaries and inconsistencies in annotations generated by different experts or automated systems. In this work, we investigate multimodal segmentation of bone infections under annotation discrepancy. We develop a bimodal end-to-end segmentation framework that integrates PET metabolic signals and CT bone-window anatomy through an early-fusion multimodal representation.To mitigate performance inflation caused by inter-slice correlation in small datasets, this study discards traditional two-dimensional evaluation methods and implements a rigorous patient-level 3D volumetric evaluation and cross-validation. Furthermore, instead of forcing a singular consensus, we propose a decoupled dual-source learning framework where parallel models are trained on independent expert annotations driven by high-sensitivity and high-specificity clinical intents. Experimental results objectively report performance variations at the patient level (Mean + SD and Mean - SD), demonstrating the effectiveness of multimodal PET-CT fusion. The cross-evaluation matrix quantitatively reveals how models successfully internalize distinct expert diagnostic philosophies, providing a robust, diversity-preserving paradigm for clinical AI deployment in bone infection segmentation.
LARGO: Low-Rank Hypernetwork for Handling Missing Modalities
Addressing missing modalities is an important challenge in multimodal image analysis and often relies on complex architectures that do not transfer easily to different datasets without architectural modifications or hyperparameter tuning. While most existing methods tackle this problem in feature space by engineering representations that are robust to missing inputs, we instead operate in weight space. We propose LARGO, a hypernetwork that compresses the dedicated missing-modality models into a single network by modelling the convolutional weights using the Canonical Polyadic (CP) tensor decomposition. Extensive experimental validation on BraTS 2018 (4 modalities, 15 scenarios) and ISLES 2022 (3 modalities, 7 scenarios) shows that our method ranks first in 47 out of 52 configurations, achieving average Dice improvements of +0.68 and +2.53 over state-of-the-art baselines (mmFormer, MAE, ShaSpec, SimMLM). A proof-of-concept experiment on avMNIST suggests that LARGO may extend beyond medical imaging to heterogeneous non-medical modalities.
Tumor-aware augmentation with task-guided attention analysis improves rectal cancer segmentation from magnetic resonance images
Although self-supervised pretraining is expected to learn broadly transferable representations, its effectiveness across imaging modalities substantially different from the pretraining domain, and on complex tumor-segmentation tasks, remains understudied. Evaluating CT-pretrained transformers on MRI rectal cancer segmentation, we identified two interacting failure modes in CT-to-MRI transfer: (a) inefficient token usage caused by zero-padding to match pretrained input dimensions, and (b) ineffective feature adaptation. We investigated these vulnerabilities using two primary CT-pretrained hierarchical shifted-window transformer backbones, SMIT and Swin UNETR, together with VoCo as a large-scale-pretrained supporting benchmark; these models differ in pretraining objectives and datasets. Mechanistic analysis leveraged an attention dilution index (ADI), an entropy-based metric quantifying attention diverted toward uninformative padding tokens, and centered kernel alignment (CKA) to measure feature reuse during MRI adaptation. ADI increased with zero-padding, while high feature reuse did not necessarily translate to improved downstream accuracy. To mitigate these issues, we introduced two interventions: a tumor-aware augmentation strategy to expand tumor appearance heterogeneity coverage, and an anisotropic cropping strategy to restore token efficiency. Fine-tuning with these strategies on identical rectal MRI datasets yielded detection rates of 91.1% (225/247) and 88.7% (219/247) for the primary SMIT and Swin UNETR backbones, with the supporting VoCo benchmark reaching 90.3% (223/247), demonstrating significantly improved robustness under CT-to-MRI transfer. This study is among the first to examine when pretrained transformers fail to transfer across imaging modalities and demonstrates how targeted mitigation strategies can systematically overcome cross-modality transfer limitations.
One Sequence to Segment Them All: Efficient Data Augmentation for CT and MRI Cross-Domain 3D Spine Segmentation
Deep learning-based medical image segmentation is increasingly used to support clinical diagnosis and develop new treatment strategies. However, model performance remains limited by the scarcity of high-quality annotated data and insufficient generalization across imaging protocols. This limitation is particularly evident in MRI and CT, where models are typically trained on a single acquisition sequence and exhibit reduced robustness when applied to unseen sequences or contrasts. Although data augmentation is widely used to improve general robustness on medical images, its impact on cross-modality generalization has not been quantitatively explored. In this work, we study a targeted set of data augmentation techniques designed to improve cross-modality transfer. We train three spine segmentation models, each on a single-modality/sequence dataset, and evaluate them across seven out-of-distribution datasets (spanning CT and MRI), reflecting a realistic single-sequence training and multi-sequence/contrast/modality deployment scenario. Our results demonstrate substantial performance gains on unseen domains (average Dice gain of 155 %) while preserving in-domain accuracy (average Dice decrease of 0.008 %), including effective transfer between CT and MRI. To mitigate the computational cost typically associated with strong data augmentation, we implement GPU-optimized augmentations that maintain, and even improve, training efficiency by approximately 10 %. We release our approach as an open-source toolbox, enabling seamless integration into commonly used frameworks such as nnUNet and MONAI. These augmentations significantly enhance robustness to heterogeneous clinical imaging scenarios without compromising training speed.
VitaminP: cross-modal learning enables whole-cell segmentation from routine histology
Accurate whole-cell and nuclear segmentation is essential for precision pathology and spatial omics, yet routine hematoxylin and eosin (H&E) staining provides limited cytoplasmic contrast, restricting analyses to nuclei. Multiplex immunofluorescence (mIF) facilitates precise whole-cell delineation but remains constrained by cost and accessibility. We introduce VitaminP, a cross-modal learning framework enabling whole cell segmentation from H&E images. By learning from paired H&E-mIF data, VitaminP transfers molecular boundary information from mIF to overcome cytoplasmic contrast in H&E, establishing cross-modal supervision as a general strategy for recovering missing biological structure. We train VitaminP on 14 public datasets covering 34 cancer types and over 7 million instances, integrating publicly available labels with extensive annotations generated in this study, forming one of the largest resources for segmentation. VitaminP outperforms four state-of-the-art methods and generalizes to unseen datasets, including an in-house dataset spanning 24 rare cancer types. We further developed VitaminPScope, an open-source platform providing an interface for scalable inference and enabling broad adoption.