PET/CT Tumor Segmentation

Accurate PSMA PET/CT interpretation is central to prostate cancer management, yet existing PET/CT AI models typically address isolated tasks. We propose a unified PSMA PET/CT vision-language model for report generation, visual question answering, and lesion segmentation. The framework adopts an LLaVA-style architecture, comprising a PET/CT vision encoder, an MLP-Mixer projection module, a LoRA-tuned large language model, and a 3D segmentation branch. Training followed a four-stage strategy: vision encoder pretraining, projection-layer alignment, VLM fine-tuning, and final multitask tuning. Language tasks used 5,747 PSMA PET/CT datasets with paired reports, while segmentation used the PSMA subset of AutoPET. The model outperformed PET2REP and a CT-based baseline across standard report-generation metrics, improved performance across VQA question types, and achieved higher Dice and lesion-level overlap F1 than SegAnyPET and nnUNet. These results support the feasibility of a unified framework for structured, interactive, interpretable PSMA PET/CT analysis with voxel-level grounding within a single multitask model architecture.

Automated lesion segmentation in whole-body PET/CT is complicated by the variety of physiological tracer uptake patterns and by the differing appearance of lesions across tracers. The autoPET/CT V challenge addresses this by making segmentation interactive: user scribbles marking foreground and background are supplied alongside the image, and the algorithm is expected to exploit them. We present our submission, a scribble-conditioned residual encoder U-Net operating on four input channels: CT, PET, and a sparse scribble map for each of foreground and background. The network is initialised from the autoPET-III winning weights and extended from two to four input channels, with the two scribble channels zero-initialised so that the pretrained representation is preserved exactly at initialisation. Every model is fine-tuned per fold from the corresponding autoPET-III fold checkpoint, so that no validation case is seen during pretraining. PET intensities are normalised against a per-scan aorta blood-pool reference derived from a CT segmentation, which removes tracer- and centre-specific scaling without requiring lesion labels. At inference the five fold models are ensembled by averaging their softmax outputs per sliding-window patch, before Gaussian-weighted stitching. On the challenge's five-fold split, with each fold evaluated on its own validation cases, mean Dice is 0.554 and mean lesion-level F1 is 0.528 without scribbles, rising to 0.751 and 0.733 after five correction rounds. About 85% of that gain follows the first scribble, and the spread between fold models narrows five-fold over the same rounds, so interaction largely compensates for how well or badly a given model segments unaided.

Interactive lesion segmentation in whole-body PET/CT requires a model to provide a strong initial prediction while also responding efficiently to sparse corrective scribbles during inference. This setting is particularly challenging because tracer distributions, physiological uptake patterns, lesion appearance, and acquisition characteristics differ substantially between FDG and PSMA studies. We present TRIAGE, Tracer-aware Refinement via Interactive Anatomy-Guided sEgmentation. The core backbone is a 3D STU-Net initialized through masked autoencoding pre-training with an asynchronous masking strategy, aiming to learn transferable anatomical and cross-modal representations before task-specific fine-tuning. In parallel, we train an auxiliary organ segmentation model whose predictions provide explicit anatomical context and help distinguish physiological uptake from malignant lesions. A dedicated tracer classifier first routes each study to an FDG- or PSMA-specific branch. Within each branch, a first-stage segmentation model consumes CT, PET, and organ context to generate an initial lesion mask. The initial prediction is then combined with cumulative foreground/background scribbles and refined by a second interactive segmentation network. The FDG and PSMA branches share the same overall processing pipeline but are trained independently to account for tracer-specific appearance and error modes. We additionally employ curriculum-style training and model ensembling to improve robustness across interaction steps and heterogeneous cohorts. Experiments are conducted using the official AutoPET V data and ten-fold split; quantitative results, ablations, and final test-set performance are left as placeholders to be completed after the challenge evaluation. Code: https://github.com/Liiiii2101/AUTOPET2026-MEDAI.

This report describes Libo Zhang's algorithmic solution to autoPETV Grand Challenge on interactive lesion segmentation in whole-body PET/CT. Interaction is encoded as two additional input channels that rasterize the accumulated foreground and background scribbles, and a residual-encoder U-Net of about 140 million parameters is trained with a three-phase curriculum over 4000 epochs: the network first learns fully automatic segmentation with silent interaction channels, then observes ground-truth-derived scribbles under randomly sampled visibility modes, and finally adapts to its own mistakes through online simulation of up to five error-driven correction steps. Training draws on 1811 autoPET and DeepPSMA studies, and the submission ensembles the best and final checkpoints of five folds by logit averaging. In interactive five-fold cross-validation with six interaction steps, the final checkpoints reach a mean AUC-Dice of 3.836 and a mean AUC-DMM of 3.869, improving monotonically in every fold, with roughly half of the total gain delivered by the first corrective scribble. Our code and trained model checkpoints are available on https://github.com/Libo1023/autoPETV-Curriculum.

Automated lesion segmentation in whole-body PET/CT imaging can assist clinicians with cancer detection, staging, and treatment planning across radiotracers and cancer types. However, training lesion segmentation models that capture variations in lesion size, distribution, and appearance requires large annotated datasets, whose creation is both time- and expertise-intensive. As a result, models trained on limited labeled PET/CT data often lack the accuracy and generalizability needed for clinical use. We present FEEDS (Foundation model-Enabled Efficient Data Sampling), a label- and compute-efficient learning strategy that uses vision foundation model embeddings to select the most informative and diverse unlabeled cases for expert annotation. Unlike unsupervised, semi-supervised, and active learning approaches, FEEDS is a one-step training paradigm requiring only a limited, representative training set, making it label- and compute-efficient. We train and validate FEEDS using the AutoPET-III dataset. We test its accuracy and generalizability on three held-out sets: AutoPET-III, DeepPSMA, and an internal Dartmouth-Hitchcock Medical Center dataset. We evaluate clinical utility at the voxel, lesion, and anatomic region level to assess performance in high-risk areas and treatment planning utility. FEEDS outperforms random-sampling-based labeling, pseudolabel-based semi-supervised learning, and training with limited labeled data alone. It generalizes across all three test sets, FDG and PSMA tracers, and multiple diseases, matching fully-labeled (100%) training performance with 70% less annotation burden. FEEDS addresses the challenge of label scarcity in an automatic lesion segmentation framework by providing a practical approach for constructing representative and diverse annotation queues from large, unannotated clinical repositories.

We present HERMES (Hybrid Ensemble for Radiotherapy-target segmentation, Malignancy staging, and Event-free Survival), a single containerized algorithm for the three HECKTOR 2026 subtasks: segmentation of the primary tumor (GTVp) and pathological lymph nodes (GTVn), radiological T/N staging, and recurrence-free survival (RFS), computed from a paired FDG-PET/CT scan and an electronic health record. A 10-fold ensemble of STU-Net Small networks produces the segmentation; the predicted mask then drives two downstream tasks. Rather than pass a generic radiomics vector to the staging models, we derive from the predicted masks a compact set of geometry features aligned with the size and number axes of AJCC/UICC 7th-edition radiological N/T staging. On internal cross-validation these features raise N-stage balanced accuracy from 0.691 to 0.720 (+0.030), our largest single design gain, at lower feature dimensionality. For prognosis we combine complementary deep and clinical risk experts in an equal-weight ensemble, and train one deep expert with a concordance-tracking survival loss of our own, whose value approximates the concordance index during training. Every component was selected on honest out-of-fold predictions under a regularization-oriented protocol, with no tuning on the public validation set, and deployed as two decorrelated submissions. On the HECKTOR 2026 validation leaderboard, HERMES achieved a weighted score of 0.6454 (Mean Dice 0.641, T balanced accuracy 0.580, N balanced accuracy 0.642, RFS C-index 0.679) and qualified for the testing phase. Team: AMC_HNC.

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.

Accurate lesion segmentation in PET/CT is critical for oncology, yet remains challenging because physiologic tracer uptake and artifacts can mimic malignant signal. We present RADIANT-PET, a reasoning-augmented framework that couples a high-sensitivity voxel-level segmentation model with lesion-level large language model (LLM) adjudication. Candidate uptake regions are generated with a deliberately permissive segmentation stage, then converted into structured textual descriptions that summarize uptake intensity, morphology, and regional and global anatomical context. An LLM classifies each candidate as true lesion vs. false positive, optionally leveraging the radiology report as additional clinical context. To strengthen lesion-level reasoning, we further optimize a local LLM via reinforcement learning using Group Relative Policy Optimization, rewarding correct lesion classification and anatomically concordant site assignment. Across AutoPET and an OSU test cohort, RADIANT-PET consistently outperforms strong image-only baselines, with the largest improvements observed when radiology reports are provided. Overall, these results demonstrate that LLM-based lesion-level reasoning adds a novel reasoning layer beyond conventional segmentation, suppressing physiologic false positives and aligning voxel-level predictions with clinical interpretation. The project repository is available at: https://github.com/jwang-580/RADIANT-PET.

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.

Accurate lesion segmentation from whole-body Positron Emission Tomography (PET)/Computed Tomography (CT) scans is essential for cancer staging and treatment planning. PET provides functional metabolic information with different radiotracers, while CT offers anatomical localization. Lesion delineation from PET/CT imaging is clinically challenging due to subtle imaging features, confounders, and inter-reader variability. Existing deep learning approaches suffer from training-related stochasticity, inconsistent predictions, missed lesions in high tumor-burden cases, and lack uncertainty quantification, limiting their clinical reliability. Using nnU-Net as a baseline, we propose an uncertainty-aware framework for whole-body PET/CT lesion segmentation that integrates (1) Bayesian ensembling to reduce training stochasticity, (2) voxel-wise uncertainty quantification with epistemic and aleatoric decomposition, and (3) epistemic uncertainty-augmented training to improve lesion detection. Two public datasets, AutoPET-III (1,611 scans) and Deep-PSMA (200 scans), comprising FDG and PSMA studies across multiple cancer types, are used for training and evaluation. Bayesian ensembling improves robustness and performance over deterministic nnU-Net models on the unseen AutoPET-III test set. Uncertainty maps highlight regions of model disagreement and correlate with misclassifications, particularly false positives. Uncertainty-augmented training improves lesion recovery at the cost of increased FPVol, reflecting a precision-recall trade-off. A case-adaptive routing strategy further improves Dice by selecting between the base and augmented models. To our knowledge, this is the first study to systematically investigate uncertainty quantification in multi-tracer, pan-cancer PET/CT segmentation and to combine Bayesian ensembling with uncertainty-aware modeling for this task.

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.

We report the design and results of the third autoPET challenge (MICCAI 2024), which benchmarked automated lesion segmentation in whole-body PET/CT under a compositional generalization setting. Training data comprised 1,014 [18F]-FDG PET/CT studies from the University Hospital Tübingen and 597 [18F]/[68Ga]-PSMA PET/CT studies from the LMU University Hospital Munich, constituting the largest publicly available annotated PSMA PET/CT dataset to date. The held-out test set of 200 studies covered four tracer-center combinations, two of which represented unseen compositional pairings. A complementary data-centric award category isolated the contribution of data handling strategies by restricting participants to a fixed baseline model. Seventeen teams submitted 27 algorithms, predominantly nnU-Net-based 3D networks with PET/CT channel concatenation. The top-ranked algorithm achieved a mean DSC of 0.66, FNV of 3.18 mL, and FPV of 2.78 mL across all four test conditions, improving DSC by 8% and reducing the false-negative volume by 5 mL relative to the provided baseline. Ranking was stable across bootstrap resampling and alternative ranking schemes for the top tier. Beyond the benchmark, we provide an in-depth analysis of segmentation performance at the patient and lesion level. Three main conclusions can be drawn: (1) in-domain multitracer PET/CT segmentation is sufficient and probably approaching reader agreement; (2) compositional generalization to unseen tracer-center combinations remains an open problem mainly driven by systematic volume overestimation; (3) heterogeneity and case difficulty drive performance variation substantially more than the choice of algorithm among top-ranked teams.

Tumor segmentation in whole-body PET/CT imaging is crucial for precise disease evaluation and treatment planning. However, it remains challenging due to variability in lesion size, contrast, and anatomical distribution. Relying on manual segmentation makes the process time-consuming and prone to intra- and inter-observer variability. This work presents a whole-body tumor segmentation method developed for the AutoPET III challenge, where the goal is to build models that generalize across tracers and multi-center data. We employ the nnU-Net framework with a ResNet-based encoder as our baseline and systematically investigate the impact of training strategies, including intensity normalization, batch dice optimization, and data augmentation using CraveMix. Our experiments show that these strategies significantly influence model performance, particularly in reducing false positives and improving robustness to lesion variability. The best-performing configuration achieves a Dice score of up to 0.80 on the preliminary test phase, and our method ranked third in the AutoPET III challenge. The code is publicly available here.