Medical ultrasound imaging is ubiquitous, but manual analysis struggles to keep pace. Automated segmentation can help but requires large labeled datasets, which are scarce. Semi-supervised learning leveraging both unlabeled and limited labeled data is a promising approach. State-of-the-art methods use consistency regularization or pseudo-labeling but grow increasingly complex. Without sufficient labels, these models often latch onto artifacts or allow anatomically implausible segmentations. In this paper, we present a simple yet effective pseudo-labeling method with an adversarially learned shape prior to regularize segmentations. Specifically, we devise an encoder-twin-decoder network where the shape prior acts as an implicit shape model, penalizing anatomically implausible but not ground-truth-deviating predictions. Without bells and whistles, our simple approach achieves state-of-the-art performance on two benchmarks under different partition protocols. We provide a strong baseline for future semi-supervised medical image segmentation. Code is available at https://github.com/WUTCM-Lab/Shape-Prior-Semi-Seg.
Referring remote sensing image segmentation (RRSIS) is a novel visual task in remote sensing images segmentation, which aims to segment objects based on a given text description, with great significance in practical application. Previous studies fuse visual and linguistic modalities by explicit feature interaction, which fail to effectively excavate useful multimodal information from dual-branch encoder. In this letter, we design a multimodal-aware fusion network (MAFN) to achieve fine-grained alignment and fusion between the two modalities. We propose a correlation fusion module (CFM) to enhance multi-scale visual features by introducing adaptively noise in transformer, and integrate cross-modal aware features. In addition, MAFN employs multi-scale refinement convolution (MSRC) to adapt to the various orientations of objects at different scales to boost their representation ability to enhances segmentation accuracy. Extensive experiments have shown that MAFN is significantly more effective than the state of the art on RRSIS-D datasets. The source code is available at https://github.com/Roaxy/MAFN.
Pre-trained segmentation models are a powerful and flexible tool for segmenting images. Recently, this trend has extended to medical imaging. Yet, often these methods only produce a single prediction for a given image, neglecting inherent uncertainty in medical images, due to unclear object boundaries and errors caused by the annotation tool. Multiple Choice Learning is a technique for generating multiple masks, through multiple learned prediction heads. However, this cannot readily be extended to producing more outputs than its initial pre-training hyperparameters, as the sparse, winner-takes-all loss function makes it easy for one prediction head to become overly dominant, thus not guaranteeing the clinical relevancy of each mask produced. We introduce SeqSAM, a sequential, RNN-inspired approach to generating multiple masks, which uses a bipartite matching loss for ensuring the clinical relevancy of each mask, and can produce an arbitrary number of masks. We show notable improvements in quality of each mask produced across two publicly available datasets. Our code is available at https://github.com/BenjaminTowle/SeqSAM.
Analyzing CT scans, MRIs and X-rays is pivotal in diagnosing and treating diseases. However, detecting and identifying abnormalities from such medical images is a time-intensive process that requires expert analysis and is prone to interobserver variability. To mitigate such issues, machine learning-based models have been introduced to automate and significantly reduce the cost of image segmentation. Despite significant advances in medical image analysis in recent years, many of the latest models are never applied in clinical settings because state-of-the-art models do not easily interface with existing medical image viewers. To address these limitations, we propose QuickDraw, an open-source framework for medical image visualization and analysis that allows users to upload DICOM images and run off-the-shelf models to generate 3D segmentation masks. In addition, our tool allows users to edit, export, and evaluate segmentation masks to iteratively improve state-of-the-art models through active learning. In this paper, we detail the design of our tool and present survey results that highlight the usability of our software. Notably, we find that QuickDraw reduces the time to manually segment a CT scan from four hours to six minutes and reduces machine learning-assisted segmentation time by 10\% compared to prior work. Our code and documentation are available at https://github.com/qd-seg/quickdraw
Image segmentation is a challenging task influenced by multiple sources of uncertainty, such as the data labeling process or the sampling of training data. In this paper we focus on binary segmentation and address these challenges using conformal prediction, a family of model- and data-agnostic methods for uncertainty quantification that provide finite-sample theoretical guarantees and applicable to any pretrained predictor. Our approach involves computing nonconformity scores, a type of prediction residual, on held-out calibration data not used during training. We use dilation, one of the fundamental operations in mathematical morphology, to construct a margin added to the borders of predicted segmentation masks. At inference, the predicted set formed by the mask and its margin contains the ground-truth mask with high probability, at a confidence level specified by the user. The size of the margin serves as an indicator of predictive uncertainty for a given model and dataset. We work in a regime of minimal information as we do not require any feedback from the predictor: only the predicted masks are needed for computing the prediction sets. Hence, our method is applicable to any segmentation model, including those based on deep learning; we evaluate our approach on several medical imaging applications.
Accurate segmentation of thin, tubular structures (e.g., blood vessels) is challenging for deep neural networks. These networks classify individual pixels, and even minor misclassifications can break the thin connections within these structures. Existing methods for improving topology accuracy, such as topology loss functions, rely on very precise, topologically-accurate training labels, which are difficult to obtain. This is because annotating images, especially 3D images, is extremely laborious and time-consuming. Low image resolution and contrast further complicates the annotation by causing tubular structures to appear disconnected. We present CoLeTra, a data augmentation strategy that integrates to the models the prior knowledge that structures that appear broken are actually connected. This is achieved by creating images with the appearance of disconnected structures while maintaining the original labels. Our extensive experiments, involving different architectures, loss functions, and datasets, demonstrate that CoLeTra leads to segmentations topologically more accurate while often improving the Dice coefficient and Hausdorff distance. CoLeTra's hyper-parameters are intuitive to tune, and our sensitivity analysis shows that CoLeTra is robust to changes in these hyper-parameters. We also release a dataset specifically suited for image segmentation methods with a focus on topology accuracy. CoLetra's code can be found at https://github.com/jmlipman/CoLeTra.
We have witnessed remarkable progress in foundation models in vision tasks. Currently, several recent works have utilized the segmenting anything model (SAM) to boost the segmentation performance in medical images, where most of them focus on training an adaptor for fine-tuning a large amount of pixel-wise annotated medical images following a fully supervised manner. In this paper, to reduce the labeling cost, we investigate a novel weakly-supervised SAM-based segmentation model, namely WeakMedSAM. Specifically, our proposed WeakMedSAM contains two modules: 1) to mitigate severe co-occurrence in medical images, a sub-class exploration module is introduced to learn accurate feature representations. 2) to improve the quality of the class activation maps, our prompt affinity mining module utilizes the prompt capability of SAM to obtain an affinity map for random-walk refinement. Our method can be applied to any SAM-like backbone, and we conduct experiments with SAMUS and EfficientSAM. The experimental results on three popularly-used benchmark datasets, i.e., BraTS 2019, AbdomenCT-1K, and MSD Cardiac dataset, show the promising results of our proposed WeakMedSAM. Our code is available at https://github.com/wanghr64/WeakMedSAM.
Accurate medical image segmentation is crucial for precise anatomical delineation. Deep learning models like U-Net have shown great success but depend heavily on large datasets and struggle with domain shifts, complex structures, and limited training samples. Recent studies have explored diffusion models for segmentation by iteratively refining masks. However, these methods still retain the conventional image-to-mask mapping, making them highly sensitive to input data, which hampers stability and generalization. In contrast, we introduce DiffAtlas, a novel generative framework that models both images and masks through diffusion during training, effectively ``GenAI-fying'' atlas-based segmentation. During testing, the model is guided to generate a specific target image-mask pair, from which the corresponding mask is obtained. DiffAtlas retains the robustness of the atlas paradigm while overcoming its scalability and domain-specific limitations. Extensive experiments on CT and MRI across same-domain, cross-modality, varying-domain, and different data-scale settings using the MMWHS and TotalSegmentator datasets demonstrate that our approach outperforms existing methods, particularly in limited-data and zero-shot modality segmentation. Code is available at https://github.com/M3DV/DiffAtlas.
Dichotomous Image Segmentation (DIS) is a high-precision object segmentation task for high-resolution natural images. The current mainstream methods focus on the optimization of local details but overlook the fundamental challenge of modeling the integrity of objects. We have found that the depth integrity-prior implicit in the the pseudo-depth maps generated by Depth Anything Model v2 and the local detail features of image patches can jointly address the above dilemmas. Based on the above findings, we have designed a novel Patch-Depth Fusion Network (PDFNet) for high-precision dichotomous image segmentation. The core of PDFNet consists of three aspects. Firstly, the object perception is enhanced through multi-modal input fusion. By utilizing the patch fine-grained strategy, coupled with patch selection and enhancement, the sensitivity to details is improved. Secondly, by leveraging the depth integrity-prior distributed in the depth maps, we propose an integrity-prior loss to enhance the uniformity of the segmentation results in the depth maps. Finally, we utilize the features of the shared encoder and, through a simple depth refinement decoder, improve the ability of the shared encoder to capture subtle depth-related information in the images. Experiments on the DIS-5K dataset show that PDFNet significantly outperforms state-of-the-art non-diffusion methods. Due to the incorporation of the depth integrity-prior, PDFNet achieves or even surpassing the performance of the latest diffusion-based methods while using less than 11% of the parameters of diffusion-based methods. The source code at https://github.com/Tennine2077/PDFNet
The growing rate of chronic wound occurrence, especially in patients with diabetes, has become a concerning trend in recent years. Chronic wounds are difficult and costly to treat, and have become a serious burden on health care systems worldwide. Chronic wounds can have devastating consequences for the patient, with infection often leading to reduced quality of life and increased mortality risk. Innovative deep learning methods for the detection and monitoring of such wounds have the potential to reduce the impact to both patient and clinician. We present a novel multimodal segmentation method which allows for the introduction of patient metadata into the training workflow whereby the patient data are expressed as Gaussian random fields. Our results indicate that the proposed method improved performance when utilising multiple models, each trained on different metadata categories. Using the Diabetic Foot Ulcer Challenge 2022 test set, when compared to the baseline results (intersection over union = 0.4670, Dice similarity coefficient = 0.5908) we demonstrate improvements of +0.0220 and +0.0229 for intersection over union and Dice similarity coefficient respectively. This paper presents the first study to focus on integrating patient data into a chronic wound segmentation workflow. Our results show significant performance gains when training individual models using specific metadata categories, followed by average merging of prediction masks using distance transforms. All source code for this study is available at: https://github.com/mmu-dermatology-research/multimodal-grf
Gliomas are aggressive brain tumors that require accurate imaging-based diagnosis, with segmentation playing a critical role in evaluating morphology and treatment decisions. Manual delineation of gliomas is time-consuming and prone to variability, motivating the use of deep learning to improve consistency and alleviate clinical workload. However, existing methods often fail to fully exploit the information available in multi-parametric MRI (mp-MRI), particularly inter-slice contextual features, and typically require considerable computational resources while lacking robustness across tumor type variations. We present GBT-SAM, a parameter-efficient deep learning framework that adapts the Segment Anything Model (SAM), a large-scale vision model, to volumetric mp-MRI data. GBT-SAM reduces input complexity by selecting fewer than 2.6\% of slices per scan while incorporating all four MRI modalities, preserving essential tumor-related information with minimal cost. Furthermore, our model is trained by a two-step fine-tuning strategy that incorporates a depth-aware module to capture inter-slice correlations and lightweight adaptation layers, resulting in just 6.5M trainable parameters, which is the lowest among SAM-based approaches. GBT-SAM achieves a Dice Score of 93.54 on the BraTS Adult Glioma dataset and demonstrates robust performance on Meningioma, Pediatric Glioma, and Sub-Saharan Glioma datasets. These results highlight GBT-SAM's potential as a computationally efficient and domain-robust framework for brain tumor segmentation using mp-MRI. Our code and models are available at https://github.com/vpulab/med-sam-brain .
Effective monitoring of underwater ecosystems is crucial for tracking environmental changes, guiding conservation efforts, and ensuring long-term ecosystem health. However, automating underwater ecosystem management with robotic platforms remains challenging due to the complexities of underwater imagery, which pose significant difficulties for traditional visual localization methods. We propose an integrated pipeline that combines Visual Place Recognition (VPR), feature matching, and image segmentation on video-derived images. This method enables robust identification of revisited areas, estimation of rigid transformations, and downstream analysis of ecosystem changes. Furthermore, we introduce the SQUIDLE+ VPR Benchmark-the first large-scale underwater VPR benchmark designed to leverage an extensive collection of unstructured data from multiple robotic platforms, spanning time intervals from days to years. The dataset encompasses diverse trajectories, arbitrary overlap and diverse seafloor types captured under varying environmental conditions, including differences in depth, lighting, and turbidity. Our code is available at: https://github.com/bev-gorry/underloc
The nnU-Net framework has played a crucial role in medical image segmentation and has become the gold standard in multitudes of applications targeting different diseases, organs, and modalities. However, so far it has been used primarily in a centralized approach where the data collected from hospitals are stored in one center and used to train the nnU-Net. This centralized approach has various limitations, such as leakage of sensitive patient information and violation of patient privacy. Federated learning is one of the approaches to train a segmentation model in a decentralized manner that helps preserve patient privacy. In this paper, we propose FednnU-Net, a federated learning extension of nnU-Net. We introduce two novel federated learning methods to the nnU-Net framework - Federated Fingerprint Extraction (FFE) and Asymmetric Federated Averaging (AsymFedAvg) - and experimentally show their consistent performance for breast, cardiac and fetal segmentation using 6 datasets representing samples from 18 institutions. Additionally, to further promote research and deployment of decentralized training in privacy constrained institutions, we make our plug-n-play framework public. The source-code is available at https://github.com/faildeny/FednnUNet .
We present TopoMortar, a brick wall dataset that is the first dataset specifically designed to evaluate topology-focused image segmentation methods, such as topology loss functions. TopoMortar enables to investigate in two ways whether methods incorporate prior topological knowledge. First, by eliminating challenges seen in real-world data, such as small training set, noisy labels, and out-of-distribution test-set images, that, as we show, impact the effectiveness of topology losses. Second, by allowing to assess in the same dataset topology accuracy across dataset challenges, isolating dataset-related effects from the effect of incorporating prior topological knowledge. In these two experiments, it is deliberately difficult to improve topology accuracy without actually using topology information, thus, permitting to attribute an improvement in topology accuracy to the incorporation of prior topological knowledge. To this end, TopoMortar includes three types of labels (accurate, noisy, pseudo-labels), two fixed training sets (large and small), and in-distribution and out-of-distribution test-set images. We compared eight loss functions on TopoMortar, and we found that clDice achieved the most topologically accurate segmentations, Skeleton Recall loss performed best particularly with noisy labels, and the relative advantageousness of the other loss functions depended on the experimental setting. Additionally, we show that simple methods, such as data augmentation and self-distillation, can elevate Cross entropy Dice loss to surpass most topology loss functions, and that those simple methods can enhance topology loss functions as well. clDice and Skeleton Recall loss, both skeletonization-based loss functions, were also the fastest to train, making this type of loss function a promising research direction. TopoMortar and our code can be found at https://github.com/jmlipman/TopoMortar
Zero-shot Referring Image Segmentation (RIS) identifies the instance mask that best aligns with a specified referring expression without training and fine-tuning, significantly reducing the labor-intensive annotation process. Despite achieving commendable results, previous CLIP-based models have a critical drawback: the models exhibit a notable reduction in their capacity to discern relative spatial relationships of objects. This is because they generate all possible masks on an image and evaluate each masked region for similarity to the given expression, often resulting in decreased sensitivity to direct positional clues in text inputs. Moreover, most methods have weak abilities to manage relationships between primary words and their contexts, causing confusion and reduced accuracy in identifying the correct target region. To address these challenges, we propose IteRPrimE (Iterative Grad-CAM Refinement and Primary word Emphasis), which leverages a saliency heatmap through Grad-CAM from a Vision-Language Pre-trained (VLP) model for image-text matching. An iterative Grad-CAM refinement strategy is introduced to progressively enhance the model's focus on the target region and overcome positional insensitivity, creating a self-correcting effect. Additionally, we design the Primary Word Emphasis module to help the model handle complex semantic relations, enhancing its ability to attend to the intended object. Extensive experiments conducted on the RefCOCO/+/g, and PhraseCut benchmarks demonstrate that IteRPrimE outperforms previous state-of-the-art zero-shot methods, particularly excelling in out-of-domain scenarios.
While numerous architectures for medical image segmentation have been proposed, achieving competitive performance with state-of-the-art models networks such as nnUNet, still leave room for further innovation. In this work, we introduce nnUZoo, an open source benchmarking framework built upon nnUNet, which incorporates various deep learning architectures, including CNNs, Transformers, and Mamba-based models. Using this framework, we provide a fair comparison to demystify performance claims across different medical image segmentation tasks. Additionally, in an effort to enrich the benchmarking, we explored five new architectures based on Mamba and Transformers, collectively named X2Net, and integrated them into nnUZoo for further evaluation. The proposed models combine the features of conventional U2Net, nnUNet, CNN, Transformer, and Mamba layers and architectures, called X2Net (UNETR2Net (UNETR), SwT2Net (SwinTransformer), SS2D2Net (SwinUMamba), Alt1DM2Net (LightUMamba), and MambaND2Net (MambaND)). We extensively evaluate the performance of different models on six diverse medical image segmentation datasets, including microscopy, ultrasound, CT, MRI, and PET, covering various body parts, organs, and labels. We compare their performance, in terms of dice score and computational efficiency, against their baseline models, U2Net, and nnUNet. CNN models like nnUNet and U2Net demonstrated both speed and accuracy, making them effective choices for medical image segmentation tasks. Transformer-based models, while promising for certain imaging modalities, exhibited high computational costs. Proposed Mamba-based X2Net architecture (SS2D2Net) achieved competitive accuracy with no significantly difference from nnUNet and U2Net, while using fewer parameters. However, they required significantly longer training time, highlighting a trade-off between model efficiency and computational cost.
Deep learning-based medical image segmentation typically requires large amount of labeled data for training, making it less applicable in clinical settings due to high annotation cost. Semi-supervised learning (SSL) has emerged as an appealing strategy due to its less dependence on acquiring abundant annotations from experts compared to fully supervised methods. Beyond existing model-centric advancements of SSL by designing novel regularization strategies, we anticipate a paradigmatic shift due to the emergence of promptable segmentation foundation models with universal segmentation capabilities using positional prompts represented by Segment Anything Model (SAM). In this paper, we present SemiSAM+, a foundation model-driven SSL framework to efficiently learn from limited labeled data for medical image segmentation. SemiSAM+ consists of one or multiple promptable foundation models as generalist models, and a trainable task-specific segmentation model as specialist model. For a given new segmentation task, the training is based on the specialist-generalist collaborative learning procedure, where the trainable specialist model delivers positional prompts to interact with the frozen generalist models to acquire pseudo-labels, and then the generalist model output provides the specialist model with informative and efficient supervision which benefits the automatic segmentation and prompt generation in turn. Extensive experiments on two public datasets and one in-house clinical dataset demonstrate that SemiSAM+ achieves significant performance improvement, especially under extremely limited annotation scenarios, and shows strong efficiency as a plug-and-play strategy that can be easily adapted to different specialist and generalist models.
Weakly supervised segmentation methods can delineate thyroid nodules in ultrasound images efficiently using training data with coarse labels, but suffer from: 1) low-confidence pseudo-labels that follow topological priors, introducing significant label noise, and 2) low-rationality loss functions that rigidly compare segmentation with labels, ignoring discriminative information for nodules with diverse and complex shapes. To solve these issues, we clarify the objective and references for weakly supervised ultrasound image segmentation, presenting a framework with high-confidence pseudo-labels to represent topological and anatomical information and high-rationality losses to capture multi-level discriminative features. Specifically, we fuse geometric transformations of four-point annotations and MedSAM model results prompted by specific annotations to generate high-confidence box, foreground, and background labels. Our high-rationality learning strategy includes: 1) Alignment loss measuring spatial consistency between segmentation and box label, and topological continuity within the foreground label, guiding the network to perceive nodule location; 2) Contrastive loss pulling features from labeled foreground regions while pushing features from labeled foreground and background regions, guiding the network to learn nodule and background feature distribution; 3) Prototype correlation loss measuring consistency between correlation maps derived by comparing features with foreground and background prototypes, refining uncertain regions to accurate nodule edges. Experimental results show that our method achieves state-of-the-art performance on the TN3K and DDTI datasets. The code is available at https://github.com/bluehenglee/MLI-MSC.
Medical image segmentation is crucial for clinical diagnosis and treatment planning, especially when dealing with complex anatomical structures such as vessels. However, accurately segmenting vessels remains challenging due to their small size, intricate edge structures, and susceptibility to artifacts and imaging noise. In this work, we propose VesselSAM, an enhanced version of the Segment Anything Model (SAM), specifically tailored for aortic vessel segmentation. VesselSAM incorporates AtrousLoRA, a novel module integrating Atrous Attention and Low-Rank Adaptation (LoRA), to enhance segmentation performance. Atrous Attention enables the model to capture multi-scale contextual information, preserving both fine-grained local details and broader global context. Additionally, LoRA facilitates efficient fine-tuning of the frozen SAM image encoder, reducing the number of trainable parameters and thereby enhancing computational efficiency. We evaluate VesselSAM using two challenging datasets: the Aortic Vessel Tree (AVT) dataset and the Type-B Aortic Dissection (TBAD) dataset. VesselSAM achieves state-of-the-art performance, attaining DSC scores of 93.50\%, 93.25\%, 93.02\%, and 93.26\% across multi-center datasets. Our results demonstrate that VesselSAM delivers high segmentation accuracy while significantly reducing computational overhead compared to existing large-scale models. This development paves the way for enhanced AI-based aortic vessel segmentation in clinical environments. The code and models will be released at https://github.com/Adnan-CAS/AtrousLora.
As a novel and challenging task, referring segmentation combines computer vision and natural language processing to localize and segment objects based on textual descriptions. While referring image segmentation (RIS) has been extensively studied in natural images, little attention has been given to aerial imagery, particularly from unmanned aerial vehicles (UAVs). The unique challenges of UAV imagery, including complex spatial scales, occlusions, and varying object orientations, render existing RIS approaches ineffective. A key limitation has been the lack of UAV-specific datasets, as manually annotating pixel-level masks and generating textual descriptions is labour-intensive and time-consuming. To address this gap, we design an automatic labelling pipeline that leverages pre-existing UAV segmentation datasets and Multimodal Large Language Models (MLLM) for generating textual descriptions. Furthermore, we propose Aerial Referring Transformer (AeroReformer), a novel framework for UAV referring image segmentation (UAV-RIS), featuring a Vision-Language Cross-Attention Module (VLCAM) for effective cross-modal understanding and a Rotation-Aware Multi-Scale Fusion (RAMSF) decoder to enhance segmentation accuracy in aerial scenes. Extensive experiments on two newly developed datasets demonstrate the superiority of AeroReformer over existing methods, establishing a new benchmark for UAV-RIS. The datasets and code will be publicly available at: https://github.com/lironui/AeroReformer.