Deep learning has demonstrated remarkable success in medical image segmentation and computer-aided diagnosis. In particular, numerous advanced methods have achieved state-of-the-art performance in brain tumor segmentation from MRI scans. While recent studies in other medical imaging domains have revealed that integrating textual reports with visual data can enhance segmentation accuracy, the field of brain tumor analysis lacks a comprehensive dataset that combines radiological images with corresponding textual annotations. This limitation has hindered the exploration of multimodal approaches that leverage both imaging and textual data. To bridge this critical gap, we introduce the TextBraTS dataset, the first publicly available volume-level multimodal dataset that contains paired MRI volumes and rich textual annotations, derived from the widely adopted BraTS2020 benchmark. Building upon this novel dataset, we propose a novel baseline framework and sequential cross-attention method for text-guided volumetric medical image segmentation. Through extensive experiments with various text-image fusion strategies and templated text formulations, our approach demonstrates significant improvements in brain tumor segmentation accuracy, offering valuable insights into effective multimodal integration techniques. Our dataset, implementation code, and pre-trained models are publicly available at https://github.com/Jupitern52/TextBraTS.
The Brain Tumor Segmentation (BraTS) cluster of challenges has significantly advanced brain tumor image analysis by providing large, curated datasets and addressing clinically relevant tasks. However, despite its success and popularity, algorithms and models developed through BraTS have seen limited adoption in both scientific and clinical communities. To accelerate their dissemination, we introduce BraTS orchestrator, an open-source Python package that provides seamless access to state-of-the-art segmentation and synthesis algorithms for diverse brain tumors from the BraTS challenge ecosystem. Available on GitHub (https://github.com/BrainLesion/BraTS), the package features intuitive tutorials designed for users with minimal programming experience, enabling both researchers and clinicians to easily deploy winning BraTS algorithms for inference. By abstracting the complexities of modern deep learning, BraTS orchestrator democratizes access to the specialized knowledge developed within the BraTS community, making these advances readily available to broader neuro-radiology and neuro-oncology audiences.
In this paper, we address the crucial task of brain tumor segmentation in medical imaging and propose innovative approaches to enhance its performance. The current state-of-the-art nnU-Net has shown promising results but suffers from extensive training requirements and underutilization of pre-trained weights. To overcome these limitations, we integrate Axial-Coronal-Sagittal convolutions and pre-trained weights from ImageNet into the nnU-Net framework, resulting in reduced training epochs, reduced trainable parameters, and improved efficiency. Two strategies for transferring 2D pre-trained weights to the 3D domain are presented, ensuring the preservation of learned relationships and feature representations critical for effective information propagation. Furthermore, we explore a joint classification and segmentation model that leverages pre-trained encoders from a brain glioma grade classification proxy task, leading to enhanced segmentation performance, especially for challenging tumor labels. Experimental results demonstrate that our proposed methods in the fast training settings achieve comparable or even outperform the ensemble of cross-validation models, a common practice in the brain tumor segmentation literature.
Precise segmentation of brain tumors, particularly contrast-enhancing regions visible in post-contrast MRI (areas highlighted by contrast agent injection), is crucial for accurate clinical diagnosis and treatment planning but remains challenging. However, current methods exhibit notable performance degradation in segmenting these enhancing brain tumor areas, largely due to insufficient consideration of MRI-specific tumor features such as complex textures and directional variations. To address this, we propose the Harmonized Frequency Fusion Network (HFF-Net), which rethinks brain tumor segmentation from a frequency-domain perspective. To comprehensively characterize tumor regions, we develop a Frequency Domain Decomposition (FDD) module that separates MRI images into low-frequency components, capturing smooth tumor contours and high-frequency components, highlighting detailed textures and directional edges. To further enhance sensitivity to tumor boundaries, we introduce an Adaptive Laplacian Convolution (ALC) module that adaptively emphasizes critical high-frequency details using dynamically updated convolution kernels. To effectively fuse tumor features across multiple scales, we design a Frequency Domain Cross-Attention (FDCA) integrating semantic, positional, and slice-specific information. We further validate and interpret frequency-domain improvements through visualization, theoretical reasoning, and experimental analyses. Extensive experiments on four public datasets demonstrate that HFF-Net achieves an average relative improvement of 4.48\% (ranging from 2.39\% to 7.72\%) in the mean Dice scores across the three major subregions, and an average relative improvement of 7.33% (ranging from 5.96% to 8.64%) in the segmentation of contrast-enhancing tumor regions, while maintaining favorable computational efficiency and clinical applicability. Code: https://github.com/VinyehShaw/HFF.
Existing methods for multimodal MRI segmentation with missing modalities typically assume that all MRI modalities are available during training. However, in clinical practice, some modalities may be missing due to the sequential nature of MRI acquisition, leading to performance degradation. Furthermore, retraining models to accommodate newly available modalities can be inefficient and may cause overfitting, potentially compromising previously learned knowledge. To address these challenges, we propose Replay-based Hypergraph Domain Incremental Learning (ReHyDIL) for brain tumor segmentation with missing modalities. ReHyDIL leverages Domain Incremental Learning (DIL) to enable the segmentation model to learn from newly acquired MRI modalities without forgetting previously learned information. To enhance segmentation performance across diverse patient scenarios, we introduce the Cross-Patient Hypergraph Segmentation Network (CHSNet), which utilizes hypergraphs to capture high-order associations between patients. Additionally, we incorporate Tversky-Aware Contrastive (TAC) loss to effectively mitigate information imbalance both across and within different modalities. Extensive experiments on the BraTS2019 dataset demonstrate that ReHyDIL outperforms state-of-the-art methods, achieving an improvement of over 2% in the Dice Similarity Coefficient across various tumor regions. Our code is available at https://github.com/reeive/ReHyDIL.
Accurate segmentation of brain images typically requires the integration of complementary information from multiple image modalities. However, clinical data for all modalities may not be available for every patient, creating a significant challenge. To address this, previous studies encode multiple modalities into a shared latent space. While somewhat effective, it remains suboptimal, as each modality contains distinct and valuable information. In this study, we propose DC-Seg (Disentangled Contrastive Learning for Segmentation), a new method that explicitly disentangles images into modality-invariant anatomical representation and modality-specific representation, by using anatomical contrastive learning and modality contrastive learning respectively. This solution improves the separation of anatomical and modality-specific features by considering the modality gaps, leading to more robust representations. Furthermore, we introduce a segmentation-based regularizer that enhances the model's robustness to missing modalities. Extensive experiments on the BraTS 2020 and a private white matter hyperintensity(WMH) segmentation dataset demonstrate that DC-Seg outperforms state-of-the-art methods in handling incomplete multimodal brain tumor segmentation tasks with varying missing modalities, while also demonstrate strong generalizability in WMH segmentation. The code is available at https://github.com/CuCl-2/DC-Seg.
We explore Generalizable Tumor Segmentation, aiming to train a single model for zero-shot tumor segmentation across diverse anatomical regions. Existing methods face limitations related to segmentation quality, scalability, and the range of applicable imaging modalities. In this paper, we uncover the potential of the internal representations within frozen medical foundation diffusion models as highly efficient zero-shot learners for tumor segmentation by introducing a novel framework named DiffuGTS. DiffuGTS creates anomaly-aware open-vocabulary attention maps based on text prompts to enable generalizable anomaly segmentation without being restricted by a predefined training category list. To further improve and refine anomaly segmentation masks, DiffuGTS leverages the diffusion model, transforming pathological regions into high-quality pseudo-healthy counterparts through latent space inpainting, and applies a novel pixel-level and feature-level residual learning approach, resulting in segmentation masks with significantly enhanced quality and generalization. Comprehensive experiments on four datasets and seven tumor categories demonstrate the superior performance of our method, surpassing current state-of-the-art models across multiple zero-shot settings. Codes are available at https://github.com/Yankai96/DiffuGTS.
Background: Brain tumor segmentation has a significant impact on the diagnosis and treatment of brain tumors. Accurate brain tumor segmentation remains challenging due to their irregular shapes, vague boundaries, and high variability. Objective: We propose a brain tumor segmentation method that combines deep learning with prior knowledge derived from a region-growing algorithm. Methods: The proposed method utilizes a multi-scale feature fusion (MSFF) module and adaptive attention mechanisms (AAM) to extract multi-scale features and capture global contextual information. To enhance the model's robustness in low-confidence regions, the Monte Carlo Dropout (MC Dropout) strategy is employed for uncertainty estimation. Results: Extensive experiments demonstrate that the proposed method achieves superior performance on Brain Tumor Segmentation (BraTS) datasets, significantly outperforming various state-of-the-art methods. On the BraTS2021 dataset, the test Dice scores are 89.18% for Enhancing Tumor (ET) segmentation, 93.67% for Whole Tumor (WT) segmentation, and 91.23% for Tumor Core (TC) segmentation. On the BraTS2019 validation set, the validation Dice scores are 87.43%, 90.92%, and 90.40% for ET, WT, and TC segmentation, respectively. Ablation studies further confirmed the contribution of each module to segmentation accuracy, indicating that each component played a vital role in overall performance improvement. Conclusion: This study proposed a novel 3D brain tumor segmentation network based on the U-Net architecture. By incorporating the prior knowledge and employing the uncertainty estimation method, the robustness and performance were improved. The code for the proposed method is available at https://github.com/chenzhao2023/UPMAD_Net_BrainSeg.
Magnetic resonance imaging (MRI) raw data, or k-Space data, is complex-valued, containing both magnitude and phase information. However, clinical and existing Artificial Intelligence (AI)-based methods focus only on magnitude images, discarding the phase data despite its potential for downstream tasks, such as tumor segmentation and classification. In this work, we introduce $\textit{PhaseGen}$, a novel complex-valued diffusion model for generating synthetic MRI raw data conditioned on magnitude images, commonly used in clinical practice. This enables the creation of artificial complex-valued raw data, allowing pretraining for models that require k-Space information. We evaluate PhaseGen on two tasks: skull-stripping directly in k-Space and MRI reconstruction using the publicly available FastMRI dataset. Our results show that training with synthetic phase data significantly improves generalization for skull-stripping on real-world data, with an increased segmentation accuracy from $41.1\%$ to $80.1\%$, and enhances MRI reconstruction when combined with limited real-world data. This work presents a step forward in utilizing generative AI to bridge the gap between magnitude-based datasets and the complex-valued nature of MRI raw data. This approach allows researchers to leverage the vast amount of avaliable image domain data in combination with the information-rich k-Space data for more accurate and efficient diagnostic tasks. We make our code publicly $\href{https://github.com/TIO-IKIM/PhaseGen}{\text{available here}}$.
Lung cancer is a leading cause of cancer-related deaths globally. PET-CT is crucial for imaging lung tumors, providing essential metabolic and anatomical information, while it faces challenges such as poor image quality, motion artifacts, and complex tumor morphology. Deep learning-based models are expected to address these problems, however, existing small-scale and private datasets limit significant performance improvements for these methods. Hence, we introduce a large-scale PET-CT lung tumor segmentation dataset, termed PCLT20K, which comprises 21,930 pairs of PET-CT images from 605 patients. Furthermore, we propose a cross-modal interactive perception network with Mamba (CIPA) for lung tumor segmentation in PET-CT images. Specifically, we design a channel-wise rectification module (CRM) that implements a channel state space block across multi-modal features to learn correlated representations and helps filter out modality-specific noise. A dynamic cross-modality interaction module (DCIM) is designed to effectively integrate position and context information, which employs PET images to learn regional position information and serves as a bridge to assist in modeling the relationships between local features of CT images. Extensive experiments on a comprehensive benchmark demonstrate the effectiveness of our CIPA compared to the current state-of-the-art segmentation methods. We hope our research can provide more exploration opportunities for medical image segmentation. The dataset and code are available at https://github.com/mj129/CIPA.
Multi-contrast magnetic resonance imaging (MRI) plays a vital role in brain tumor segmentation and diagnosis by leveraging complementary information from different contrasts. Each contrast highlights specific tumor characteristics, enabling a comprehensive understanding of tumor morphology, edema, and pathological heterogeneity. However, existing methods still face the challenges of multi-level specificity perception across different contrasts, especially with limited annotations. These challenges include data heterogeneity, granularity differences, and interference from redundant information. To address these limitations, we propose a Task-oriented Uncertainty Collaborative Learning (TUCL) framework for multi-contrast MRI segmentation. TUCL introduces a task-oriented prompt attention (TPA) module with intra-prompt and cross-prompt attention mechanisms to dynamically model feature interactions across contrasts and tasks. Additionally, a cyclic process is designed to map the predictions back to the prompt to ensure that the prompts are effectively utilized. In the decoding stage, the TUCL framework proposes a dual-path uncertainty refinement (DUR) strategy which ensures robust segmentation by refining predictions iteratively. Extensive experimental results on limited labeled data demonstrate that TUCL significantly improves segmentation accuracy (88.2\% in Dice and 10.853 mm in HD95). It shows that TUCL has the potential to extract multi-contrast information and reduce the reliance on extensive annotations. The code is available at: https://github.com/Zhenxuan-Zhang/TUCL_BrainSeg.
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 .
We present RMA-Mamba, a novel architecture that advances the capabilities of vision state space models through a specialized reverse mamba attention module (RMA). The key innovation lies in RMA-Mamba's ability to capture long-range dependencies while maintaining precise local feature representation through its hierarchical processing pipeline. By integrating Vision Mamba (VMamba)'s efficient sequence modeling with RMA's targeted feature refinement, our architecture achieves superior feature learning across multiple scales. This dual-mechanism approach enables robust handling of complex morphological patterns while maintaining computational efficiency. We demonstrate RMA-Mamba's effectiveness in the challenging domain of pathological liver segmentation (from both CT and MRI), where traditional segmentation approaches often fail due to tissue variations. When evaluated on a newly introduced cirrhotic liver dataset (CirrMRI600+) of T2-weighted MRI scans, RMA-Mamba achieves the state-of-the-art performance with a Dice coefficient of 92.08%, mean IoU of 87.36%, and recall of 92.96%. The architecture's generalizability is further validated on the cancerous liver segmentation from CT scans (LiTS: Liver Tumor Segmentation dataset), yielding a Dice score of 92.9% and mIoU of 88.99%. Our code is available for public: https://github.com/JunZengz/RMAMamba.
With the rapid development of artificial intelligence (AI), AI-assisted medical imaging analysis demonstrates remarkable performance in early lung cancer screening. However, the costly annotation process and privacy concerns limit the construction of large-scale medical datasets, hampering the further application of AI in healthcare. To address the data scarcity in lung cancer screening, we propose Lung-DDPM, a thoracic CT image synthesis approach that effectively generates high-fidelity 3D synthetic CT images, which prove helpful in downstream lung nodule segmentation tasks. Our method is based on semantic layout-guided denoising diffusion probabilistic models (DDPM), enabling anatomically reasonable, seamless, and consistent sample generation even from incomplete semantic layouts. Our results suggest that the proposed method outperforms other state-of-the-art (SOTA) generative models in image quality evaluation and downstream lung nodule segmentation tasks. Specifically, Lung-DDPM achieved superior performance on our large validation cohort, with a Fr\'echet inception distance (FID) of 0.0047, maximum mean discrepancy (MMD) of 0.0070, and mean squared error (MSE) of 0.0024. These results were 7.4$\times$, 3.1$\times$, and 29.5$\times$ better than the second-best competitors, respectively. Furthermore, the lung nodule segmentation model, trained on a dataset combining real and Lung-DDPM-generated synthetic samples, attained a dice coefficient (Dice) of 0.3914 and sensitivity of 0.4393. This represents 8.8\% and 18.6\% improvements in DICE and sensitivity compared to the model trained solely on real samples. The experimental results highlight Lung-DDPM's potential for a broader range of medical imaging applications, such as general tumor segmentation, cancer survival estimation, and risk prediction.
Vision foundation models (VFMs) are pre-trained on extensive image datasets to learn general representations for diverse types of data. These models can subsequently be fine-tuned for specific downstream tasks, significantly boosting performance across a broad range of applications. However, existing vision foundation models that claim to be applicable to various radiology tasks are mostly pre-trained on 3D computed tomography (CT), which benefits from the availability of extensive 3D CT databases. Significant differences between CT and magnetic resonance imaging (MRI) in imaging principles, signal characteristics, and data distribution may hinder their practical performance and versatility in MRI-specific applications. Here, we propose Triad, a vision foundation model for 3D MRI. Triad adopts a widely used autoencoder architecture to learn robust representations from 131,170 3D MRI volumes and uses organ-independent imaging descriptions to constrain the semantic distribution of the visual modality. The above pre-training dataset is called Triad-131K, which is currently the largest 3D MRI pre-training dataset. We evaluate Triad across three tasks, namely, organ/tumor segmentation, organ/cancer classification, and medical image registration, in two data modalities (within-domain and out-of-domain) settings using 25 downstream datasets. By initializing models with Triad's pre-trained weights, nnUNet-Triad improves segmentation performance by 6.88% compared to nnUNet-Scratch across 17 datasets. Swin-B-Triad achieves a 3.97% improvement over Swin-B-Scratch in classification tasks across five datasets. SwinUNETR-Triad improves by 4.00% compared to SwinUNETR-Scratch in registration tasks across two datasets. Our study demonstrates that pre-training can maximize performance when the data modalities and organs of upstream and downstream tasks are consistent.
The retroperitoneum hosts a variety of tumors, including rare benign and malignant types, which pose diagnostic and treatment challenges due to their infrequency and proximity to vital structures. Estimating tumor volume is difficult due to their irregular shapes, and manual segmentation is time-consuming. Automatic segmentation using U-Net and its variants, incorporating Vision Transformer (ViT) elements, has shown promising results but struggles with high computational demands. To address this, architectures like the Mamba State Space Model (SSM) and Extended Long-Short Term Memory (xLSTM) offer efficient solutions by handling long-range dependencies with lower resource consumption. This study evaluates U-Net enhancements, including CNN, ViT, Mamba, and xLSTM, on a new in-house CT dataset and a public organ segmentation dataset. The proposed ViLU-Net model integrates Vi-blocks for improved segmentation. Results highlight xLSTM's efficiency in the U-Net framework. The code is publicly accessible on GitHub.
Accurate and efficient segmentation of brain tumors is critical for diagnosis, treatment planning, and monitoring in clinical practice. In this study, we present an enhanced ResUNet architecture for automatic brain tumor segmentation, integrating an EfficientNetB0 encoder, a channel attention mechanism, and an Atrous Spatial Pyramid Pooling (ASPP) module. The EfficientNetB0 encoder leverages pre-trained features to improve feature extraction efficiency, while the channel attention mechanism enhances the model's focus on tumor-relevant features. ASPP enables multiscale contextual learning, crucial for handling tumors of varying sizes and shapes. The proposed model was evaluated on two benchmark datasets: TCGA LGG and BraTS 2020. Experimental results demonstrate that our method consistently outperforms the baseline ResUNet and its EfficientNet variant, achieving Dice coefficients of 0.903 and 0.851 and HD95 scores of 9.43 and 3.54 for whole tumor and tumor core regions on the BraTS 2020 dataset, respectively. compared with state-of-the-art methods, our approach shows competitive performance, particularly in whole tumor and tumor core segmentation. These results indicate that combining a powerful encoder with attention mechanisms and ASPP can significantly enhance brain tumor segmentation performance. The proposed approach holds promise for further optimization and application in other medical image segmentation tasks.
Foundation models (FMs) have shown transformative potential in radiology by performing diverse, complex tasks across imaging modalities. Here, we developed CT-FM, a large-scale 3D image-based pre-trained model designed explicitly for various radiological tasks. CT-FM was pre-trained using 148,000 computed tomography (CT) scans from the Imaging Data Commons through label-agnostic contrastive learning. We evaluated CT-FM across four categories of tasks, namely, whole-body and tumor segmentation, head CT triage, medical image retrieval, and semantic understanding, showing superior performance against state-of-the-art models. Beyond quantitative success, CT-FM demonstrated the ability to cluster regions anatomically and identify similar anatomical and structural concepts across scans. Furthermore, it remained robust across test-retest settings and indicated reasonable salient regions attached to its embeddings. This study demonstrates the value of large-scale medical imaging foundation models and by open-sourcing the model weights, code, and data, aims to support more adaptable, reliable, and interpretable AI solutions in radiology.
In Sub-Saharan Africa (SSA), the utilization of lower-quality Magnetic Resonance Imaging (MRI) technology raises questions about the applicability of machine learning methods for clinical tasks. This study aims to provide a robust deep learning-based brain tumor segmentation (BraTS) method tailored for the SSA population using a threefold approach. Firstly, the impact of domain shift from the SSA training data on model efficacy was examined, revealing no significant effect. Secondly, a comparative analysis of 3D and 2D full-resolution models using the nnU-Net framework indicates similar performance of both the models trained for 300 epochs achieving a five-fold cross-validation score of 0.93. Lastly, addressing the performance gap observed in SSA validation as opposed to the relatively larger BraTS glioma (GLI) validation set, two strategies are proposed: fine-tuning SSA cases using the GLI+SSA best-pretrained 2D fullres model at 300 epochs, and introducing a novel neural style transfer-based data augmentation technique for the SSA cases. This investigation underscores the potential of enhancing brain tumor prediction within SSA's unique healthcare landscape.
Head and neck tumors and metastatic lymph nodes are crucial for treatment planning and prognostic analysis. Accurate segmentation and quantitative analysis of these structures require pixel-level annotation, making automated segmentation techniques essential for the diagnosis and treatment of head and neck cancer. In this study, we investigated the effects of multiple strategies on the segmentation of pre-radiotherapy (pre-RT) and mid-radiotherapy (mid-RT) images. For the segmentation of pre-RT images, we utilized: 1) a fully supervised learning approach, and 2) the same approach enhanced with pre-trained weights and the MixUp data augmentation technique. For mid-RT images, we introduced a novel computational-friendly network architecture that features separate encoders for mid-RT images and registered pre-RT images with their labels. The mid-RT encoder branch integrates information from pre-RT images and labels progressively during the forward propagation. We selected the highest-performing model from each fold and used their predictions to create an ensemble average for inference. In the final test, our models achieved a segmentation performance of 82.38% for pre-RT and 72.53% for mid-RT on aggregated Dice Similarity Coefficient (DSC) as HiLab. Our code is available at https://github.com/WltyBY/HNTS-MRG2024_train_code.