The segmentation of metastatic bone disease (MBD) in whole-body MRI (WB-MRI) is a challenging problem. Due to varying appearances and anatomical locations of lesions, ambiguous boundaries, and severe class imbalance, obtaining reliable segmentations requires large, well-annotated datasets capturing lesion variability. Generating such datasets requires substantial time and expertise, and is prone to error. While self-supervised learning (SSL) can leverage large unlabeled datasets, learned generic representations often fail to capture the nuanced features needed for accurate lesion detection. In this work, we propose a Supervised Anatomical Pretraining (SAP) method that learns from a limited dataset of anatomical labels. First, an MRI-based skeletal segmentation model is developed and trained on WB-MRI scans from healthy individuals for high-quality skeletal delineation. Then, we compare its downstream efficacy in segmenting MBD on a cohort of 44 patients with metastatic prostate cancer, against both a baseline random initialization and a state-of-the-art SSL method. SAP significantly outperforms both the baseline and SSL-pretrained models, achieving a normalized surface Dice of 0.76 and a Dice coefficient of 0.64. The method achieved a lesion detection F2 score of 0.44, improving on 0.24 (baseline) and 0.31 (SSL). When considering only clinically relevant lesions larger than 1~ml, SAP achieves a detection sensitivity of 100% in 28 out of 32 patients. Learning bone morphology from anatomy yields an effective and domain-relevant inductive bias that can be leveraged for the downstream segmentation task of bone lesions. All code and models are made publicly available.
Mammography is the gold standard for the detection and diagnosis of breast cancer. This procedure can be significantly enhanced with Artificial Intelligence (AI)-based software, which assists radiologists in identifying abnormalities. However, training AI systems requires large and diverse datasets, which are often difficult to obtain due to privacy and ethical constraints. To address this issue, the paper introduces MAMmography ensemBle mOdel (MAMBO), a novel patch-based diffusion approach designed to generate full-resolution mammograms. Diffusion models have shown breakthrough results in realistic image generation, yet few studies have focused on mammograms, and none have successfully generated high-resolution outputs required to capture fine-grained features of small lesions. To achieve this, MAMBO integrates separate diffusion models to capture both local and global (image-level) contexts. The contextual information is then fed into the final patch-based model, significantly aiding the noise removal process. This thoughtful design enables MAMBO to generate highly realistic mammograms of up to 3840x3840 pixels. Importantly, this approach can be used to enhance the training of classification models and extended to anomaly detection. Experiments, both numerical and radiologist validation, assess MAMBO's capabilities in image generation, super-resolution, and anomaly detection, highlighting its potential to enhance mammography analysis for more accurate diagnoses and earlier lesion detection.
Accurate lesion-level segmentation on MRI is critical for multiple sclerosis (MS) diagnosis, prognosis, and disease monitoring. However, current evaluation practices largely rely on semantic segmentation post-processed with connected components (CC), which cannot separate confluent lesions (aggregates of confluent lesion units, CLUs) due to reliance on spatial connectivity. To address this misalignment with clinical needs, we introduce formal definitions of CLUs and associated CLU-aware detection metrics, and include them in an exhaustive instance segmentation evaluation framework. Within this framework, we systematically evaluate CC and post-processing-based Automated Confluent Splitting (ACLS), the only existing methods for lesion instance segmentation in MS. Our analysis reveals that CC consistently underestimates CLU counts, while ACLS tends to oversplit lesions, leading to overestimated lesion counts and reduced precision. To overcome these limitations, we propose ConfLUNet, the first end-to-end instance segmentation framework for MS lesions. ConfLUNet jointly optimizes lesion detection and delineation from a single FLAIR image. Trained on 50 patients, ConfLUNet significantly outperforms CC and ACLS on the held-out test set (n=13) in instance segmentation (Panoptic Quality: 42.0% vs. 37.5%/36.8%; p = 0.017/0.005) and lesion detection (F1: 67.3% vs. 61.6%/59.9%; p = 0.028/0.013). For CLU detection, ConfLUNet achieves the highest F1[CLU] (81.5%), improving recall over CC (+12.5%, p = 0.015) and precision over ACLS (+31.2%, p = 0.003). By combining rigorous definitions, new CLU-aware metrics, a reproducible evaluation framework, and the first dedicated end-to-end model, this work lays the foundation for lesion instance segmentation in MS.
Transformer-based CLIP models are widely used for text-image probing and feature extraction, making it relevant to understand the internal mechanisms behind their predictions. While recent works show that Sparse Autoencoders (SAEs) yield interpretable latent components, they focus on what these encode and miss how they drive predictions. We introduce a scalable framework that reveals what latent components activate for, how they align with expected semantics, and how important they are to predictions. To achieve this, we adapt attribution patching for instance-wise component attributions in CLIP and highlight key faithfulness limitations of the widely used Logit Lens technique. By combining attributions with semantic alignment scores, we can automatically uncover reliance on components that encode semantically unexpected or spurious concepts. Applied across multiple CLIP variants, our method uncovers hundreds of surprising components linked to polysemous words, compound nouns, visual typography and dataset artifacts. While text embeddings remain prone to semantic ambiguity, they are more robust to spurious correlations compared to linear classifiers trained on image embeddings. A case study on skin lesion detection highlights how such classifiers can amplify hidden shortcuts, underscoring the need for holistic, mechanistic interpretability. We provide code at https://github.com/maxdreyer/attributing-clip.
Natural images exhibit label diversity (clean vs. noisy) in noisy-labeled image classification and prevalence diversity (abundant vs. sparse) in long-tailed image classification. Similarly, medical images in universal lesion detection (ULD) exhibit substantial variations in image quality, encompassing attributes such as clarity and label correctness. How to effectively leverage training images with diverse qualities becomes a problem in learning deep models. Conventional training mechanisms, such as self-paced curriculum learning (SCL) and online hard example mining (OHEM), relieve this problem by reweighting images with high loss values. Despite their success, these methods still confront two challenges: (i) the loss-based measure of sample hardness is imprecise, preventing optimum handling of different cases, and (ii) there exists under-utilization in SCL or over-utilization OHEM with the identified hard samples. To address these issues, this paper revisits the minibatch sampling (MBS), a technique widely used in deep network training but largely unexplored concerning the handling of diverse-quality training samples. We discover that the samples within a minibatch influence each other during training; thus, we propose a novel Mixed-order Minibatch Sampling (MoMBS) method to optimize the use of training samples with diverse qualities. MoMBS introduces a measure that takes both loss and uncertainty into account to surpass a sole reliance on loss and allows for a more refined categorization of high-loss samples by distinguishing them as either poorly labeled and under represented or well represented and overfitted. We prioritize under represented samples as the main gradient contributors in a minibatch and keep them from the negative influences of poorly labeled or overfitted samples with a mixed-order minibatch sampling design.
Monkeypox is a viral disease characterized by distinctive skin lesions and has been reported in many countries. The recent global outbreak has emphasized the urgent need for scalable, accessible, and accurate diagnostic solutions to support public health responses. In this study, we developed ITMAINN, an intelligent, AI-driven healthcare system specifically designed to detect Monkeypox from skin lesion images using advanced deep learning techniques. Our system consists of three main components. First, we trained and evaluated several pretrained models using transfer learning on publicly available skin lesion datasets to identify the most effective models. For binary classification (Monkeypox vs. non-Monkeypox), the Vision Transformer, MobileViT, Transformer-in-Transformer, and VGG16 achieved the highest performance, each with an accuracy and F1-score of 97.8%. For multiclass classification, which contains images of patients with Monkeypox and five other classes (chickenpox, measles, hand-foot-mouth disease, cowpox, and healthy), ResNetViT and ViT Hybrid models achieved 92% accuracy, with F1 scores of 92.24% and 92.19%, respectively. The best-performing and most lightweight model, MobileViT, was deployed within the mobile application. The second component is a cross-platform smartphone application that enables users to detect Monkeypox through image analysis, track symptoms, and receive recommendations for nearby healthcare centers based on their location. The third component is a real-time monitoring dashboard designed for health authorities to support them in tracking cases, analyzing symptom trends, guiding public health interventions, and taking proactive measures. This system is fundamental in developing responsive healthcare infrastructure within smart cities. Our solution, ITMAINN, is part of revolutionizing public health management.
Multi-modal medical image fusion (MMIF) is increasingly recognized as an essential technique for enhancing diagnostic precision and facilitating effective clinical decision-making within computer-aided diagnosis systems. MMIF combines data from X-ray, MRI, CT, PET, SPECT, and ultrasound to create detailed, clinically useful images of patient anatomy and pathology. These integrated representations significantly advance diagnostic accuracy, lesion detection, and segmentation. This comprehensive review meticulously surveys the evolution, methodologies, algorithms, current advancements, and clinical applications of MMIF. We present a critical comparative analysis of traditional fusion approaches, including pixel-, feature-, and decision-level methods, and delves into recent advancements driven by deep learning, generative models, and transformer-based architectures. A critical comparative analysis is presented between these conventional methods and contemporary techniques, highlighting differences in robustness, computational efficiency, and interpretability. The article addresses extensive clinical applications across oncology, neurology, and cardiology, demonstrating MMIF's vital role in precision medicine through improved patient-specific therapeutic outcomes. Moreover, the review thoroughly investigates the persistent challenges affecting MMIF's broad adoption, including issues related to data privacy, heterogeneity, computational complexity, interpretability of AI-driven algorithms, and integration within clinical workflows. It also identifies significant future research avenues, such as the integration of explainable AI, adoption of privacy-preserving federated learning frameworks, development of real-time fusion systems, and standardization efforts for regulatory compliance.
Multimodal pathological image understanding has garnered widespread interest due to its potential to improve diagnostic accuracy and enable personalized treatment through integrated visual and textual data. However, existing methods exhibit limited reasoning capabilities, which hamper their ability to handle complex diagnostic scenarios. Additionally, the enormous size of pathological images leads to severe computational burdens, further restricting their practical deployment. To address these limitations, we introduce a novel bilateral reinforcement learning framework comprising two synergistic branches. One reinforcement branch enhances the reasoning capability by enabling the model to learn task-specific decision processes, i.e., pathology rationales, directly from labels without explicit reasoning supervision. While the other branch dynamically allocates a tailored number of tokens to different images based on both their visual content and task context, thereby optimizing computational efficiency. We apply our method to various pathological tasks such as visual question answering, cancer subtyping, and lesion detection. Extensive experiments show an average +41.7 absolute performance improvement with 70.3% lower inference costs over the base models, achieving both reasoning accuracy and computational efficiency.
While deep learning has shown strong performance in musculoskeletal imaging, existing work has largely focused on pathologies where diagnosis is not a clinical challenge, leaving more difficult problems underexplored, such as detecting Bankart lesions (anterior-inferior glenoid labral tears) on standard MRIs. Diagnosing these lesions is challenging due to their subtle imaging features, often leading to reliance on invasive MRI arthrograms (MRAs). This study introduces ScopeMRI, the first publicly available, expert-annotated dataset for shoulder pathologies, and presents a deep learning (DL) framework for detecting Bankart lesions on both standard MRIs and MRAs. ScopeMRI includes 586 shoulder MRIs (335 standard, 251 MRAs) from 558 patients who underwent arthroscopy. Ground truth labels were derived from intraoperative findings, the gold standard for diagnosis. Separate DL models for MRAs and standard MRIs were trained using a combination of CNNs and transformers. Predictions from sagittal, axial, and coronal views were ensembled to optimize performance. The models were evaluated on a 20% hold-out test set (117 MRIs: 46 MRAs, 71 standard MRIs). The models achieved an AUC of 0.91 and 0.93, sensitivity of 83% and 94%, and specificity of 91% and 86% for standard MRIs and MRAs, respectively. Notably, model performance on non-invasive standard MRIs matched or surpassed radiologists interpreting MRAs. External validation demonstrated initial generalizability across imaging protocols. This study demonstrates that DL models can achieve radiologist-level diagnostic performance on standard MRIs, reducing the need for invasive MRAs. By releasing ScopeMRI and a modular codebase for training and evaluating deep learning models on 3D medical imaging data, we aim to accelerate research in musculoskeletal imaging and support the development of new datasets for clinically challenging diagnostic tasks.
Data augmentation is essential in medical imaging for improving classification accuracy, lesion detection, and organ segmentation under limited data conditions. However, two significant challenges remain. First, a pronounced domain gap between natural photographs and medical images can distort critical disease features. Second, augmentation studies in medical imaging are fragmented and limited to single tasks or architectures, leaving the benefits of advanced mix-based strategies unclear. To address these challenges, we propose a unified evaluation framework with six mix-based augmentation methods integrated with both convolutional and transformer backbones on brain tumour MRI and eye disease fundus datasets. Our contributions are threefold. (1) We introduce MediAug, a comprehensive and reproducible benchmark for advanced data augmentation in medical imaging. (2) We systematically evaluate MixUp, YOCO, CropMix, CutMix, AugMix, and SnapMix with ResNet-50 and ViT-B backbones. (3) We demonstrate through extensive experiments that MixUp yields the greatest improvement on the brain tumor classification task for ResNet-50 with 79.19% accuracy and SnapMix yields the greatest improvement for ViT-B with 99.44% accuracy, and that YOCO yields the greatest improvement on the eye disease classification task for ResNet-50 with 91.60% accuracy and CutMix yields the greatest improvement for ViT-B with 97.94% accuracy. Code will be available at https://github.com/AIGeeksGroup/MediAug.
Radiologists routinely detect and size lesions in CT to stage cancer and assess tumor burden. To potentially aid their efforts, multiple lesion detection algorithms have been developed with a large public dataset called DeepLesion (32,735 lesions, 32,120 CT slices, 10,594 studies, 4,427 patients, 8 body part labels). However, this dataset contains missing measurements and lesion tags, and exhibits a severe imbalance in the number of lesions per label category. In this work, we utilize a limited subset of DeepLesion (6\%, 1331 lesions, 1309 slices) containing lesion annotations and body part label tags to train a VFNet model to detect lesions and tag them. We address the class imbalance by conducting three experiments: 1) Balancing data by the body part labels, 2) Balancing data by the number of lesions per patient, and 3) Balancing data by the lesion size. In contrast to a randomly sampled (unbalanced) data subset, our results indicated that balancing the body part labels always increased sensitivity for lesions >= 1cm for classes with low data quantities (Bone: 80\% vs. 46\%, Kidney: 77\% vs. 61\%, Soft Tissue: 70\% vs. 60\%, Pelvis: 83\% vs. 76\%). Similar trends were seen for three other models tested (FasterRCNN, RetinaNet, FoveaBox). Balancing data by lesion size also helped the VFNet model improve recalls for all classes in contrast to an unbalanced dataset. We also provide a structured reporting guideline for a ``Lesions'' subsection to be entered into the ``Findings'' section of a radiology report. To our knowledge, we are the first to report the class imbalance in DeepLesion, and have taken data-driven steps to address it in the context of joint lesion detection and tagging.
T2 hyperintensities in spinal cord MR images are crucial biomarkers for conditions such as degenerative cervical myelopathy. However, current clinical diagnoses primarily rely on manual evaluation. Deep learning methods have shown promise in lesion detection, but most supervised approaches are heavily dependent on large, annotated datasets. Unsupervised anomaly detection (UAD) offers a compelling alternative by eliminating the need for abnormal data annotations. However, existing UAD methods rely on curated normal datasets and their performance frequently deteriorates when applied to clinical datasets due to domain shifts. We propose an Uncertainty-based Unsupervised Anomaly Detection framework, termed U2AD, to address these limitations. Unlike traditional methods, U2AD is designed to be trained and tested within the same clinical dataset, following a "mask-and-reconstruction" paradigm built on a Vision Transformer-based architecture. We introduce an uncertainty-guided masking strategy to resolve task conflicts between normal reconstruction and anomaly detection to achieve an optimal balance. Specifically, we employ a Monte-Carlo sampling technique to estimate reconstruction uncertainty mappings during training. By iteratively optimizing reconstruction training under the guidance of both epistemic and aleatoric uncertainty, U2AD reduces overall reconstruction variance while emphasizing regions. Experimental results demonstrate that U2AD outperforms existing supervised and unsupervised methods in patient-level identification and segment-level localization tasks. This framework establishes a new benchmark for incorporating uncertainty guidance into UAD, highlighting its clinical utility in addressing domain shifts and task conflicts in medical image anomaly detection. Our code is available: https://github.com/zhibaishouheilab/U2AD
Anomaly detection (AD) identifies outliers for applications like defect and lesion detection. While CLIP shows promise for zero-shot AD tasks due to its strong generalization capabilities, its inherent Anomaly-Unawareness leads to limited discrimination between normal and abnormal features. To address this problem, we propose Anomaly-Aware CLIP (AA-CLIP), which enhances CLIP's anomaly discrimination ability in both text and visual spaces while preserving its generalization capability. AA-CLIP is achieved through a straightforward yet effective two-stage approach: it first creates anomaly-aware text anchors to differentiate normal and abnormal semantics clearly, then aligns patch-level visual features with these anchors for precise anomaly localization. This two-stage strategy, with the help of residual adapters, gradually adapts CLIP in a controlled manner, achieving effective AD while maintaining CLIP's class knowledge. Extensive experiments validate AA-CLIP as a resource-efficient solution for zero-shot AD tasks, achieving state-of-the-art results in industrial and medical applications. The code is available at https://github.com/Mwxinnn/AA-CLIP.
Skin cancer is the most common type of cancer in the world, accounting for approximately 30% of all diagnosed tumors. Early diagnosis reduces mortality rates and prevents disfiguring effects in different body regions. In recent years, machine learning techniques, particularly deep learning, have shown promising results in this task, presenting studies that have demonstrated that combining a patient's clinical information with images of the lesion is crucial for improving the classification of skin lesions. Despite that, meaningful use of clinical information with multiple images is mandatory, requiring further investigation. Thus, this project aims to contribute to developing multimodal machine learning-based models to cope with the skin lesion classification task employing a lightweight transformer model. As a main hypothesis, models can take multiple images from different sources as input, along with clinical information from the patient's history, leading to a more reliable diagnosis. Our model deals with the not-trivial task of combining images and clinical information (from anamneses) concerning the skin lesions in a lightweight transformer architecture that does not demand high computation resources but still presents competitive classification results.
Artificial intelligence has significantly advanced skin cancer diagnosis by enabling rapid and accurate detection of malignant lesions. In this domain, most publicly available image datasets consist of single, isolated skin lesions positioned at the center of the image. While these lesion-centric datasets have been fundamental for developing diagnostic algorithms, they lack the context of the surrounding skin, which is critical for improving lesion detection. The iToBoS dataset was created to address this challenge. It includes 16,954 images of skin regions from 100 participants, captured using 3D total body photography. Each image roughly corresponds to a $7 \times 9$ cm section of skin with all suspicious lesions annotated using bounding boxes. Additionally, the dataset provides metadata such as anatomical location, age group, and sun damage score for each image. This dataset aims to facilitate training and benchmarking of algorithms, with the goal of enabling early detection of skin cancer and deployment of this technology in non-clinical environments.
Retinal diseases are a leading cause of vision impairment and blindness, with timely diagnosis being critical for effective treatment. Optical Coherence Tomography (OCT) has become a standard imaging modality for retinal disease diagnosis, but OCT images often suffer from issues such as speckle noise, complex lesion shapes, and varying lesion sizes, making interpretation challenging. In this paper, we propose a novel framework, WaveNet-SF, to enhance retinal disease detection by integrating spatial-domain and frequency-domain learning. The framework utilizes wavelet transforms to decompose OCT images into low- and high-frequency components, enabling the model to extract both global structural features and fine-grained details. To improve lesion detection, we introduce a multi-scale wavelet spatial attention (MSW-SA) module, which enhances the model's focus on regions of interest at multiple scales. Additionally, a high-frequency feature compensation block (HFFC) is incorporated to recover edge information lost during wavelet decomposition, suppress noise, and preserve fine details crucial for lesion detection. Our approach achieves state-of-the-art (SOTA) classification accuracies of 97.82% and 99. 58% on the OCT-C8 and OCT2017 datasets, respectively, surpassing existing methods. These results demonstrate the efficacy of WaveNet-SF in addressing the challenges of OCT image analysis and its potential as a powerful tool for retinal disease diagnosis.
Patients with metastatic breast cancer (mBC) undergo continuous medical imaging during treatment, making accurate lesion detection and monitoring over time critical for clinical decisions. Predicting drug response from post-treatment data is essential for personalized care and pharmacological research. In collaboration with the U.S. Food and Drug Administration and Novartis Pharmaceuticals, we analyzed serial chest CT scans from two large-scale Phase III trials, MONALEESA 3 and MONALEESA 7. This paper has two objectives (a) Data Structuring developing a Registration Aided Automated Correspondence (RAMAC) algorithm for precise lesion tracking in longitudinal CT data, and (b) Survival Analysis creating imaging features and models from RAMAC structured data to predict patient outcomes. The RAMAC algorithm uses a two phase pipeline: three dimensional rigid registration aligns CT images, and a distance metric-based Hungarian algorithm tracks lesion correspondence. Using structured data, we developed interpretable models to assess progression-free survival (PFS) in mBC patients by combining baseline radiomics, post-treatment changes (Weeks 8, 16, 24), and demographic features. Radiomics effects were studied across time points separately and through a non-correlated additive framework. Radiomics features were reduced using (a) a regularized (L1-penalized) additive Cox proportional hazards model, and (b) variable selection via best subset selection. Performance, measured using the concordance index (C-index), improved with additional time points. Joint modeling, considering correlations among radiomics effects over time, provided insights into relationships between longitudinal radiomics and survival outcomes.
As deep learning models gain attraction in medical data, ensuring transparent and trustworthy decision-making is essential. In skin cancer diagnosis, while advancements in lesion detection and classification have improved accuracy, the black-box nature of these methods poses challenges in understanding their decision processes, leading to trust issues among physicians. This study leverages the CLIP (Contrastive Language-Image Pretraining) model, trained on different skin lesion datasets, to capture meaningful relationships between visual features and diagnostic criteria terms. To further enhance transparency, we propose a method called MedGrad E-CLIP, which builds on gradient-based E-CLIP by incorporating a weighted entropy mechanism designed for complex medical imaging like skin lesions. This approach highlights critical image regions linked to specific diagnostic descriptions. The developed integrated pipeline not only classifies skin lesions by matching corresponding descriptions but also adds an essential layer of explainability developed especially for medical data. By visually explaining how different features in an image relates to diagnostic criteria, this approach demonstrates the potential of advanced vision-language models in medical image analysis, ultimately improving transparency, robustness, and trust in AI-driven diagnostic systems.
Clinically significant prostate cancer (csPCa) is a leading cause of cancer death in men, yet it has a high survival rate if diagnosed early. Bi-parametric MRI (bpMRI) reading has become a prominent screening test for csPCa. However, this process has a high false positive (FP) rate, incurring higher diagnostic costs and patient discomfort. This paper introduces RadHop-Net, a novel and lightweight CNN for FP reduction. The pipeline consists of two stages: Stage 1 employs data driven radiomics to extract candidate ROIs. In contrast, Stage 2 expands the receptive field about each ROI using RadHop-Net to compensate for the predicted error from Stage 1. Moreover, a novel loss function for regression problems is introduced to balance the influence between FPs and true positives (TPs). RadHop-Net is trained in a radiomics-to-error manner, thus decoupling from the common voxel-to-label approach. The proposed Stage 2 improves the average precision (AP) in lesion detection from 0.407 to 0.468 in the publicly available pi-cai dataset, also maintaining a significantly smaller model size than the state-of-the-art.
Multiple Sclerosis (MS) is a chronic disease that causes lesions in the central nervous system. Diagnosing MS is a challenging process that strongly relies on Magnetic Resonance Imaging (MRI) and exhibits high and largely unexplained variability across patients. In this paper, we propose a novel XAI-ResUNet architecture by integrating ResNet-50 as an encoder in a U-Net-like architecture and demystifying the detection and segmentation process by incorporating EigenGradCAM into the encoder. We used the training and testing sets of the MSSEG-2016 dataset for our experiments. We compared three architectures with ResNet-50 pre-trained on ImageNet, RadImageNet, and without pre-training. Our preliminary results show that ResNet-50 pre-trained on ImageNet outperforms the others, achieving a DSC of 0.638. We also demonstrate how pre-training on large image datasets can affect MS lesion detection and segmentation. Our code is publicly available at https://github.com/VishmiVishara/XAI-ResUNet.