SPA: Efficient User-Preference Alignment against Uncertainty in Medical Image Segmentation

Medical image segmentation data inherently contain uncertainty, often stemming from both imperfect image quality and variability in labeling preferences on ambiguous pixels, which depend on annotators' expertise and the clinical context of the annotations. For instance, a boundary pixel might be labeled as tumor in diagnosis to avoid under-assessment of severity, but as normal tissue in radiotherapy to prevent damage to sensitive structures. As segmentation preferences vary across downstream applications, it is often desirable for an image segmentation model to offer user-adaptable predictions rather than a fixed output. While prior uncertainty-aware and interactive methods offer adaptability, they are inefficient at test time: uncertainty-aware models require users to choose from numerous similar outputs, while interactive models demand significant user input through click or box prompts to refine segmentation. To address these challenges, we propose \textbf{SPA}, a segmentation framework that efficiently adapts to diverse test-time preferences with minimal human interaction. By presenting users a select few, distinct segmentation candidates that best capture uncertainties, it reduces clinician workload in reaching the preferred segmentation. To accommodate user preference, we introduce a probabilistic mechanism that leverages user feedback to adapt model's segmentation preference. The proposed framework is evaluated on a diverse range of medical image segmentation tasks: color fundus images, CT, and MRI. It demonstrates 1) a significant reduction in clinician time and effort compared with existing interactive segmentation approaches, 2) strong adaptability based on human feedback, and 3) state-of-the-art image segmentation performance across diverse modalities and semantic labels.

Universal Topology Refinement for Medical Image Segmentation with Polynomial Feature Synthesis

Although existing medical image segmentation methods provide impressive pixel-wise accuracy, they often neglect topological correctness, making their segmentations unusable for many downstream tasks. One option is to retrain such models whilst including a topology-driven loss component. However, this is computationally expensive and often impractical. A better solution would be to have a versatile plug-and-play topology refinement method that is compatible with any domain-specific segmentation pipeline. Directly training a post-processing model to mitigate topological errors often fails as such models tend to be biased towards the topological errors of a target segmentation network. The diversity of these errors is confined to the information provided by a labelled training set, which is especially problematic for small datasets. Our method solves this problem by training a model-agnostic topology refinement network with synthetic segmentations that cover a wide variety of topological errors. Inspired by the Stone-Weierstrass theorem, we synthesize topology-perturbation masks with randomly sampled coefficients of orthogonal polynomial bases, which ensures a complete and unbiased representation. Practically, we verified the efficiency and effectiveness of our methods as being compatible with multiple families of polynomial bases, and show evidence that our universal plug-and-play topology refinement network outperforms both existing topology-driven learning-based and post-processing methods. We also show that combining our method with learning-based models provides an effortless add-on, which can further improve the performance of existing approaches.

Stability and Generalizability in SDE Diffusion Models with Measure-Preserving Dynamics

Inverse problems describe the process of estimating the causal factors from a set of measurements or data. Mapping of often incomplete or degraded data to parameters is ill-posed, thus data-driven iterative solutions are required, for example when reconstructing clean images from poor signals. Diffusion models have shown promise as potent generative tools for solving inverse problems due to their superior reconstruction quality and their compatibility with iterative solvers. However, most existing approaches are limited to linear inverse problems represented as Stochastic Differential Equations (SDEs). This simplification falls short of addressing the challenging nature of real-world problems, leading to amplified cumulative errors and biases. We provide an explanation for this gap through the lens of measure-preserving dynamics of Random Dynamical Systems (RDS) with which we analyse Temporal Distribution Discrepancy and thus introduce a theoretical framework based on RDS for SDE diffusion models. We uncover several strategies that inherently enhance the stability and generalizability of diffusion models for inverse problems and introduce a novel score-based diffusion framework, the \textbf{D}ynamics-aware S\textbf{D}E \textbf{D}iffusion \textbf{G}enerative \textbf{M}odel (D$^3$GM). The \textit{Measure-preserving property} can return the degraded measurement to the original state despite complex degradation with the RDS concept of \textit{stability}. Our extensive experimental results corroborate the effectiveness of D$^3$GM across multiple benchmarks including a prominent application for inverse problems, magnetic resonance imaging. Code and data will be publicly available.

Probabilistic Contrastive Learning with Explicit Concentration on the Hypersphere

Self-supervised contrastive learning has predominantly adopted deterministic methods, which are not suited for environments characterized by uncertainty and noise. This paper introduces a new perspective on incorporating uncertainty into contrastive learning by embedding representations within a spherical space, inspired by the von Mises-Fisher distribution (vMF). We introduce an unnormalized form of vMF and leverage the concentration parameter, kappa, as a direct, interpretable measure to quantify uncertainty explicitly. This approach not only provides a probabilistic interpretation of the embedding space but also offers a method to calibrate model confidence against varying levels of data corruption and characteristics. Our empirical results demonstrate that the estimated concentration parameter correlates strongly with the degree of unforeseen data corruption encountered at test time, enables failure analysis, and enhances existing out-of-distribution detection methods.

A Foundation Model for Brain Lesion Segmentation with Mixture of Modality Experts

Brain lesion segmentation plays an essential role in neurological research and diagnosis. As brain lesions can be caused by various pathological alterations, different types of brain lesions tend to manifest with different characteristics on different imaging modalities. Due to this complexity, brain lesion segmentation methods are often developed in a task-specific manner. A specific segmentation model is developed for a particular lesion type and imaging modality. However, the use of task-specific models requires predetermination of the lesion type and imaging modality, which complicates their deployment in real-world scenarios. In this work, we propose a universal foundation model for 3D brain lesion segmentation, which can automatically segment different types of brain lesions for input data of various imaging modalities. We formulate a novel Mixture of Modality Experts (MoME) framework with multiple expert networks attending to different imaging modalities. A hierarchical gating network combines the expert predictions and fosters expertise collaboration. Furthermore, we introduce a curriculum learning strategy during training to avoid the degeneration of each expert network and preserve their specialization. We evaluated the proposed method on nine brain lesion datasets, encompassing five imaging modalities and eight lesion types. The results show that our model outperforms state-of-the-art universal models and provides promising generalization to unseen datasets.

The state-of-the-art in Cardiac MRI Reconstruction: Results of the CMRxRecon Challenge in MICCAI 2023

Cardiac MRI, crucial for evaluating heart structure and function, faces limitations like slow imaging and motion artifacts. Undersampling reconstruction, especially data-driven algorithms, has emerged as a promising solution to accelerate scans and enhance imaging performance using highly under-sampled data. Nevertheless, the scarcity of publicly available cardiac k-space datasets and evaluation platform hinder the development of data-driven reconstruction algorithms. To address this issue, we organized the Cardiac MRI Reconstruction Challenge (CMRxRecon) in 2023, in collaboration with the 26th International Conference on MICCAI. CMRxRecon presented an extensive k-space dataset comprising cine and mapping raw data, accompanied by detailed annotations of cardiac anatomical structures. With overwhelming participation, the challenge attracted more than 285 teams and over 600 participants. Among them, 22 teams successfully submitted Docker containers for the testing phase, with 7 teams submitted for both cine and mapping tasks. All teams use deep learning based approaches, indicating that deep learning has predominately become a promising solution for the problem. The first-place winner of both tasks utilizes the E2E-VarNet architecture as backbones. In contrast, U-Net is still the most popular backbone for both multi-coil and single-coil reconstructions. This paper provides a comprehensive overview of the challenge design, presents a summary of the submitted results, reviews the employed methods, and offers an in-depth discussion that aims to inspire future advancements in cardiac MRI reconstruction models. The summary emphasizes the effective strategies observed in Cardiac MRI reconstruction, including backbone architecture, loss function, pre-processing techniques, physical modeling, and model complexity, thereby providing valuable insights for further developments in this field.

Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement

Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL's versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL}) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10\% annotated training data, averaged across all six datasets.

Multi-Center Fetal Brain Tissue Annotation (FeTA) Challenge 2022 Results

Segmentation is a critical step in analyzing the developing human fetal brain. There have been vast improvements in automatic segmentation methods in the past several years, and the Fetal Brain Tissue Annotation (FeTA) Challenge 2021 helped to establish an excellent standard of fetal brain segmentation. However, FeTA 2021 was a single center study, and the generalizability of algorithms across different imaging centers remains unsolved, limiting real-world clinical applicability. The multi-center FeTA Challenge 2022 focuses on advancing the generalizability of fetal brain segmentation algorithms for magnetic resonance imaging (MRI). In FeTA 2022, the training dataset contained images and corresponding manually annotated multi-class labels from two imaging centers, and the testing data contained images from these two imaging centers as well as two additional unseen centers. The data from different centers varied in many aspects, including scanners used, imaging parameters, and fetal brain super-resolution algorithms applied. 16 teams participated in the challenge, and 17 algorithms were evaluated. Here, a detailed overview and analysis of the challenge results are provided, focusing on the generalizability of the submissions. Both in- and out of domain, the white matter and ventricles were segmented with the highest accuracy, while the most challenging structure remains the cerebral cortex due to anatomical complexity. The FeTA Challenge 2022 was able to successfully evaluate and advance generalizability of multi-class fetal brain tissue segmentation algorithms for MRI and it continues to benchmark new algorithms. The resulting new methods contribute to improving the analysis of brain development in utero.

T3D: Towards 3D Medical Image Understanding through Vision-Language Pre-training

Expert annotation of 3D medical image for downstream analysis is resource-intensive, posing challenges in clinical applications. Visual self-supervised learning (vSSL), though effective for learning visual invariance, neglects the incorporation of domain knowledge from medicine. To incorporate medical knowledge into visual representation learning, vision-language pre-training (VLP) has shown promising results in 2D image. However, existing VLP approaches become generally impractical when applied to high-resolution 3D medical images due to GPU hardware constraints and the potential loss of critical details caused by downsampling, which is the intuitive solution to hardware constraints. To address the above limitations, we introduce T3D, the first VLP framework designed for high-resolution 3D medical images. T3D incorporates two text-informed pretext tasks: (\lowerromannumeral{1}) text-informed contrastive learning; (\lowerromannumeral{2}) text-informed image restoration. These tasks focus on learning 3D visual representations from high-resolution 3D medical images and integrating clinical knowledge from radiology reports, without distorting information through forced alignment of downsampled volumes with detailed anatomical text. Trained on a newly curated large-scale dataset of 3D medical images and radiology reports, T3D significantly outperforms current vSSL methods in tasks like organ and tumor segmentation, as well as disease classification. This underlines T3D's potential in representation learning for 3D medical image analysis. All data and code will be available upon acceptance.

G2D: From Global to Dense Radiography Representation Learning via Vision-Language Pre-training

Recently, medical vision-language pre-training (VLP) has reached substantial progress to learn global visual representation from medical images and their paired radiology reports. However, medical imaging tasks in real world usually require finer granularity in visual features. These tasks include visual localization tasks (e.g., semantic segmentation, object detection) and visual grounding task. Yet, current medical VLP methods face challenges in learning these fine-grained features, as they primarily focus on brute-force alignment between image patches and individual text tokens for local visual feature learning, which is suboptimal for downstream dense prediction tasks. In this work, we propose a new VLP framework, named \textbf{G}lobal to \textbf{D}ense level representation learning (G2D) that achieves significantly improved granularity and more accurate grounding for the learned features, compared to existing medical VLP approaches. In particular, G2D learns dense and semantically-grounded image representations via a pseudo segmentation task parallel with the global vision-language alignment. Notably, generating pseudo segmentation targets does not incur extra trainable parameters: they are obtained on the fly during VLP with a parameter-free processor. G2D achieves superior performance across 6 medical imaging tasks and 25 diseases, particularly in semantic segmentation, which necessitates fine-grained, semantically-grounded image features. In this task, G2D surpasses peer models even when fine-tuned with just 1\% of the training data, compared to the 100\% used by these models. The code will be released upon acceptance.