Unleashing the Potential of Vision-Language Pre-Training for 3D Zero-Shot Lesion Segmentation via Mask-Attribute Alignment

Recent advancements in medical vision-language pre-training models have driven significant progress in zero-shot disease recognition. However, transferring image-level knowledge to pixel-level tasks, such as lesion segmentation in 3D CT scans, remains a critical challenge. Due to the complexity and variability of pathological visual characteristics, existing methods struggle to align fine-grained lesion features not encountered during training with disease-related textual representations. In this paper, we present Malenia, a novel multi-scale lesion-level mask-attribute alignment framework, specifically designed for 3D zero-shot lesion segmentation. Malenia improves the compatibility between mask representations and their associated elemental attributes, explicitly linking the visual features of unseen lesions with the extensible knowledge learned from previously seen ones. Furthermore, we design a Cross-Modal Knowledge Injection module to enhance both visual and textual features with mutually beneficial information, effectively guiding the generation of segmentation results. Comprehensive experiments across three datasets and 12 lesion categories validate the superior performance of Malenia. Codes will be publicly available.

MedDiff-FM: A Diffusion-based Foundation Model for Versatile Medical Image Applications

Diffusion models have achieved significant success in both the natural image and medical image domains, encompassing a wide range of applications. Previous investigations in medical images have often been constrained to specific anatomical regions, particular applications, and limited datasets, resulting in isolated diffusion models. This paper introduces a diffusion-based foundation model to address a diverse range of medical image tasks, namely MedDiff-FM. MedDiff-FM leverages 3D CT images from multiple publicly available datasets, covering anatomical regions from head to abdomen, to pre-train a diffusion foundation model, and explores the capabilities of the diffusion foundation model across a variety of application scenarios. The diffusion foundation model handles multi-level image processing both at the image-level and patch-level, and utilizes position embedding to establish multi-level spatial relationships as well as anatomical structures and region classes to control certain anatomical regions. MedDiff-FM manages several downstream tasks seamlessly, including image denoising, anomaly detection, and image synthesis. MedDiff-FM is also capable of performing lesion generation and lesion inpainting by rapidly fine-tuning the diffusion foundation model using ControlNet with task-specific conditions. Experimental results demonstrate the effectiveness of MedDiff-FM in addressing diverse downstream medical image tasks.

MeNTi: Bridging Medical Calculator and LLM Agent with Nested Tool Calling

Integrating tools into Large Language Models (LLMs) has facilitated the widespread application. Despite this, in specialized downstream task contexts, reliance solely on tools is insufficient to fully address the complexities of the real world. This particularly restricts the effective deployment of LLMs in fields such as medicine. In this paper, we focus on the downstream tasks of medical calculators, which use standardized tests to assess an individual's health status. We introduce MeNTi, a universal agent architecture for LLMs. MeNTi integrates a specialized medical toolkit and employs meta-tool and nested calling mechanisms to enhance LLM tool utilization. Specifically, it achieves flexible tool selection and nested tool calling to address practical issues faced in intricate medical scenarios, including calculator selection, slot filling, and unit conversion. To assess the capabilities of LLMs for quantitative assessment throughout the clinical process of calculator scenarios, we introduce CalcQA. This benchmark requires LLMs to use medical calculators to perform calculations and assess patient health status. CalcQA is constructed by professional physicians and includes 100 case-calculator pairs, complemented by a toolkit of 281 medical tools. The experimental results demonstrate significant performance improvements with our framework. This research paves new directions for applying LLMs in demanding scenarios of medicine.

BrainMVP: Multi-modal Vision Pre-training for Brain Image Analysis using Multi-parametric MRI

Accurate diagnosis of brain abnormalities is greatly enhanced by the inclusion of complementary multi-parametric MRI imaging data. There is significant potential to develop a universal pre-training model that can be quickly adapted for image modalities and various clinical scenarios. However, current models often rely on uni-modal image data, neglecting the cross-modal correlations among different image modalities or struggling to scale up pre-training in the presence of missing modality data. In this paper, we propose BrainMVP, a multi-modal vision pre-training framework for brain image analysis using multi-parametric MRI scans. First, we collect 16,022 brain MRI scans (over 2.4 million images), encompassing eight MRI modalities sourced from a diverse range of centers and devices. Then, a novel pre-training paradigm is proposed for the multi-modal MRI data, addressing the issue of missing modalities and achieving multi-modal information fusion. Cross-modal reconstruction is explored to learn distinctive brain image embeddings and efficient modality fusion capabilities. A modality-wise data distillation module is proposed to extract the essence representation of each MR image modality for both the pre-training and downstream application purposes. Furthermore, we introduce a modality-aware contrastive learning module to enhance the cross-modality association within a study. Extensive experiments on downstream tasks demonstrate superior performance compared to state-of-the-art pre-training methods in the medical domain, with Dice Score improvement of 0.28%-14.47% across six segmentation benchmarks and a consistent accuracy improvement of 0.65%-18.07% in four individual classification tasks.

A foundation model for generalizable disease diagnosis in chest X-ray images

Medical artificial intelligence (AI) is revolutionizing the interpretation of chest X-ray (CXR) images by providing robust tools for disease diagnosis. However, the effectiveness of these AI models is often limited by their reliance on large amounts of task-specific labeled data and their inability to generalize across diverse clinical settings. To address these challenges, we introduce CXRBase, a foundational model designed to learn versatile representations from unlabelled CXR images, facilitating efficient adaptation to various clinical tasks. CXRBase is initially trained on a substantial dataset of 1.04 million unlabelled CXR images using self-supervised learning methods. This approach allows the model to discern meaningful patterns without the need for explicit labels. After this initial phase, CXRBase is fine-tuned with labeled data to enhance its performance in disease detection, enabling accurate classification of chest diseases. CXRBase provides a generalizable solution to improve model performance and alleviate the annotation workload of experts to enable broad clinical AI applications from chest imaging.

MedViLaM: A multimodal large language model with advanced generalizability and explainability for medical data understanding and generation

Medicine is inherently multimodal and multitask, with diverse data modalities spanning text, imaging. However, most models in medical field are unimodal single tasks and lack good generalizability and explainability. In this study, we introduce MedViLaM, a unified vision-language model towards a generalist model for medical data that can flexibly encode and interpret various forms of medical data, including clinical language and imaging, all using the same set of model weights. To facilitate the creation of such multi-task model, we have curated MultiMedBench, a comprehensive pretaining dataset and benchmark consisting of several distinct tasks, i.e., continuous question-answering, multi-label disease classification, disease localization, generation and summarization of radiology reports. MedViLaM demonstrates strong performance across all MultiMedBench tasks, frequently outpacing other generalist models by a significant margin. Additionally, we present instances of zero-shot generalization to new medical concepts and tasks, effective transfer learning across different tasks, and the emergence of zero-shot medical reasoning.

DeReStainer: H&E to IHC Pathological Image Translation via Decoupled Staining Channels

Breast cancer is a highly fatal disease among cancers in women, and early detection is crucial for treatment. HER2 status, a valuable diagnostic marker based on Immunohistochemistry (IHC) staining, is instrumental in determining breast cancer status. The high cost of IHC staining and the ubiquity of Hematoxylin and Eosin (H&E) staining make the conversion from H&E to IHC staining essential. In this article, we propose a destain-restain framework for converting H&E staining to IHC staining, leveraging the characteristic that H&E staining and IHC staining of the same tissue sections share the Hematoxylin channel. We further design loss functions specifically for Hematoxylin and Diaminobenzidin (DAB) channels to generate IHC images exploiting insights from separated staining channels. Beyond the benchmark metrics on BCI contest, we have developed semantic information metrics for the HER2 level. The experimental results demonstrated that our method outperforms previous open-sourced methods in terms of image intrinsic property and semantic information.

GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI

Large Vision-Language Models (LVLMs) are capable of handling diverse data types such as imaging, text, and physiological signals, and can be applied in various fields. In the medical field, LVLMs have a high potential to offer substantial assistance for diagnosis and treatment. Before that, it is crucial to develop benchmarks to evaluate LVLMs' effectiveness in various medical applications. Current benchmarks are often built upon specific academic literature, mainly focusing on a single domain, and lacking varying perceptual granularities. Thus, they face specific challenges, including limited clinical relevance, incomplete evaluations, and insufficient guidance for interactive LVLMs. To address these limitations, we developed the GMAI-MMBench, the most comprehensive general medical AI benchmark with well-categorized data structure and multi-perceptual granularity to date. It is constructed from 285 datasets across 39 medical image modalities, 18 clinical-related tasks, 18 departments, and 4 perceptual granularities in a Visual Question Answering (VQA) format. Additionally, we implemented a lexical tree structure that allows users to customize evaluation tasks, accommodating various assessment needs and substantially supporting medical AI research and applications. We evaluated 50 LVLMs, and the results show that even the advanced GPT-4o only achieves an accuracy of 52\%, indicating significant room for improvement. Moreover, we identified five key insufficiencies in current cutting-edge LVLMs that need to be addressed to advance the development of better medical applications. We believe that GMAI-MMBench will stimulate the community to build the next generation of LVLMs toward GMAI.

Multi-modal Data Binding for Survival Analysis Modeling with Incomplete Data and Annotations

Survival analysis stands as a pivotal process in cancer treatment research, crucial for predicting patient survival rates accurately. Recent advancements in data collection techniques have paved the way for enhancing survival predictions by integrating information from multiple modalities. However, real-world scenarios often present challenges with incomplete data, particularly when dealing with censored survival labels. Prior works have addressed missing modalities but have overlooked incomplete labels, which can introduce bias and limit model efficacy. To bridge this gap, we introduce a novel framework that simultaneously handles incomplete data across modalities and censored survival labels. Our approach employs advanced foundation models to encode individual modalities and align them into a universal representation space for seamless fusion. By generating pseudo labels and incorporating uncertainty, we significantly enhance predictive accuracy. The proposed method demonstrates outstanding prediction accuracy in two survival analysis tasks on both employed datasets. This innovative approach overcomes limitations associated with disparate modalities and improves the feasibility of comprehensive survival analysis using multiple large foundation models.

Cost-effective Instruction Learning for Pathology Vision and Language Analysis

The advent of vision-language models fosters the interactive conversations between AI-enabled models and humans. Yet applying these models into clinics must deal with daunting challenges around large-scale training data, financial, and computational resources. Here we propose a cost-effective instruction learning framework for conversational pathology named as CLOVER. CLOVER only trains a lightweight module and uses instruction tuning while freezing the parameters of the large language model. Instead of using costly GPT-4, we propose well-designed prompts on GPT-3.5 for building generation-based instructions, emphasizing the utility of pathological knowledge derived from the Internet source. To augment the use of instructions, we construct a high-quality set of template-based instructions in the context of digital pathology. From two benchmark datasets, our findings reveal the strength of hybrid-form instructions in the visual question-answer in pathology. Extensive results show the cost-effectiveness of CLOVER in answering both open-ended and closed-ended questions, where CLOVER outperforms strong baselines that possess 37 times more training parameters and use instruction data generated from GPT-4. Through the instruction tuning, CLOVER exhibits robustness of few-shot learning in the external clinical dataset. These findings demonstrate that cost-effective modeling of CLOVER could accelerate the adoption of rapid conversational applications in the landscape of digital pathology.