Decouple and Reason: Anatomically Guided Two-Stage Voxel-Level Grounding of Free-Text Findings in 3D Chest CT

Automatic voxel-level grounding of free-text findings in 3D chest Computed Tomography (CT) is critical for clinical interpretability. However, this task remains highly challenging due to the intricate spatial complexity of large 3D volumes and the heterogeneity of free-text findings. Existing end-to-end approaches often struggle to simultaneously learn the localized feature representations required for accurate 3D segmentation and the complex semantic understanding needed for text alignment, leading to suboptimal grounding performance. To overcome this fundamental limitation, we propose a novel decoupled framework that disentangles the problem into two specialized stages: (1) class-agnostic lesion segmentation and (2) text-volume reasoning. This structural separation allows the model to first extract candidate sub-volumes by localizing potential abnormalities. Subsequently, intensive cross-modal reasoning is performed to align these localized sub-volumes with free-text medical findings. To resolve the spatial ambiguities inherent in local regions, the reasoning module is augmented with explicit anatomical guidance, utilizing relative spatial coordinates and lung lobe priors. Evaluated on the ReXGroundingCT benchmark, our method achieves state-of-the-art performance in overall grounding quality on the official leaderboard. These results demonstrate that decoupling detection from reasoning is a highly effective paradigm for handling the complexity of 3D medical visual grounding. Our code is publicly available at https://github.com/khuhm/DAGG.

MAGE: Color-Invariant and Spatial Knowledge Distillation for Gastric Neoplasm Classification

Accurate differentiation between gastric adenoma and carcinoma during endoscopy is critical for clinical decision-making. Yet, this task is highly challenging due to high inter-class similarity and ambiguous boundaries between the two classes. Existing ROI-based classification methods often suffer from detection/segmentation error propagation and loss of surrounding global context. In contrast, full-image classification lacks the necessary spatial focus. Furthermore, we observe that deep neural networks gravitate towards domain-specific texture biases(e.g. bleeding, lighting artifacts), often causing models to predict based on spurious correlations instead of intrinsic morphological features. To address these limitations, we propose a novel framework, Masked Achromatic Guidance Expert (MAGE). During training, we introduce an auxiliary local expert branch trained on masked achromatic views of the neoplasm. By suppressing background context and color, this branch is forced to learn highly discriminative, purely structural features. We then employ a dual-objective distillation strategy, transferring both classification logits and spatial attention maps to provide implicit spatial supervision to the main branch that receives full WLI as input. This dual-objective distillation forces the model to ground its predictions in morphology rather than relying on shortcuts, while still retaining clinically relevant color cues. At inference time, our deployable model operates on images without annotated masks, ensuring real-time deployability . Extensive experiments on a clinical gastric endoscopy dataset show that our method significantly outperforms existing detection-based methodologies (e.g. YOLO) and classification-based methodologies (e.g. Swin-Transformer), providing not only superior classification performance but also interpretable attention maps for clinical reliability.

Multi-Class Segmentation of Aortic Branches and Zones in Computed Tomography Angiography: The AortaSeg24 Challenge

Multi-class segmentation of the aorta in computed tomography angiography (CTA) scans is essential for diagnosing and planning complex endovascular treatments for patients with aortic dissections. However, existing methods reduce aortic segmentation to a binary problem, limiting their ability to measure diameters across different branches and zones. Furthermore, no open-source dataset is currently available to support the development of multi-class aortic segmentation methods. To address this gap, we organized the AortaSeg24 MICCAI Challenge, introducing the first dataset of 100 CTA volumes annotated for 23 clinically relevant aortic branches and zones. This dataset was designed to facilitate both model development and validation. The challenge attracted 121 teams worldwide, with participants leveraging state-of-the-art frameworks such as nnU-Net and exploring novel techniques, including cascaded models, data augmentation strategies, and custom loss functions. We evaluated the submitted algorithms using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD), highlighting the approaches adopted by the top five performing teams. This paper presents the challenge design, dataset details, evaluation metrics, and an in-depth analysis of the top-performing algorithms. The annotated dataset, evaluation code, and implementations of the leading methods are publicly available to support further research. All resources can be accessed at https://aortaseg24.grand-challenge.org.

Lesion-Aware Cross-Phase Attention Network for Renal Tumor Subtype Classification on Multi-Phase CT Scans

Multi-phase computed tomography (CT) has been widely used for the preoperative diagnosis of kidney cancer due to its non-invasive nature and ability to characterize renal lesions. However, since enhancement patterns of renal lesions across CT phases are different even for the same lesion type, the visual assessment by radiologists suffers from inter-observer variability in clinical practice. Although deep learning-based approaches have been recently explored for differential diagnosis of kidney cancer, they do not explicitly model the relationships between CT phases in the network design, limiting the diagnostic performance. In this paper, we propose a novel lesion-aware cross-phase attention network (LACPANet) that can effectively capture temporal dependencies of renal lesions across CT phases to accurately classify the lesions into five major pathological subtypes from time-series multi-phase CT images. We introduce a 3D inter-phase lesion-aware attention mechanism to learn effective 3D lesion features that are used to estimate attention weights describing the inter-phase relations of the enhancement patterns. We also present a multi-scale attention scheme to capture and aggregate temporal patterns of lesion features at different spatial scales for further improvement. Extensive experiments on multi-phase CT scans of kidney cancer patients from the collected dataset demonstrate that our LACPANet outperforms state-of-the-art approaches in diagnostic accuracy.

A Unified Multi-Phase CT Synthesis and Classification Framework for Kidney Cancer Diagnosis with Incomplete Data

Multi-phase CT is widely adopted for the diagnosis of kidney cancer due to the complementary information among phases. However, the complete set of multi-phase CT is often not available in practical clinical applications. In recent years, there have been some studies to generate the missing modality image from the available data. Nevertheless, the generated images are not guaranteed to be effective for the diagnosis task. In this paper, we propose a unified framework for kidney cancer diagnosis with incomplete multi-phase CT, which simultaneously recovers missing CT images and classifies cancer subtypes using the completed set of images. The advantage of our framework is that it encourages a synthesis model to explicitly learn to generate missing CT phases that are helpful for classifying cancer subtypes. We further incorporate lesion segmentation network into our framework to exploit lesion-level features for effective cancer classification in the whole CT volumes. The proposed framework is based on fully 3D convolutional neural networks to jointly optimize both synthesis and classification of 3D CT volumes. Extensive experiments on both in-house and external datasets demonstrate the effectiveness of our framework for the diagnosis with incomplete data compared with state-of-the-art baselines. In particular, cancer subtype classification using the completed CT data by our method achieves higher performance than the classification using the given incomplete data.

Exploring 3D U-Net Training Configurations and Post-Processing Strategies for the MICCAI 2023 Kidney and Tumor Segmentation Challenge

In 2023, it is estimated that 81,800 kidney cancer cases will be newly diagnosed, and 14,890 people will die from this cancer in the United States. Preoperative dynamic contrast-enhanced abdominal computed tomography (CT) is often used for detecting lesions. However, there exists inter-observer variability due to subtle differences in the imaging features of kidney and kidney tumors. In this paper, we explore various 3D U-Net training configurations and effective post-processing strategies for accurate segmentation of kidneys, cysts, and kidney tumors in CT images. We validated our model on the dataset of the 2023 Kidney and Kidney Tumor Segmentation (KiTS23) challenge. Our method took second place in the final ranking of the KiTS23 challenge on unseen test data with an average Dice score of 0.820 and an average Surface Dice of 0.712.

Image Generation with Self Pixel-wise Normalization

Region-adaptive normalization (RAN) methods have been widely used in the generative adversarial network (GAN)-based image-to-image translation technique. However, since these approaches need a mask image to infer the pixel-wise affine transformation parameters, they cannot be applied to the general image generation models having no paired mask images. To resolve this problem, this paper presents a novel normalization method, called self pixel-wise normalization (SPN), which effectively boosts the generative performance by performing the pixel-adaptive affine transformation without the mask image. In our method, the transforming parameters are derived from a self-latent mask that divides the feature map into the foreground and background regions. The visualization of the self-latent masks shows that SPN effectively captures a single object to be generated as the foreground. Since the proposed method produces the self-latent mask without external data, it is easily applicable in the existing generative models. Extensive experiments on various datasets reveal that the proposed method significantly improves the performance of image generation technique in terms of Frechet inception distance (FID) and Inception score (IS).

Rethinking Coarse-to-Fine Approach in Single Image Deblurring

Coarse-to-fine strategies have been extensively used for the architecture design of single image deblurring networks. Conventional methods typically stack sub-networks with multi-scale input images and gradually improve sharpness of images from the bottom sub-network to the top sub-network, yielding inevitably high computational costs. Toward a fast and accurate deblurring network design, we revisit the coarse-to-fine strategy and present a multi-input multi-output U-net (MIMO-UNet). The MIMO-UNet has three distinct features. First, the single encoder of the MIMO-UNet takes multi-scale input images to ease the difficulty of training. Second, the single decoder of the MIMO-UNet outputs multiple deblurred images with different scales to mimic multi-cascaded U-nets using a single U-shaped network. Last, asymmetric feature fusion is introduced to merge multi-scale features in an efficient manner. Extensive experiments on the GoPro and RealBlur datasets demonstrate that the proposed network outperforms the state-of-the-art methods in terms of both accuracy and computational complexity. Source code is available for research purposes at https://github.com/chosj95/MIMO-UNet.

Content-aware Directed Propagation Network with Pixel Adaptive Kernel Attention

Convolutional neural networks (CNNs) have been not only widespread but also achieved noticeable results on numerous applications including image classification, restoration, and generation. Although the weight-sharing property of convolutions makes them widely adopted in various tasks, its content-agnostic characteristic can also be considered a major drawback. To solve this problem, in this paper, we propose a novel operation, called pixel adaptive kernel attention (PAKA). PAKA provides directivity to the filter weights by multiplying spatially varying attention from learnable features. The proposed method infers pixel-adaptive attention maps along the channel and spatial directions separately to address the decomposed model with fewer parameters. Our method is trainable in an end-to-end manner and applicable to any CNN-based models. In addition, we propose an improved information aggregation module with PAKA, called the hierarchical PAKA module (HPM). We demonstrate the superiority of our HPM by presenting state-of-the-art performance on semantic segmentation compared to the conventional information aggregation modules. We validate the proposed method through additional ablation studies and visualizing the effect of PAKA providing directivity to the weights of convolutions. We also show the generalizability of the proposed method by applying it to multi-modal tasks especially color-guided depth map super-resolution.

A Simple yet Effective Way for Improving the Performance of GANs

This paper presents a simple but effective way that improves the performance of generative adversarial networks (GANs) without imposing the training overhead or modifying the network architectures of existing methods. The proposed method employs a novel cascading rejection (CR) module for discriminator, which extracts multiple non-overlapped features in an iterative manner. The CR module supports the discriminator to effectively distinguish between real and generated images, which results in a strong penalization to the generator. In order to deceive the robust discriminator containing the CR module, the generator produces the images that are more similar to the real images. Since the proposed CR module requires only a few simple vector operations, it can be readily applied to existing frameworks with marginal training overheads. Quantitative evaluations on various datasets including CIFAR-10, Celeb-HQ, LSUN, and tiny-ImageNet confirm that the proposed method significantly improves the performance of GANs and conditional GANs in terms of Frechet inception distance (FID) indicating the diversity and visual appearance of the generated images.