A Signal-Language Foundation Model for Broad-Spectrum Cardiovascular Assessment from Routine Electrocardiography

Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

A Closer Look at Edema Area Segmentation in SD-OCT Images Using Adversarial Framework

The development of artificial intelligence models for macular edema (ME) analy-sis always relies on expert-annotated pixel-level image datasets which are expen-sive to collect prospectively. While anomaly-detection-based weakly-supervised methods have shown promise in edema area (EA) segmentation task, their per-formance still lags behind fully-supervised approaches. In this paper, we leverage the strong correlation between EA and retinal layers in spectral-domain optical coherence tomography (SD-OCT) images, along with the update characteristics of weakly-supervised learning, to enhance an off-the-shelf adversarial framework for EA segmentation with a novel layer-structure-guided post-processing step and a test-time-adaptation (TTA) strategy. By incorporating additional retinal lay-er information, our framework reframes the dense EA prediction task as one of confirming intersection points between the EA contour and retinal layers, result-ing in predictions that better align with the shape prior of EA. Besides, the TTA framework further helps address discrepancies in the manifestations and presen-tations of EA between training and test sets. Extensive experiments on two pub-licly available datasets demonstrate that these two proposed ingredients can im-prove the accuracy and robustness of EA segmentation, bridging the gap between weakly-supervised and fully-supervised models.

Test-Time Generative Augmentation for Medical Image Segmentation

In this paper, we propose a novel approach to enhance medical image segmentation during test time. Instead of employing hand-crafted transforms or functions on the input test image to create multiple views for test-time augmentation, we advocate for the utilization of an advanced domain-fine-tuned generative model (GM), e.g., stable diffusion (SD), for test-time augmentation. Given that the GM has been trained to comprehend and encapsulate comprehensive domain data knowledge, it is superior than segmentation models in terms of representing the data characteristics and distribution. Hence, by integrating the GM into test-time augmentation, we can effectively generate multiple views of a given test sample, aligning with the content and appearance characteristics of the sample and the related local data distribution. This approach renders the augmentation process more adaptable and resilient compared to conventional handcrafted transforms. Comprehensive experiments conducted across three medical image segmentation tasks (nine datasets) demonstrate the efficacy and versatility of the proposed TTGA in enhancing segmentation outcomes. Moreover, TTGA significantly improves pixel-wise error estimation, thereby facilitating the deployment of a more reliable segmentation system. Code will be released at: https://github.com/maxiao0234/TTGA.