No Modality Left Behind: Adapting to Missing Modalities via Knowledge Distillation for Brain Tumor Segmentation

Accurate brain tumor segmentation is essential for preoperative evaluation and personalized treatment. Multi-modal MRI is widely used due to its ability to capture complementary tumor features across different sequences. However, in clinical practice, missing modalities are common, limiting the robustness and generalizability of existing deep learning methods that rely on complete inputs, especially under non-dominant modality combinations. To address this, we propose AdaMM, a multi-modal brain tumor segmentation framework tailored for missing-modality scenarios, centered on knowledge distillation and composed of three synergistic modules. The Graph-guided Adaptive Refinement Module explicitly models semantic associations between generalizable and modality-specific features, enhancing adaptability to modality absence. The Bi-Bottleneck Distillation Module transfers structural and textural knowledge from teacher to student models via global style matching and adversarial feature alignment. The Lesion-Presence-Guided Reliability Module predicts prior probabilities of lesion types through an auxiliary classification task, effectively suppressing false positives under incomplete inputs. Extensive experiments on the BraTS 2018 and 2024 datasets demonstrate that AdaMM consistently outperforms existing methods, exhibiting superior segmentation accuracy and robustness, particularly in single-modality and weak-modality configurations. In addition, we conduct a systematic evaluation of six categories of missing-modality strategies, confirming the superiority of knowledge distillation and offering practical guidance for method selection and future research. Our source code is available at https://github.com/Quanato607/AdaMM.

AREPAS: Anomaly Detection in Fine-Grained Anatomy with Reconstruction-Based Semantic Patch-Scoring

Early detection of newly emerging diseases, lesion severity assessment, differentiation of medical conditions and automated screening are examples for the wide applicability and importance of anomaly detection (AD) and unsupervised segmentation in medicine. Normal fine-grained tissue variability such as present in pulmonary anatomy is a major challenge for existing generative AD methods. Here, we propose a novel generative AD approach addressing this issue. It consists of an image-to-image translation for anomaly-free reconstruction and a subsequent patch similarity scoring between observed and generated image-pairs for precise anomaly localization. We validate the new method on chest computed tomography (CT) scans for the detection and segmentation of infectious disease lesions. To assess generalizability, we evaluate the method on an ischemic stroke lesion segmentation task in T1-weighted brain MRI. Results show improved pixel-level anomaly segmentation in both chest CTs and brain MRIs, with relative DICE score improvements of +1.9% and +4.4%, respectively, compared to other state-of-the-art reconstruction-based methods.

Modality-Agnostic Input Channels Enable Segmentation of Brain lesions in Multimodal MRI with Sequences Unavailable During Training

Segmentation models are important tools for the detection and analysis of lesions in brain MRI. Depending on the type of brain pathology that is imaged, MRI scanners can acquire multiple, different image modalities (contrasts). Most segmentation models for multimodal brain MRI are restricted to fixed modalities and cannot effectively process new ones at inference. Some models generalize to unseen modalities but may lose discriminative modality-specific information. This work aims to develop a model that can perform inference on data that contain image modalities unseen during training, previously seen modalities, and heterogeneous combinations of both, thus allowing a user to utilize any available imaging modalities. We demonstrate this is possible with a simple, thus practical alteration to the U-net architecture, by integrating a modality-agnostic input channel or pathway, alongside modality-specific input channels. To train this modality-agnostic component, we develop an image augmentation scheme that synthesizes artificial MRI modalities. Augmentations differentially alter the appearance of pathological and healthy brain tissue to create artificial contrasts between them while maintaining realistic anatomical integrity. We evaluate the method using 8 MRI databases that include 5 types of pathologies (stroke, tumours, traumatic brain injury, multiple sclerosis and white matter hyperintensities) and 8 modalities (T1, T1+contrast, T2, PD, SWI, DWI, ADC and FLAIR). The results demonstrate that the approach preserves the ability to effectively process MRI modalities encountered during training, while being able to process new, unseen modalities to improve its segmentation. Project code: https://github.com/Anthony-P-Addison/AGN-MOD-SEG

Simultaneous Segmentation of Ventricles and Normal/Abnormal White Matter Hyperintensities in Clinical MRI using Deep Learning

Multiple sclerosis (MS) diagnosis and monitoring rely heavily on accurate assessment of brain MRI biomarkers, particularly white matter hyperintensities (WMHs) and ventricular changes. Current segmentation approaches suffer from several limitations: they typically segment these structures independently despite their pathophysiological relationship, struggle to differentiate between normal and pathological hyperintensities, and are poorly optimized for anisotropic clinical MRI data. We propose a novel 2D pix2pix-based deep learning framework for simultaneous segmentation of ventricles and WMHs with the unique capability to distinguish between normal periventricular hyperintensities and pathological MS lesions. Our method was developed and validated on FLAIR MRI scans from 300 MS patients. Compared to established methods (SynthSeg, Atlas Matching, BIANCA, LST-LPA, LST-LGA, and WMH-SynthSeg), our approach achieved superior performance for both ventricle segmentation (Dice: 0.801+/-0.025, HD95: 18.46+/-7.1mm) and WMH segmentation (Dice: 0.624+/-0.061, precision: 0.755+/-0.161). Furthermore, our method successfully differentiated between normal and abnormal hyperintensities with a Dice coefficient of 0.647. Notably, our approach demonstrated exceptional computational efficiency, completing end-to-end processing in approximately 4 seconds per case, up to 36 times faster than baseline methods, while maintaining minimal resource requirements. This combination of improved accuracy, clinically relevant differentiation capability, and computational efficiency addresses critical limitations in current neuroimaging analysis, potentially enabling integration into routine clinical workflows and enhancing MS diagnosis and monitoring.

Learning to segment anatomy and lesions from disparately labeled sources in brain MRI

Segmenting healthy tissue structures alongside lesions in brain Magnetic Resonance Images (MRI) remains a challenge for today's algorithms due to lesion-caused disruption of the anatomy and lack of jointly labeled training datasets, where both healthy tissues and lesions are labeled on the same images. In this paper, we propose a method that is robust to lesion-caused disruptions and can be trained from disparately labeled training sets, i.e., without requiring jointly labeled samples, to automatically segment both. In contrast to prior work, we decouple healthy tissue and lesion segmentation in two paths to leverage multi-sequence acquisitions and merge information with an attention mechanism. During inference, an image-specific adaptation reduces adverse influences of lesion regions on healthy tissue predictions. During training, the adaptation is taken into account through meta-learning and co-training is used to learn from disparately labeled training images. Our model shows an improved performance on several anatomical structures and lesions on a publicly available brain glioblastoma dataset compared to the state-of-the-art segmentation methods.

Analysis of the MICCAI Brain Tumor Segmentation -- Metastases (BraTS-METS) 2025 Lighthouse Challenge: Brain Metastasis Segmentation on Pre- and Post-treatment MRI

Despite continuous advancements in cancer treatment, brain metastatic disease remains a significant complication of primary cancer and is associated with an unfavorable prognosis. One approach for improving diagnosis, management, and outcomes is to implement algorithms based on artificial intelligence for the automated segmentation of both pre- and post-treatment MRI brain images. Such algorithms rely on volumetric criteria for lesion identification and treatment response assessment, which are still not available in clinical practice. Therefore, it is critical to establish tools for rapid volumetric segmentations methods that can be translated to clinical practice and that are trained on high quality annotated data. The BraTS-METS 2025 Lighthouse Challenge aims to address this critical need by establishing inter-rater and intra-rater variability in dataset annotation by generating high quality annotated datasets from four individual instances of segmentation by neuroradiologists while being recorded on video (two instances doing "from scratch" and two instances after AI pre-segmentation). This high-quality annotated dataset will be used for testing phase in 2025 Lighthouse challenge and will be publicly released at the completion of the challenge. The 2025 Lighthouse challenge will also release the 2023 and 2024 segmented datasets that were annotated using an established pipeline of pre-segmentation, student annotation, two neuroradiologists checking, and one neuroradiologist finalizing the process. It builds upon its previous edition by including post-treatment cases in the dataset. Using these high-quality annotated datasets, the 2025 Lighthouse challenge plans to test benchmark algorithms for automated segmentation of pre-and post-treatment brain metastases (BM), trained on diverse and multi-institutional datasets of MRI images obtained from patients with brain metastases.

FLAIRBrainSeg: Fine-grained brain segmentation using FLAIR MRI only

This paper introduces a novel method for brain segmentation using only FLAIR MRIs, specifically targeting cases where access to other imaging modalities is limited. By leveraging existing automatic segmentation methods, we train a network to approximate segmentations, typically obtained from T1-weighted MRIs. Our method, called FLAIRBrainSeg, produces segmentations of 132 structures and is robust to multiple sclerosis lesions. Experiments on both in-domain and out-of-domain datasets demonstrate that our method outperforms modality-agnostic approaches based on image synthesis, the only currently available alternative for performing brain parcellation using FLAIR MRI alone. This technique holds promise for scenarios where T1-weighted MRIs are unavailable and offers a valuable alternative for clinicians and researchers in need of reliable anatomical segmentation.

Modality-Independent Brain Lesion Segmentation with Privacy-aware Continual Learning

Traditional brain lesion segmentation models for multi-modal MRI are typically tailored to specific pathologies, relying on datasets with predefined modalities. Adapting to new MRI modalities or pathologies often requires training separate models, which contrasts with how medical professionals incrementally expand their expertise by learning from diverse datasets over time. Inspired by this human learning process, we propose a unified segmentation model capable of sequentially learning from multiple datasets with varying modalities and pathologies. Our approach leverages a privacy-aware continual learning framework that integrates a mixture-of-experts mechanism and dual knowledge distillation to mitigate catastrophic forgetting while not compromising performance on newly encountered datasets. Extensive experiments across five diverse brain MRI datasets and four dataset sequences demonstrate the effectiveness of our framework in maintaining a single adaptable model, capable of handling varying hospital protocols, imaging modalities, and disease types. Compared to widely used privacy-aware continual learning methods such as LwF, SI, EWC, and MiB, our method achieves an average Dice score improvement of approximately 11%. Our framework represents a significant step toward more versatile and practical brain lesion segmentation models, with implementation available at \href{https://github.com/xmindflow/BrainCL}{GitHub}.

MediAug: Exploring Visual Augmentation in Medical Imaging

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.

Large Scale Supervised Pretraining For Traumatic Brain Injury Segmentation

The segmentation of lesions in Moderate to Severe Traumatic Brain Injury (msTBI) presents a significant challenge in neuroimaging due to the diverse characteristics of these lesions, which vary in size, shape, and distribution across brain regions and tissue types. This heterogeneity complicates traditional image processing techniques, resulting in critical errors in tasks such as image registration and brain parcellation. To address these challenges, the AIMS-TBI Segmentation Challenge 2024 aims to advance innovative segmentation algorithms specifically designed for T1-weighted MRI data, the most widely utilized imaging modality in clinical practice. Our proposed solution leverages a large-scale multi-dataset supervised pretraining approach inspired by the MultiTalent method. We train a Resenc L network on a comprehensive collection of datasets covering various anatomical and pathological structures, which equips the model with a robust understanding of brain anatomy and pathology. Following this, the model is fine-tuned on msTBI-specific data to optimize its performance for the unique characteristics of T1-weighted MRI scans and outperforms the baseline without pretraining up to 2 Dice points.