MoME: Mixture of Visual Language Medical Experts for Medical Imaging Segmentation

In this study, we propose MoME, a Mixture of Visual Language Medical Experts, for Medical Image Segmentation. MoME adapts the successful Mixture of Experts (MoE) paradigm, widely used in Large Language Models (LLMs), for medical vision-language tasks. The architecture enables dynamic expert selection by effectively utilizing multi-scale visual features tailored to the intricacies of medical imagery, enriched with textual embeddings. This work explores a novel integration of vision-language models for this domain. Utilizing an assembly of 10 datasets, encompassing 3,410 CT scans, MoME demonstrates strong performance on a comprehensive medical imaging segmentation benchmark. Our approach explores the integration of foundation models for medical imaging, benefiting from the established efficacy of MoE in boosting model performance by incorporating textual information. Demonstrating competitive precision across multiple datasets, MoME explores a novel architecture for achieving robust results in medical image analysis.

Context-Gated Cross-Modal Perception with Visual Mamba for PET-CT Lung Tumor Segmentation

Accurate lung tumor segmentation is vital for improving diagnosis and treatment planning, and effectively combining anatomical and functional information from PET and CT remains a major challenge. In this study, we propose vMambaX, a lightweight multimodal framework integrating PET and CT scan images through a Context-Gated Cross-Modal Perception Module (CGM). Built on the Visual Mamba architecture, vMambaX adaptively enhances inter-modality feature interaction, emphasizing informative regions while suppressing noise. Evaluated on the PCLT20K dataset, the model outperforms baseline models while maintaining lower computational complexity. These results highlight the effectiveness of adaptive cross-modal gating for multimodal tumor segmentation and demonstrate the potential of vMambaX as an efficient and scalable framework for advanced lung cancer analysis. The code is available at https://github.com/arco-group/vMambaX.

AortaDiff: A Unified Multitask Diffusion Framework For Contrast-Free AAA Imaging

While contrast-enhanced CT (CECT) is standard for assessing abdominal aortic aneurysms (AAA), the required iodinated contrast agents pose significant risks, including nephrotoxicity, patient allergies, and environmental harm. To reduce contrast agent use, recent deep learning methods have focused on generating synthetic CECT from non-contrast CT (NCCT) scans. However, most adopt a multi-stage pipeline that first generates images and then performs segmentation, which leads to error accumulation and fails to leverage shared semantic and anatomical structures. To address this, we propose a unified deep learning framework that generates synthetic CECT images from NCCT scans while simultaneously segmenting the aortic lumen and thrombus. Our approach integrates conditional diffusion models (CDM) with multi-task learning, enabling end-to-end joint optimization of image synthesis and anatomical segmentation. Unlike previous multitask diffusion models, our approach requires no initial predictions (e.g., a coarse segmentation mask), shares both encoder and decoder parameters across tasks, and employs a semi-supervised training strategy to learn from scans with missing segmentation labels, a common constraint in real-world clinical data. We evaluated our method on a cohort of 264 patients, where it consistently outperformed state-of-the-art single-task and multi-stage models. For image synthesis, our model achieved a PSNR of 25.61 dB, compared to 23.80 dB from a single-task CDM. For anatomical segmentation, it improved the lumen Dice score to 0.89 from 0.87 and the challenging thrombus Dice score to 0.53 from 0.48 (nnU-Net). These segmentation enhancements led to more accurate clinical measurements, reducing the lumen diameter MAE to 4.19 mm from 5.78 mm and the thrombus area error to 33.85% from 41.45% when compared to nnU-Net. Code is available at https://github.com/yuxuanou623/AortaDiff.git.

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.

Transplant-Ready? Evaluating AI Lung Segmentation Models in Candidates with Severe Lung Disease

This study evaluates publicly available deep-learning based lung segmentation models in transplant-eligible patients to determine their performance across disease severity levels, pathology categories, and lung sides, and to identify limitations impacting their use in preoperative planning in lung transplantation. This retrospective study included 32 patients who underwent chest CT scans at Duke University Health System between 2017 and 2019 (total of 3,645 2D axial slices). Patients with standard axial CT scans were selected based on the presence of two or more lung pathologies of varying severity. Lung segmentation was performed using three previously developed deep learning models: Unet-R231, TotalSegmentator, MedSAM. Performance was assessed using quantitative metrics (volumetric similarity, Dice similarity coefficient, Hausdorff distance) and a qualitative measure (four-point clinical acceptability scale). Unet-R231 consistently outperformed TotalSegmentator and MedSAM in general, for different severity levels, and pathology categories (p<0.05). All models showed significant performance declines from mild to moderate-to-severe cases, particularly in volumetric similarity (p<0.05), without significant differences among lung sides or pathology types. Unet-R231 provided the most accurate automated lung segmentation among evaluated models with TotalSegmentator being a close second, though their performance declined significantly in moderate-to-severe cases, emphasizing the need for specialized model fine-tuning in severe pathology contexts.

HybridMamba: A Dual-domain Mamba for 3D Medical Image Segmentation

In the domain of 3D biomedical image segmentation, Mamba exhibits the superior performance for it addresses the limitations in modeling long-range dependencies inherent to CNNs and mitigates the abundant computational overhead associated with Transformer-based frameworks when processing high-resolution medical volumes. However, attaching undue importance to global context modeling may inadvertently compromise critical local structural information, thus leading to boundary ambiguity and regional distortion in segmentation outputs. Therefore, we propose the HybridMamba, an architecture employing dual complementary mechanisms: 1) a feature scanning strategy that progressively integrates representations both axial-traversal and local-adaptive pathways to harmonize the relationship between local and global representations, and 2) a gated module combining spatial-frequency analysis for comprehensive contextual modeling. Besides, we collect a multi-center CT dataset related to lung cancer. Experiments on MRI and CT datasets demonstrate that HybridMamba significantly outperforms the state-of-the-art methods in 3D medical image segmentation.

Implicit Shape-Prior for Few-Shot Assisted 3D Segmentation

The objective of this paper is to significantly reduce the manual workload required from medical professionals in complex 3D segmentation tasks that cannot be yet fully automated. For instance, in radiotherapy planning, organs at risk must be accurately identified in computed tomography (CT) or magnetic resonance imaging (MRI) scans to ensure they are spared from harmful radiation. Similarly, diagnosing age-related degenerative diseases such as sarcopenia, which involve progressive muscle volume loss and strength, is commonly based on muscular mass measurements often obtained from manual segmentation of medical volumes. To alleviate the manual-segmentation burden, this paper introduces an implicit shape prior to segment volumes from sparse slice manual annotations generalized to the multi-organ case, along with a simple framework for automatically selecting the most informative slices to guide and minimize the next interactions. The experimental validation shows the method's effectiveness on two medical use cases: assisted segmentation in the context of at risks organs for brain cancer patients, and acceleration of the creation of a new database with unseen muscle shapes for patients with sarcopenia.

Random forest-based out-of-distribution detection for robust lung cancer segmentation

Accurate detection and segmentation of cancerous lesions from computed tomography (CT) scans is essential for automated treatment planning and cancer treatment response assessment. Transformer-based models with self-supervised pretraining can produce reliably accurate segmentation from in-distribution (ID) data but degrade when applied to out-of-distribution (OOD) datasets. We address this challenge with RF-Deep, a random forest classifier that utilizes deep features from a pretrained transformer encoder of the segmentation model to detect OOD scans and enhance segmentation reliability. The segmentation model comprises a Swin Transformer encoder, pretrained with masked image modeling (SimMIM) on 10,432 unlabeled 3D CT scans covering cancerous and non-cancerous conditions, with a convolution decoder, trained to segment lung cancers in 317 3D scans. Independent testing was performed on 603 3D CT public datasets that included one ID dataset and four OOD datasets comprising chest CTs with pulmonary embolism (PE) and COVID-19, and abdominal CTs with kidney cancers and healthy volunteers. RF-Deep detected OOD cases with a FPR95 of 18.26%, 27.66%, and less than 0.1% on PE, COVID-19, and abdominal CTs, consistently outperforming established OOD approaches. The RF-Deep classifier provides a simple and effective approach to enhance reliability of cancer segmentation in ID and OOD scenarios.

SimCroP: Radiograph Representation Learning with Similarity-driven Cross-granularity Pre-training

Medical vision-language pre-training shows great potential in learning representative features from massive paired radiographs and reports. However, in computed tomography (CT) scans, the distribution of lesions which contain intricate structures is characterized by spatial sparsity. Besides, the complex and implicit relationships between different pathological descriptions in each sentence of the report and their corresponding sub-regions in radiographs pose additional challenges. In this paper, we propose a Similarity-Driven Cross-Granularity Pre-training (SimCroP) framework on chest CTs, which combines similarity-driven alignment and cross-granularity fusion to improve radiograph interpretation. We first leverage multi-modal masked modeling to optimize the encoder for understanding precise low-level semantics from radiographs. Then, similarity-driven alignment is designed to pre-train the encoder to adaptively select and align the correct patches corresponding to each sentence in reports. The cross-granularity fusion module integrates multimodal information across instance level and word-patch level, which helps the model better capture key pathology structures in sparse radiographs, resulting in improved performance for multi-scale downstream tasks. SimCroP is pre-trained on a large-scale paired CT-reports dataset and validated on image classification and segmentation tasks across five public datasets. Experimental results demonstrate that SimCroP outperforms both cutting-edge medical self-supervised learning methods and medical vision-language pre-training methods. Codes and models are available at https://github.com/ToniChopp/SimCroP.

Lifespan Pancreas Morphology for Control vs Type 2 Diabetes using AI on Largescale Clinical Imaging

Purpose: Understanding how the pancreas changes is critical for detecting deviations in type 2 diabetes and other pancreatic disease. We measure pancreas size and shape using morphological measurements from ages 0 to 90. Our goals are to 1) identify reliable clinical imaging modalities for AI-based pancreas measurement, 2) establish normative morphological aging trends, and 3) detect potential deviations in type 2 diabetes. Approach: We analyzed a clinically acquired dataset of 2533 patients imaged with abdominal CT or MRI. We resampled the scans to 3mm isotropic resolution, segmented the pancreas using automated methods, and extracted 13 morphological pancreas features across the lifespan. First, we assessed CT and MRI measurements to determine which modalities provide consistent lifespan trends. Second, we characterized distributions of normative morphological patterns stratified by age group and sex. Third, we used GAMLSS regression to model pancreas morphology trends in 1350 patients matched for age, sex, and type 2 diabetes status to identify any deviations from normative aging associated with type 2 diabetes. Results: When adjusting for confounders, the aging trends for 10 of 13 morphological features were significantly different between patients with type 2 diabetes and non-diabetic controls (p < 0.05 after multiple comparisons corrections). Additionally, MRI appeared to yield different pancreas measurements than CT using our AI-based method. Conclusions: We provide lifespan trends demonstrating that the size and shape of the pancreas is altered in type 2 diabetes using 675 control patients and 675 diabetes patients. Moreover, our findings reinforce that the pancreas is smaller in type 2 diabetes. Additionally, we contribute a reference of lifespan pancreas morphology from a large cohort of non-diabetic control patients in a clinical setting.