LGESynthNet: Controlled Scar Synthesis for Improved Scar Segmentation in Cardiac LGE-MRI Imaging

Segmentation of enhancement in LGE cardiac MRI is critical for diagnosing various ischemic and non-ischemic cardiomyopathies. However, creating pixel-level annotations for these images is challenging and labor-intensive, leading to limited availability of annotated data. Generative models, particularly diffusion models, offer promise for synthetic data generation, yet many rely on large training datasets and often struggle with fine-grained conditioning control, especially for small or localized features. We introduce LGESynthNet, a latent diffusion-based framework for controllable enhancement synthesis, enabling explicit control over size, location, and transmural extent. Formulated as inpainting using a ControlNet-based architecture, the model integrates: (a) a reward model for conditioning-specific supervision, (b) a captioning module for anatomically descriptive text prompts, and (c) a biomedical text encoder. Trained on just 429 images (79 patients), it produces realistic, anatomically coherent samples. A quality control filter selects outputs with high conditioning-fidelity, which when used for training augmentation, improve downstream segmentation and detection performance, by up-to 6 and 20 points respectively.

Dual Agreement Consistency Learning with Foundation Models for Semi-Supervised Fetal Heart Ultrasound Segmentation and Diagnosis

Congenital heart disease (CHD) screening from fetal echocardiography requires accurate analysis of multiple standard cardiac views, yet developing reliable artificial intelligence models remains challenging due to limited annotations and variable image quality. In this work, we propose FM-DACL, a semi-supervised Dual Agreement Consistency Learning framework for the FETUS 2026 challenge on fetal heart ultrasound segmentation and diagnosis. The method combines a pretrained ultrasound foundation model (EchoCare) with a convolutional network through heterogeneous co-training and an exponential moving average teacher to better exploit unlabeled data. Experiments on the multi-center challenge dataset show that FM-DACL achieves a Dice score of 59.66 and NSD of 42.82 using heterogeneous backbones, demonstrating the feasibility of the proposed semi-supervised framework. These results suggest that FM-DACL provides a flexible approach for leveraging heterogeneous models in low-annotation fetal cardiac ultrasound analysis. The code is available on https://github.com/13204942/FM-DACL.

Unrolled Reconstruction with Integrated Super-Resolution for Accelerated 3D LGE MRI

Accelerated 3D late gadolinium enhancement (LGE) MRI requires robust reconstruction methods to recover thin atrial structures from undersampled k-space data. While unrolled model-based networks effectively integrate physics-driven data consistency with learned priors, they operate at the acquired resolution and may fail to fully recover high-frequency detail. We propose a hybrid unrolled reconstruction framework in which an Enhanced Deep Super-Resolution (EDSR) network replaces the proximal operator within each iteration of the optimization loop, enabling joint super-resolution enhancement and data consistency enforcement. The model is trained end-to-end on retrospectively undersampled preclinical 3D LGE datasets and compared against compressed sensing, Model-Based Deep Learning (MoDL), and self-guided Deep Image Prior (DIP) baselines. Across acceleration factors, the proposed method consistently improves PSNR and SSIM over standard unrolled reconstruction and better preserves fine cardiac structures, leading to improved LA (left atrium) segmentation performance. These results demonstrate that integrating super-resolution priors directly within model-based reconstruction provides measurable gains in accelerated 3D LGE MRI.

No Image, No Problem: End-to-End Multi-Task Cardiac Analysis from Undersampled k-Space

Conventional clinical CMR pipelines rely on a sequential "reconstruct-then-analyze" paradigm, forcing an ill-posed intermediate step that introduces avoidable artifacts and information bottlenecks. This creates a fundamental mathematical paradox: it attempts to recover high-dimensional pixel arrays (i.e., images) from undersampled k-space, rather than directly extracting the low-dimensional physiological labels actually required for diagnosis. To unlock the direct diagnostic potential of k-space, we propose k-MTR (k-space Multi-Task Representation), a k-space representation learning framework that aligns undersampled k-space data and fully-sampled images into a shared semantic manifold. Leveraging a large-scale controlled simulation of 42,000 subjects, k-MTR forces the k-space encoder to restore anatomical information lost to undersampling directly within the latent space, bypassing the explicit inverse problem for downstream analysis. We demonstrate that this latent alignment enables the dense latent space embedded with high-level physiological semantics directly from undersampled frequencies. Across continuous phenotype regression, disease classification, and anatomical segmentation, k-MTR achieves highly competitive performance against state-of-the-art image-domain baselines. By showcasing that precise spatial geometries and multi-task features can be successfully recovered directly from the k-space representations, k-MTR provides a robust architectural blueprint for task-aware cardiac MRI workflows.

Tell2Adapt: A Unified Framework for Source Free Unsupervised Domain Adaptation via Vision Foundation Model

Source Free Unsupervised Domain Adaptation (SFUDA) is critical for deploying deep learning models across diverse clinical settings. However, existing methods are typically designed for low-gap, specific domain shifts and cannot generalize into a unified, multi-modalities, and multi-target framework, which presents a major barrier to real-world application. To overcome this issue, we introduce Tell2Adapt, a novel SFUDA framework that harnesses the vast, generalizable knowledge of the Vision Foundation Model (VFM). Our approach ensures high-fidelity VFM prompts through Context-Aware Prompts Regularization (CAPR), which robustly translates varied text prompts into canonical instructions. This enables the generation of high-quality pseudo-labels for efficiently adapting the lightweight student model to target domain. To guarantee clinical reliability, the framework incorporates Visual Plausibility Refinement (VPR), which leverages the VFM's anatomical knowledge to re-ground the adapted model's predictions in target image's low-level visual features, effectively removing noise and false positives. We conduct one of the most extensive SFUDA evaluations to date, validating our framework across 10 domain adaptation directions and 22 anatomical targets, including brain, cardiac, polyp, and abdominal targets. Our results demonstrate that Tell2Adapt consistently outperforms existing approaches, achieving SOTA for a unified SFUDA framework in medical image segmentation. Code are avaliable at https://github.com/derekshiii/Tell2Adapt.

Balancing Fidelity, Utility, and Privacy in Synthetic Cardiac MRI Generation: A Comparative Study

Deep learning in cardiac MRI (CMR) is fundamentally constrained by both data scarcity and privacy regulations. This study systematically benchmarks three generative architectures: Denoising Diffusion Probabilistic Models (DDPM), Latent Diffusion Models (LDM), and Flow Matching (FM) for synthetic CMR generation. Utilizing a two-stage pipeline where anatomical masks condition image synthesis, we evaluate generated data across three critical axes: fidelity, utility, and privacy. Our results show that diffusion-based models, particularly DDPM, provide the most effective balance between downstream segmentation utility, image fidelity, and privacy preservation under limited-data conditions, while FM demonstrates promising privacy characteristics with slightly lower task-level performance. These findings quantify the trade-offs between cross-domain generalization and patient confidentiality, establishing a framework for safe and effective synthetic data augmentation in medical imaging.

RhythmBERT: A Self-Supervised Language Model Based on Latent Representations of ECG Waveforms for Heart Disease Detection

Electrocardiogram (ECG) analysis is crucial for diagnosing heart disease, but most self-supervised learning methods treat ECG as a generic time series, overlooking physiologic semantics and rhythm-level structure. Existing contrastive methods utilize augmentations that distort morphology, whereas generative approaches employ fixed-window segmentation, which misaligns cardiac cycles. To address these limitations, we propose RhythmBERT, a generative ECG language model that considers ECG as a language paradigm by encoding P, QRS, and T segments into symbolic tokens via autoencoder-based latent representations. These discrete tokens capture rhythm semantics, while complementary continuous embeddings retain fine-grained morphology, enabling a unified view of waveform structure and rhythm. RhythmBERT is pretrained on approximately 800,000 unlabeled ECG recordings with a masked prediction objective, allowing it to learn contextual representations in a label-efficient manner. Evaluations show that despite using only a single lead, RhythmBERT achieves comparable or superior performance to strong 12-lead baselines. This generalization extends from prevalent conditions such as atrial fibrillation to clinically challenging cases such as subtle ST-T abnormalities and myocardial infarction. Our results suggest that considering ECG as structured language offers a scalable and physiologically aligned pathway for advancing cardiac analysis.

Flow Matching-enabled Test-Time Refinement for Unsupervised Cardiac MR Registration

Diffusion-based unsupervised image registration has been explored for cardiac cine MR, but expensive multi-step inference limits practical use. We propose FlowReg, a flow-matching framework in displacement field space that achieves strong registration in as few as two steps and supports further refinement with more steps. FlowReg uses warmup-reflow training: a single-step network first acts as a teacher, then a student learns to refine from arbitrary intermediate states, removing the need for a pre-trained model as in existing methods. An Initial Guess strategy feeds back the model prediction as the next starting point, improving refinement from step two onward. On ACDC and MM2 across six tasks (including cross-dataset generalization), FlowReg outperforms the state of the art on five tasks (+0.6% mean Dice score on average), with the largest gain in the left ventricle (+1.09%), and reduces LVEF estimation error on all six tasks (-2.58 percentage points), using only 0.7% extra parameters and no segmentation labels. Code is available at https://github.com/mathpluscode/FlowReg.

Mask-HybridGNet: Graph-based segmentation with emergent anatomical correspondence from pixel-level supervision

Graph-based medical image segmentation represents anatomical structures using boundary graphs, providing fixed-topology landmarks and inherent population-level correspondences. However, their clinical adoption has been hindered by a major requirement: training datasets with manually annotated landmarks that maintain point-to-point correspondences across patients rarely exist in practice. We introduce Mask-HybridGNet, a framework that trains graph-based models directly using standard pixel-wise masks, eliminating the need for manual landmark annotations. Our approach aligns variable-length ground truth boundaries with fixed-length landmark predictions by combining Chamfer distance supervision and edge-based regularization to ensure local smoothness and regular landmark distribution, further refined via differentiable rasterization. A significant emergent property of this framework is that predicted landmark positions become consistently associated with specific anatomical locations across patients without explicit correspondence supervision. This implicit atlas learning enables temporal tracking, cross-slice reconstruction, and morphological population analyses. Beyond direct segmentation, Mask-HybridGNet can extract correspondences from existing segmentation masks, allowing it to generate stable anatomical atlases from any high-quality pixel-based model. Experiments across chest radiography, cardiac ultrasound, cardiac MRI, and fetal imaging demonstrate that our model achieves competitive results against state-of-the-art pixel-based methods, while ensuring anatomical plausibility by enforcing boundary connectivity through a fixed graph adjacency matrix. This framework leverages the vast availability of standard segmentation masks to build structured models that maintain topological integrity and provide implicit correspondences.

Synthesis of Late Gadolinium Enhancement Images via Implicit Neural Representations for Cardiac Scar Segmentation

Late gadolinium enhancement (LGE) imaging is the clinical standard for myocardial scar assessment, but limited annotated datasets hinder the development of automated segmentation methods. We propose a novel framework that synthesises both LGE images and their corresponding segmentation masks using implicit neural representations (INRs) combined with denoising diffusion models. Our approach first trains INRs to capture continuous spatial representations of LGE data and associated myocardium and fibrosis masks. These INRs are then compressed into compact latent embeddings, preserving essential anatomical information. A diffusion model operates on this latent space to generate new representations, which are decoded into synthetic LGE images with anatomically consistent segmentation masks. Experiments on 133 cardiac MRI scans suggest that augmenting training data with 200 synthetic volumes contributes to improved fibrosis segmentation performance, with the Dice score showing an increase from 0.509 to 0.524. Our approach provides an annotation-free method to help mitigate data scarcity.The code for this research is publicly available.