SPARS: Self-Play Adversarial Reinforcement Learning for Segmentation of Liver Tumours

Accurate tumour segmentation is vital for various targeted diagnostic and therapeutic procedures for cancer, e.g., planning biopsies or tumour ablations. Manual delineation is extremely labour-intensive, requiring substantial expert time. Fully-supervised machine learning models aim to automate such localisation tasks, but require a large number of costly and often subjective 3D voxel-level labels for training. The high-variance and subjectivity in such labels impacts model generalisability, even when large datasets are available. Histopathology labels may offer more objective labels but the infeasibility of acquiring pixel-level annotations to develop tumour localisation methods based on histology remains challenging in-vivo. In this work, we propose a novel weakly-supervised semantic segmentation framework called SPARS (Self-Play Adversarial Reinforcement Learning for Segmentation), which utilises an object presence classifier, trained on a small number of image-level binary cancer presence labels, to localise cancerous regions on CT scans. Such binary labels of patient-level cancer presence can be sourced more feasibly from biopsies and histopathology reports, enabling a more objective cancer localisation on medical images. Evaluating with real patient data, we observed that SPARS yielded a mean dice score of $77.3 \pm 9.4$, which outperformed other weakly-supervised methods by large margins. This performance was comparable with recent fully-supervised methods that require voxel-level annotations. Our results demonstrate the potential of using SPARS to reduce the need for extensive human-annotated labels to detect cancer in real-world healthcare settings.

MIAS-SAM: Medical Image Anomaly Segmentation without thresholding

This paper presents MIAS-SAM, a novel approach for the segmentation of anomalous regions in medical images. MIAS-SAM uses a patch-based memory bank to store relevant image features, which are extracted from normal data using the SAM encoder. At inference time, the embedding patches extracted from the SAM encoder are compared with those in the memory bank to obtain the anomaly map. Finally, MIAS-SAM computes the center of gravity of the anomaly map to prompt the SAM decoder, obtaining an accurate segmentation from the previously extracted features. Differently from prior works, MIAS-SAM does not require to define a threshold value to obtain the segmentation from the anomaly map. Experimental results conducted on three publicly available datasets, each with a different imaging modality (Brain MRI, Liver CT, and Retina OCT) show accurate anomaly segmentation capabilities measured using DICE score. The code is available at: https://github.com/warpcut/MIAS-SAM

ViCTr: Vital Consistency Transfer for Pathology Aware Image Synthesis

Synthesizing medical images remains challenging due to limited annotated pathological data, modality domain gaps, and the complexity of representing diffuse pathologies such as liver cirrhosis. Existing methods often struggle to maintain anatomical fidelity while accurately modeling pathological features, frequently relying on priors derived from natural images or inefficient multi-step sampling. In this work, we introduce ViCTr (Vital Consistency Transfer), a novel two-stage framework that combines a rectified flow trajectory with a Tweedie-corrected diffusion process to achieve high-fidelity, pathology-aware image synthesis. First, we pretrain ViCTr on the ATLAS-8k dataset using Elastic Weight Consolidation (EWC) to preserve critical anatomical structures. We then fine-tune the model adversarially with Low-Rank Adaptation (LoRA) modules for precise control over pathology severity. By reformulating Tweedie's formula within a linear trajectory framework, ViCTr supports one-step sampling, reducing inference from 50 steps to just 4, without sacrificing anatomical realism. We evaluate ViCTr on BTCV (CT), AMOS (MRI), and CirrMRI600+ (cirrhosis) datasets. Results demonstrate state-of-the-art performance, achieving a Medical Frechet Inception Distance (MFID) of 17.01 for cirrhosis synthesis 28% lower than existing approaches and improving nnUNet segmentation by +3.8% mDSC when used for data augmentation. Radiologist reviews indicate that ViCTr-generated liver cirrhosis MRIs are clinically indistinguishable from real scans. To our knowledge, ViCTr is the first method to provide fine-grained, pathology-aware MRI synthesis with graded severity control, closing a critical gap in AI-driven medical imaging research.

Attention GhostUNet++: Enhanced Segmentation of Adipose Tissue and Liver in CT Images

Accurate segmentation of abdominal adipose tissue, including subcutaneous (SAT) and visceral adipose tissue (VAT), along with liver segmentation, is essential for understanding body composition and associated health risks such as type 2 diabetes and cardiovascular disease. This study proposes Attention GhostUNet++, a novel deep learning model incorporating Channel, Spatial, and Depth Attention mechanisms into the Ghost UNet++ bottleneck for automated, precise segmentation. Evaluated on the AATTCT-IDS and LiTS datasets, the model achieved Dice coefficients of 0.9430 for VAT, 0.9639 for SAT, and 0.9652 for liver segmentation, surpassing baseline models. Despite minor limitations in boundary detail segmentation, the proposed model significantly enhances feature refinement, contextual understanding, and computational efficiency, offering a robust solution for body composition analysis. The implementation of the proposed Attention GhostUNet++ model is available at:https://github.com/MansoorHayat777/Attention-GhostUNetPlusPlus.

Anatomy-constrained modelling of image-derived input functions in dynamic PET using multi-organ segmentation

Accurate kinetic analysis of [$^{18}$F]FDG distribution in dynamic positron emission tomography (PET) requires anatomically constrained modelling of image-derived input functions (IDIFs). Traditionally, IDIFs are obtained from the aorta, neglecting anatomical variations and complex vascular contributions. This study proposes a multi-organ segmentation-based approach that integrates IDIFs from the aorta, portal vein, pulmonary artery, and ureters. Using high-resolution CT segmentations of the liver, lungs, kidneys, and bladder, we incorporate organ-specific blood supply sources to improve kinetic modelling. Our method was evaluated on dynamic [$^{18}$F]FDG PET data from nine patients, resulting in a mean squared error (MSE) reduction of $13.39\%$ for the liver and $10.42\%$ for the lungs. These initial results highlight the potential of multiple IDIFs in improving anatomical modelling and fully leveraging dynamic PET imaging. This approach could facilitate the integration of tracer kinetic modelling into clinical routine.

Benchmarking Multi-Organ Segmentation Tools for Multi-Parametric T1-weighted Abdominal MRI

The segmentation of multiple organs in multi-parametric MRI studies is critical for many applications in radiology, such as correlating imaging biomarkers with disease status (e.g., cirrhosis, diabetes). Recently, three publicly available tools, such as MRSegmentator (MRSeg), TotalSegmentator MRI (TS), and TotalVibeSegmentator (VIBE), have been proposed for multi-organ segmentation in MRI. However, the performance of these tools on specific MRI sequence types has not yet been quantified. In this work, a subset of 40 volumes from the public Duke Liver Dataset was curated. The curated dataset contained 10 volumes each from the pre-contrast fat saturated T1, arterial T1w, venous T1w, and delayed T1w phases, respectively. Ten abdominal structures were manually annotated in these volumes. Next, the performance of the three public tools was benchmarked on this curated dataset. The results indicated that MRSeg obtained a Dice score of 80.7 $\pm$ 18.6 and Hausdorff Distance (HD) error of 8.9 $\pm$ 10.4 mm. It fared the best ($p < .05$) across the different sequence types in contrast to TS and VIBE.

Top-K Maximum Intensity Projection Priors for 3D Liver Vessel Segmentation

Liver-vessel segmentation is an essential task in the pre-operative planning of liver resection. State-of-the-art 2D or 3D convolution-based methods focusing on liver vessel segmentation on 2D CT cross-sectional views, which do not take into account the global liver-vessel topology. To maintain this global vessel topology, we rely on the underlying physics used in the CT reconstruction process, and apply this to liver-vessel segmentation. Concretely, we introduce the concept of top-k maximum intensity projections, which mimics the CT reconstruction by replacing the integral along each projection direction, with keeping the top-k maxima along each projection direction. We use these top-k maximum projections to condition a diffusion model and generate 3D liver-vessel trees. We evaluate our 3D liver-vessel segmentation on the 3D-ircadb-01 dataset, and achieve the highest Dice coefficient, intersection-over-union (IoU), and Sensitivity scores compared to prior work.

Cross Modality Medical Image Synthesis for Improving Liver Segmentation

Deep learning-based computer-aided diagnosis (CAD) of medical images requires large datasets. However, the lack of large publicly available labeled datasets limits the development of deep learning-based CAD systems. Generative Adversarial Networks (GANs), in particular, CycleGAN, can be used to generate new cross-domain images without paired training data. However, most CycleGAN-based synthesis methods lack the potential to overcome alignment and asymmetry between the input and generated data. We propose a two-stage technique for the synthesis of abdominal MRI using cross-modality translation of abdominal CT. We show that the synthetic data can help improve the performance of the liver segmentation network. We increase the number of abdominal MRI images through cross-modality image transformation of unpaired CT images using a CycleGAN inspired deformation invariant network called EssNet. Subsequently, we combine the synthetic MRI images with the original MRI images and use them to improve the accuracy of the U-Net on a liver segmentation task. We train the U-Net on real MRI images and then on real and synthetic MRI images. Consequently, by comparing both scenarios, we achieve an improvement in the performance of U-Net. In summary, the improvement achieved in the Intersection over Union (IoU) is 1.17%. The results show potential to address the data scarcity challenge in medical imaging.

A Reverse Mamba Attention Network for Pathological Liver Segmentation

We present RMA-Mamba, a novel architecture that advances the capabilities of vision state space models through a specialized reverse mamba attention module (RMA). The key innovation lies in RMA-Mamba's ability to capture long-range dependencies while maintaining precise local feature representation through its hierarchical processing pipeline. By integrating Vision Mamba (VMamba)'s efficient sequence modeling with RMA's targeted feature refinement, our architecture achieves superior feature learning across multiple scales. This dual-mechanism approach enables robust handling of complex morphological patterns while maintaining computational efficiency. We demonstrate RMA-Mamba's effectiveness in the challenging domain of pathological liver segmentation (from both CT and MRI), where traditional segmentation approaches often fail due to tissue variations. When evaluated on a newly introduced cirrhotic liver dataset (CirrMRI600+) of T2-weighted MRI scans, RMA-Mamba achieves the state-of-the-art performance with a Dice coefficient of 92.08%, mean IoU of 87.36%, and recall of 92.96%. The architecture's generalizability is further validated on the cancerous liver segmentation from CT scans (LiTS: Liver Tumor Segmentation dataset), yielding a Dice score of 92.9% and mIoU of 88.99%. The source code of the proposed RMA-Mamba is available at https://github.com/JunZengz/RMAMamba.

MedSAM2: Segment Anything in 3D Medical Images and Videos

Medical image and video segmentation is a critical task for precision medicine, which has witnessed considerable progress in developing task or modality-specific and generalist models for 2D images. However, there have been limited studies on building general-purpose models for 3D images and videos with comprehensive user studies. Here, we present MedSAM2, a promptable segmentation foundation model for 3D image and video segmentation. The model is developed by fine-tuning the Segment Anything Model 2 on a large medical dataset with over 455,000 3D image-mask pairs and 76,000 frames, outperforming previous models across a wide range of organs, lesions, and imaging modalities. Furthermore, we implement a human-in-the-loop pipeline to facilitate the creation of large-scale datasets resulting in, to the best of our knowledge, the most extensive user study to date, involving the annotation of 5,000 CT lesions, 3,984 liver MRI lesions, and 251,550 echocardiogram video frames, demonstrating that MedSAM2 can reduce manual costs by more than 85%. MedSAM2 is also integrated into widely used platforms with user-friendly interfaces for local and cloud deployment, making it a practical tool for supporting efficient, scalable, and high-quality segmentation in both research and healthcare environments.