Omni-Fusion of Spatial and Spectral for Hyperspectral Image Segmentation

Medical Hyperspectral Imaging (MHSI) has emerged as a promising tool for enhanced disease diagnosis, particularly in computational pathology, offering rich spectral information that aids in identifying subtle biochemical properties of tissues. Despite these advantages, effectively fusing both spatial-dimensional and spectral-dimensional information from MHSIs remains challenging due to its high dimensionality and spectral redundancy inherent characteristics. To solve the above challenges, we propose a novel spatial-spectral omni-fusion network for hyperspectral image segmentation, named as Omni-Fuse. Here, we introduce abundant cross-dimensional feature fusion operations, including a cross-dimensional enhancement module that refines both spatial and spectral features through bidirectional attention mechanisms, a spectral-guided spatial query selection to select the most spectral-related spatial feature as the query, and a two-stage cross-dimensional decoder which dynamically guide the model to focus on the selected spatial query. Despite of numerous attention blocks, Omni-Fuse remains efficient in execution. Experiments on two microscopic hyperspectral image datasets show that our approach can significantly improve the segmentation performance compared with the state-of-the-art methods, with over 5.73 percent improvement in DSC. Code available at: https://github.com/DeepMed-Lab-ECNU/Omni-Fuse.

RAPS-3D: Efficient interactive segmentation for 3D radiological imaging

Promptable segmentation, introduced by the Segment Anything Model (SAM), is a promising approach for medical imaging, as it enables clinicians to guide and refine model predictions interactively. However, SAM's architecture is designed for 2D images and does not extend naturally to 3D volumetric data such as CT or MRI scans. Adapting 2D models to 3D typically involves autoregressive strategies, where predictions are propagated slice by slice, resulting in increased inference complexity. Processing large 3D volumes also requires significant computational resources, often leading existing 3D methods to also adopt complex strategies like sliding-window inference to manage memory usage, at the cost of longer inference times and greater implementation complexity. In this paper, we present a simplified 3D promptable segmentation method, inspired by SegVol, designed to reduce inference time and eliminate prompt management complexities associated with sliding windows while achieving state-of-the-art performance.

Mamba Goes HoME: Hierarchical Soft Mixture-of-Experts for 3D Medical Image Segmentation

In recent years, artificial intelligence has significantly advanced medical image segmentation. However, challenges remain, including efficient 3D medical image processing across diverse modalities and handling data variability. In this work, we introduce Hierarchical Soft Mixture-of-Experts (HoME), a two-level token-routing layer for efficient long-context modeling, specifically designed for 3D medical image segmentation. Built on the Mamba state-space model (SSM) backbone, HoME enhances sequential modeling through sparse, adaptive expert routing. The first stage employs a Soft Mixture-of-Experts (SMoE) layer to partition input sequences into local groups, routing tokens to specialized per-group experts for localized feature extraction. The second stage aggregates these outputs via a global SMoE layer, enabling cross-group information fusion and global context refinement. This hierarchical design, combining local expert routing with global expert refinement improves generalizability and segmentation performance, surpassing state-of-the-art results across datasets from the three most commonly used 3D medical imaging modalities and data quality.

TABNet: A Triplet Augmentation Self-Recovery Framework with Boundary-Aware Pseudo-Labels for Medical Image Segmentation

Background and objective: Medical image segmentation is a core task in various clinical applications. However, acquiring large-scale, fully annotated medical image datasets is both time-consuming and costly. Scribble annotations, as a form of sparse labeling, provide an efficient and cost-effective alternative for medical image segmentation. However, the sparsity of scribble annotations limits the feature learning of the target region and lacks sufficient boundary supervision, which poses significant challenges for training segmentation networks. Methods: We propose TAB Net, a novel weakly-supervised medical image segmentation framework, consisting of two key components: the triplet augmentation self-recovery (TAS) module and the boundary-aware pseudo-label supervision (BAP) module. The TAS module enhances feature learning through three complementary augmentation strategies: intensity transformation improves the model's sensitivity to texture and contrast variations, cutout forces the network to capture local anatomical structures by masking key regions, and jigsaw augmentation strengthens the modeling of global anatomical layout by disrupting spatial continuity. By guiding the network to recover complete masks from diverse augmented inputs, TAS promotes a deeper semantic understanding of medical images under sparse supervision. The BAP module enhances pseudo-supervision accuracy and boundary modeling by fusing dual-branch predictions into a loss-weighted pseudo-label and introducing a boundary-aware loss for fine-grained contour refinement. Results: Experimental evaluations on two public datasets, ACDC and MSCMR seg, demonstrate that TAB Net significantly outperforms state-of-the-art methods for scribble-based weakly supervised segmentation. Moreover, it achieves performance comparable to that of fully supervised methods.

Prompt learning with bounding box constraints for medical image segmentation

Pixel-wise annotations are notoriously labourious and costly to obtain in the medical domain. To mitigate this burden, weakly supervised approaches based on bounding box annotations-much easier to acquire-offer a practical alternative. Vision foundation models have recently shown noteworthy segmentation performance when provided with prompts such as points or bounding boxes. Prompt learning exploits these models by adapting them to downstream tasks and automating segmentation, thereby reducing user intervention. However, existing prompt learning approaches depend on fully annotated segmentation masks. This paper proposes a novel framework that combines the representational power of foundation models with the annotation efficiency of weakly supervised segmentation. More specifically, our approach automates prompt generation for foundation models using only bounding box annotations. Our proposed optimization scheme integrates multiple constraints derived from box annotations with pseudo-labels generated by the prompted foundation model. Extensive experiments across multimodal datasets reveal that our weakly supervised method achieves an average Dice score of 84.90% in a limited data setting, outperforming existing fully-supervised and weakly-supervised approaches. The code is available at https://github.com/Minimel/box-prompt-learning-VFM.git

Autoadaptive Medical Segment Anything Model

Medical image segmentation is a key task in the imaging workflow, influencing many image-based decisions. Traditional, fully-supervised segmentation models rely on large amounts of labeled training data, typically obtained through manual annotation, which can be an expensive, time-consuming, and error-prone process. This signals a need for accurate, automatic, and annotation-efficient methods of training these models. We propose ADA-SAM (automated, domain-specific, and adaptive segment anything model), a novel multitask learning framework for medical image segmentation that leverages class activation maps from an auxiliary classifier to guide the predictions of the semi-supervised segmentation branch, which is based on the Segment Anything (SAM) framework. Additionally, our ADA-SAM model employs a novel gradient feedback mechanism to create a learnable connection between the segmentation and classification branches by using the segmentation gradients to guide and improve the classification predictions. We validate ADA-SAM on real-world clinical data collected during rehabilitation trials, and demonstrate that our proposed method outperforms both fully-supervised and semi-supervised baselines by double digits in limited label settings. Our code is available at: https://github.com/tbwa233/ADA-SAM.

Calibrated Self-supervised Vision Transformers Improve Intracranial Arterial Calcification Segmentation from Clinical CT Head Scans

Vision Transformers (ViTs) have gained significant popularity in the natural image domain but have been less successful in 3D medical image segmentation. Nevertheless, 3D ViTs are particularly interesting for large medical imaging volumes due to their efficient self-supervised training within the masked autoencoder (MAE) framework, which enables the use of imaging data without the need for expensive manual annotations. intracranial arterial calcification (IAC) is an imaging biomarker visible on routinely acquired CT scans linked to neurovascular diseases such as stroke and dementia, and automated IAC quantification could enable their large-scale risk assessment. We pre-train ViTs with MAE and fine-tune them for IAC segmentation for the first time. To develop our models, we use highly heterogeneous data from a large clinical trial, the third International Stroke Trial (IST-3). We evaluate key aspects of MAE pre-trained ViTs in IAC segmentation, and analyse the clinical implications. We show: 1) our calibrated self-supervised ViT beats a strong supervised nnU-Net baseline by 3.2 Dice points, 2) low patch sizes are crucial for ViTs for IAC segmentation and interpolation upsampling with regular convolutions is preferable to transposed convolutions for ViT-based models, and 3) our ViTs increase robustness to higher slice thicknesses and improve risk group classification in a clinical scenario by 46%. Our code is available online.

SWinMamba: Serpentine Window State Space Model for Vascular Segmentation

Vascular segmentation in medical images is crucial for disease diagnosis and surgical navigation. However, the segmented vascular structure is often discontinuous due to its slender nature and inadequate prior modeling. In this paper, we propose a novel Serpentine Window Mamba (SWinMamba) to achieve accurate vascular segmentation. The proposed SWinMamba innovatively models the continuity of slender vascular structures by incorporating serpentine window sequences into bidirectional state space models. The serpentine window sequences enable efficient feature capturing by adaptively guiding global visual context modeling to the vascular structure. Specifically, the Serpentine Window Tokenizer (SWToken) adaptively splits the input image using overlapping serpentine window sequences, enabling flexible receptive fields (RFs) for vascular structure modeling. The Bidirectional Aggregation Module (BAM) integrates coherent local features in the RFs for vascular continuity representation. In addition, dual-domain learning with Spatial-Frequency Fusion Unit (SFFU) is designed to enhance the feature representation of vascular structure. Extensive experiments on three challenging datasets demonstrate that the proposed SWinMamba achieves superior performance with complete and connected vessels.

Are Vision Transformer Representations Semantically Meaningful? A Case Study in Medical Imaging

Vision transformers (ViTs) have rapidly gained prominence in medical imaging tasks such as disease classification, segmentation, and detection due to their superior accuracy compared to conventional deep learning models. However, due to their size and complex interactions via the self-attention mechanism, they are not well understood. In particular, it is unclear whether the representations produced by such models are semantically meaningful. In this paper, using a projected gradient-based algorithm, we show that their representations are not semantically meaningful and they are inherently vulnerable to small changes. Images with imperceptible differences can have very different representations; on the other hand, images that should belong to different semantic classes can have nearly identical representations. Such vulnerability can lead to unreliable classification results; for example, unnoticeable changes cause the classification accuracy to be reduced by over 60\%. %. To the best of our knowledge, this is the first work to systematically demonstrate this fundamental lack of semantic meaningfulness in ViT representations for medical image classification, revealing a critical challenge for their deployment in safety-critical systems.

MedFormer: Hierarchical Medical Vision Transformer with Content-Aware Dual Sparse Selection Attention

Medical image recognition serves as a key way to aid in clinical diagnosis, enabling more accurate and timely identification of diseases and abnormalities. Vision transformer-based approaches have proven effective in handling various medical recognition tasks. However, these methods encounter two primary challenges. First, they are often task-specific and architecture-tailored, limiting their general applicability. Second, they usually either adopt full attention to model long-range dependencies, resulting in high computational costs, or rely on handcrafted sparse attention, potentially leading to suboptimal performance. To tackle these issues, we present MedFormer, an efficient medical vision transformer with two key ideas. First, it employs a pyramid scaling structure as a versatile backbone for various medical image recognition tasks, including image classification and dense prediction tasks such as semantic segmentation and lesion detection. This structure facilitates hierarchical feature representation while reducing the computation load of feature maps, highly beneficial for boosting performance. Second, it introduces a novel Dual Sparse Selection Attention (DSSA) with content awareness to improve computational efficiency and robustness against noise while maintaining high performance. As the core building technique of MedFormer, DSSA is explicitly designed to attend to the most relevant content. In addition, a detailed theoretical analysis has been conducted, demonstrating that MedFormer has superior generality and efficiency in comparison to existing medical vision transformers. Extensive experiments on a variety of imaging modality datasets consistently show that MedFormer is highly effective in enhancing performance across all three above-mentioned medical image recognition tasks. The code is available at https://github.com/XiaZunhui/MedFormer.