Mamba-Sea: A Mamba-based Framework with Global-to-Local Sequence Augmentation for Generalizable Medical Image Segmentation

To segment medical images with distribution shifts, domain generalization (DG) has emerged as a promising setting to train models on source domains that can generalize to unseen target domains. Existing DG methods are mainly based on CNN or ViT architectures. Recently, advanced state space models, represented by Mamba, have shown promising results in various supervised medical image segmentation. The success of Mamba is primarily owing to its ability to capture long-range dependencies while keeping linear complexity with input sequence length, making it a promising alternative to CNNs and ViTs. Inspired by the success, in the paper, we explore the potential of the Mamba architecture to address distribution shifts in DG for medical image segmentation. Specifically, we propose a novel Mamba-based framework, Mamba-Sea, incorporating global-to-local sequence augmentation to improve the model's generalizability under domain shift issues. Our Mamba-Sea introduces a global augmentation mechanism designed to simulate potential variations in appearance across different sites, aiming to suppress the model's learning of domain-specific information. At the local level, we propose a sequence-wise augmentation along input sequences, which perturbs the style of tokens within random continuous sub-sequences by modeling and resampling style statistics associated with domain shifts. To our best knowledge, Mamba-Sea is the first work to explore the generalization of Mamba for medical image segmentation, providing an advanced and promising Mamba-based architecture with strong robustness to domain shifts. Remarkably, our proposed method is the first to surpass a Dice coefficient of 90% on the Prostate dataset, which exceeds previous SOTA of 88.61%. The code is available at https://github.com/orange-czh/Mamba-Sea.

Advanced Segmentation of Diabetic Retinopathy Lesions Using DeepLabv3+

To improve the segmentation of diabetic retinopathy lesions (microaneurysms, hemorrhages, exudates, and soft exudates), we implemented a binary segmentation method specific to each type of lesion. As post-segmentation, we combined the individual model outputs into a single image to better analyze the lesion types. This approach facilitated parameter optimization and improved accuracy, effectively overcoming challenges related to dataset limitations and annotation complexity. Specific preprocessing steps included cropping and applying contrast-limited adaptive histogram equalization to the L channel of the LAB image. Additionally, we employed targeted data augmentation techniques to further refine the model's efficacy. Our methodology utilized the DeepLabv3+ model, achieving a segmentation accuracy of 99%. These findings highlight the efficacy of innovative strategies in advancing medical image analysis, particularly in the precise segmentation of diabetic retinopathy lesions. The IDRID dataset was utilized to validate and demonstrate the robustness of our approach.

Performance Estimation for Supervised Medical Image Segmentation Models on Unlabeled Data Using UniverSeg

The performance of medical image segmentation models is usually evaluated using metrics like the Dice score and Hausdorff distance, which compare predicted masks to ground truth annotations. However, when applying the model to unseen data, such as in clinical settings, it is often impractical to annotate all the data, making the model's performance uncertain. To address this challenge, we propose the Segmentation Performance Evaluator (SPE), a framework for estimating segmentation models' performance on unlabeled data. This framework is adaptable to various evaluation metrics and model architectures. Experiments on six publicly available datasets across six evaluation metrics including pixel-based metrics such as Dice score and distance-based metrics like HD95, demonstrated the versatility and effectiveness of our approach, achieving a high correlation (0.956$\pm$0.046) and low MAE (0.025$\pm$0.019) compare with real Dice score on the independent test set. These results highlight its ability to reliably estimate model performance without requiring annotations. The SPE framework integrates seamlessly into any model training process without adding training overhead, enabling performance estimation and facilitating the real-world application of medical image segmentation algorithms. The source code is publicly available

Beyond Labels: Zero-Shot Diabetic Foot Ulcer Wound Segmentation with Self-attention Diffusion Models and the Potential for Text-Guided Customization

Diabetic foot ulcers (DFUs) pose a significant challenge in healthcare, requiring precise and efficient wound assessment to enhance patient outcomes. This study introduces the Attention Diffusion Zero-shot Unsupervised System (ADZUS), a novel text-guided diffusion model that performs wound segmentation without relying on labeled training data. Unlike conventional deep learning models, which require extensive annotation, ADZUS leverages zero-shot learning to dynamically adapt segmentation based on descriptive prompts, offering enhanced flexibility and adaptability in clinical applications. Experimental evaluations demonstrate that ADZUS surpasses traditional and state-of-the-art segmentation models, achieving an IoU of 86.68\% and the highest precision of 94.69\% on the chronic wound dataset, outperforming supervised approaches such as FUSegNet. Further validation on a custom-curated DFU dataset reinforces its robustness, with ADZUS achieving a median DSC of 75\%, significantly surpassing FUSegNet's 45\%. The model's text-guided segmentation capability enables real-time customization of segmentation outputs, allowing targeted analysis of wound characteristics based on clinical descriptions. Despite its competitive performance, the computational cost of diffusion-based inference and the need for potential fine-tuning remain areas for future improvement. ADZUS represents a transformative step in wound segmentation, providing a scalable, efficient, and adaptable AI-driven solution for medical imaging.

WT-BCP: Wavelet Transform based Bidirectional Copy-Paste for Semi-Supervised Medical Image Segmentation

Semi-supervised medical image segmentation (SSMIS) shows promise in reducing reliance on scarce labeled medical data. However, SSMIS field confronts challenges such as distribution mismatches between labeled and unlabeled data, artificial perturbations causing training biases, and inadequate use of raw image information, especially low-frequency (LF) and high-frequency (HF) components.To address these challenges, we propose a Wavelet Transform based Bidirectional Copy-Paste SSMIS framework, named WT-BCP, which improves upon the Mean Teacher approach. Our method enhances unlabeled data understanding by copying random crops between labeled and unlabeled images and employs WT to extract LF and HF details.We propose a multi-input and multi-output model named XNet-Plus, to receive the fused information after WT. Moreover, consistency training among multiple outputs helps to mitigate learning biases introduced by artificial perturbations. During consistency training, the mixed images resulting from WT are fed into both models, with the student model's output being supervised by pseudo-labels and ground-truth. Extensive experiments conducted on 2D and 3D datasets confirm the effectiveness of our model.Code: https://github.com/simzhangbest/WT-BCP.

SuperCL: Superpixel Guided Contrastive Learning for Medical Image Segmentation Pre-training

Medical image segmentation is a critical yet challenging task, primarily due to the difficulty of obtaining extensive datasets of high-quality, expert-annotated images. Contrastive learning presents a potential but still problematic solution to this issue. Because most existing methods focus on extracting instance-level or pixel-to-pixel representation, which ignores the characteristics between intra-image similar pixel groups. Moreover, when considering contrastive pairs generation, most SOTA methods mainly rely on manually setting thresholds, which requires a large number of gradient experiments and lacks efficiency and generalization. To address these issues, we propose a novel contrastive learning approach named SuperCL for medical image segmentation pre-training. Specifically, our SuperCL exploits the structural prior and pixel correlation of images by introducing two novel contrastive pairs generation strategies: Intra-image Local Contrastive Pairs (ILCP) Generation and Inter-image Global Contrastive Pairs (IGCP) Generation. Considering superpixel cluster aligns well with the concept of contrastive pairs generation, we utilize the superpixel map to generate pseudo masks for both ILCP and IGCP to guide supervised contrastive learning. Moreover, we also propose two modules named Average SuperPixel Feature Map Generation (ASP) and Connected Components Label Generation (CCL) to better exploit the prior structural information for IGCP. Finally, experiments on 8 medical image datasets indicate our SuperCL outperforms existing 12 methods. i.e. Our SuperCL achieves a superior performance with more precise predictions from visualization figures and 3.15%, 5.44%, 7.89% DSC higher than the previous best results on MMWHS, CHAOS, Spleen with 10% annotations. Our code will be released after acceptance.

Med-2D SegNet: A Light Weight Deep Neural Network for Medical 2D Image Segmentation

Accurate and efficient medical image segmentation is crucial for advancing clinical diagnostics and surgical planning, yet remains a complex challenge due to the variability in anatomical structures and the demand for low-complexity models. In this paper, we introduced Med-2D SegNet, a novel and highly efficient segmentation architecture that delivers outstanding accuracy while maintaining a minimal computational footprint. Med-2D SegNet achieves state-of-the-art performance across multiple benchmark datasets, including KVASIR-SEG, PH2, EndoVis, and GLAS, with an average Dice similarity coefficient (DSC) of 89.77% across 20 diverse datasets. Central to its success is the compact Med Block, a specialized encoder design that incorporates dimension expansion and parameter reduction, enabling precise feature extraction while keeping model parameters to a low count of just 2.07 million. Med-2D SegNet excels in cross-dataset generalization, particularly in polyp segmentation, where it was trained on KVASIR-SEG and showed strong performance on unseen datasets, demonstrating its robustness in zero-shot learning scenarios, even though we acknowledge that further improvements are possible. With top-tier performance in both binary and multi-class segmentation, Med-2D SegNet redefines the balance between accuracy and efficiency, setting a new benchmark for medical image analysis. This work paves the way for developing accessible, high-performance diagnostic tools suitable for clinical environments and resource-constrained settings, making it a step forward in the democratization of advanced medical technology.

Prompt-Tuning SAM: From Generalist to Specialist with only 2048 Parameters and 16 Training Images

The Segment Anything Model (SAM) is widely used for segmenting a diverse range of objects in natural images from simple user prompts like points or bounding boxes. However, SAM's performance decreases substantially when applied to non-natural domains like microscopic imaging. Furthermore, due to SAM's interactive design, it requires a precise prompt for each image and object, which is unfeasible in many automated biomedical applications. Previous solutions adapt SAM by training millions of parameters via fine-tuning large parts of the model or of adapter layers. In contrast, we show that as little as 2,048 additional parameters are sufficient for turning SAM into a use-case specialist for a certain downstream task. Our novel PTSAM (prompt-tuned SAM) method uses prompt-tuning, a parameter-efficient fine-tuning technique, to adapt SAM for a specific task. We validate the performance of our approach on multiple microscopic and one medical dataset. Our results show that prompt-tuning only SAM's mask decoder already leads to a performance on-par with state-of-the-art techniques while requiring roughly 2,000x less trainable parameters. For addressing domain gaps, we find that additionally prompt-tuning SAM's image encoder is beneficial, further improving segmentation accuracy by up to 18% over state-of-the-art results. Since PTSAM can be reliably trained with as little as 16 annotated images, we find it particularly helpful for applications with limited training data and domain shifts.

Efficient Parameter Adaptation for Multi-Modal Medical Image Segmentation and Prognosis

Cancer detection and prognosis relies heavily on medical imaging, particularly CT and PET scans. Deep Neural Networks (DNNs) have shown promise in tumor segmentation by fusing information from these modalities. However, a critical bottleneck exists: the dependency on CT-PET data concurrently for training and inference, posing a challenge due to the limited availability of PET scans. Hence, there is a clear need for a flexible and efficient framework that can be trained with the widely available CT scans and can be still adapted for PET scans when they become available. In this work, we propose a parameter-efficient multi-modal adaptation (PEMMA) framework for lightweight upgrading of a transformer-based segmentation model trained only on CT scans such that it can be efficiently adapted for use with PET scans when they become available. This framework is further extended to perform prognosis task maintaining the same efficient cross-modal fine-tuning approach. The proposed approach is tested with two well-known segementation backbones, namely UNETR and Swin UNETR. Our approach offers two main advantages. Firstly, we leverage the inherent modularity of the transformer architecture and perform low-rank adaptation (LoRA) as well as decomposed low-rank adaptation (DoRA) of the attention weights to achieve parameter-efficient adaptation. Secondly, by minimizing cross-modal entanglement, PEMMA allows updates using only one modality without causing catastrophic forgetting in the other. Our method achieves comparable performance to early fusion, but with only 8% of the trainable parameters, and demonstrates a significant +28% Dice score improvement on PET scans when trained with a single modality. Furthermore, in prognosis, our method improves the concordance index by +10% when adapting a CT-pretrained model to include PET scans, and by +23% when adapting for both PET and EHR data.

Segmentation with Noisy Labels via Spatially Correlated Distributions

In semantic segmentation, the accuracy of models heavily depends on the high-quality annotations. However, in many practical scenarios such as medical imaging and remote sensing, obtaining true annotations is not straightforward and usually requires significant human labor. Relying on human labor often introduces annotation errors, including mislabeling, omissions, and inconsistency between annotators. In the case of remote sensing, differences in procurement time can lead to misaligned ground truth annotations. These label errors are not independently distributed, and instead usually appear in spatially connected regions where adjacent pixels are more likely to share the same errors. To address these issues, we propose an approximate Bayesian estimation based on a probabilistic model that assumes training data includes label errors, incorporating the tendency for these errors to occur with spatial correlations between adjacent pixels. Bayesian inference requires computing the posterior distribution of label errors, which becomes intractable when spatial correlations are present. We represent the correlation of label errors between adjacent pixels through a Gaussian distribution whose covariance is structured by a Kac-Murdock-Szeg\"{o} (KMS) matrix, solving the computational challenges. Through experiments on multiple segmentation tasks, we confirm that leveraging the spatial correlation of label errors significantly improves performance. Notably, in specific tasks such as lung segmentation, the proposed method achieves performance comparable to training with clean labels under moderate noise levels. Code is available at https://github.com/pfnet-research/Bayesian_SpatialCorr.