DM-SegNet: Dual-Mamba Architecture for 3D Medical Image Segmentation with Global Context Modeling

Accurate 3D medical image segmentation demands architectures capable of reconciling global context modeling with spatial topology preservation. While State Space Models (SSMs) like Mamba show potential for sequence modeling, existing medical SSMs suffer from encoder-decoder incompatibility: the encoder's 1D sequence flattening compromises spatial structures, while conventional decoders fail to leverage Mamba's state propagation. We present DM-SegNet, a Dual-Mamba architecture integrating directional state transitions with anatomy-aware hierarchical decoding. The core innovations include a quadri-directional spatial Mamba module employing four-directional 3D scanning to maintain anatomical spatial coherence, a gated spatial convolution layer that enhances spatially sensitive feature representation prior to state modeling, and a Mamba-driven decoding framework enabling bidirectional state synchronization across scales. Extensive evaluation on two clinically significant benchmarks demonstrates the efficacy of DM-SegNet: achieving state-of-the-art Dice Similarity Coefficient (DSC) of 85.44% on the Synapse dataset for abdominal organ segmentation and 90.22% on the BraTS2023 dataset for brain tumor segmentation.

FuseUNet: A Multi-Scale Feature Fusion Method for U-like Networks

Medical image segmentation is a critical task in computer vision, with UNet serving as a milestone architecture. The typical component of UNet family is the skip connection, however, their skip connections face two significant limitations: (1) they lack effective interaction between features at different scales, and (2) they rely on simple concatenation or addition operations, which constrain efficient information integration. While recent improvements to UNet have focused on enhancing encoder and decoder capabilities, these limitations remain overlooked. To overcome these challenges, we propose a novel multi-scale feature fusion method that reimagines the UNet decoding process as solving an initial value problem (IVP), treating skip connections as discrete nodes. By leveraging principles from the linear multistep method, we propose an adaptive ordinary differential equation method to enable effective multi-scale feature fusion. Our approach is independent of the encoder and decoder architectures, making it adaptable to various U-Net-like networks. Experiments on ACDC, KiTS2023, MSD brain tumor, and ISIC2017/2018 skin lesion segmentation datasets demonstrate improved feature utilization, reduced network parameters, and maintained high performance. The code is available at https://github.com/nayutayuki/FuseUNet.

TissUnet: Improved Extracranial Tissue and Cranium Segmentation for Children through Adulthood

Extracranial tissues visible on brain magnetic resonance imaging (MRI) may hold significant value for characterizing health conditions and clinical decision-making, yet they are rarely quantified. Current tools have not been widely validated, particularly in settings of developing brains or underlying pathology. We present TissUnet, a deep learning model that segments skull bone, subcutaneous fat, and muscle from routine three-dimensional T1-weighted MRI, with or without contrast enhancement. The model was trained on 155 paired MRI-computed tomography (CT) scans and validated across nine datasets covering a wide age range and including individuals with brain tumors. In comparison to AI-CT-derived labels from 37 MRI-CT pairs, TissUnet achieved a median Dice coefficient of 0.79 [IQR: 0.77-0.81] in a healthy adult cohort. In a second validation using expert manual annotations, median Dice was 0.83 [IQR: 0.83-0.84] in healthy individuals and 0.81 [IQR: 0.78-0.83] in tumor cases, outperforming previous state-of-the-art method. Acceptability testing resulted in an 89% acceptance rate after adjudication by a tie-breaker(N=108 MRIs), and TissUnet demonstrated excellent performance in the blinded comparative review (N=45 MRIs), including both healthy and tumor cases in pediatric populations. TissUnet enables fast, accurate, and reproducible segmentation of extracranial tissues, supporting large-scale studies on craniofacial morphology, treatment effects, and cardiometabolic risk using standard brain T1w MRI.

PCA for Enhanced Cross-Dataset Generalizability in Breast Ultrasound Tumor Segmentation

In medical image segmentation, limited external validity remains a critical obstacle when models are deployed across unseen datasets, an issue particularly pronounced in the ultrasound image domain. Existing solutions-such as domain adaptation and GAN-based style transfer-while promising, often fall short in the medical domain where datasets are typically small and diverse. This paper presents a novel application of principal component analysis (PCA) to address this limitation. PCA preprocessing reduces noise and emphasizes essential features by retaining approximately 90\% of the dataset variance. We evaluate our approach across six diverse breast tumor ultrasound datasets comprising 3,983 B-mode images and corresponding expert tumor segmentation masks. For each dataset, a corresponding dimensionality reduced PCA-dataset is created and U-Net-based segmentation models are trained on each of the twelve datasets. Each model trained on an original dataset was inferenced on the remaining five out-of-domain original datasets (baseline results), while each model trained on a PCA dataset was inferenced on five out-of-domain PCA datasets. Our experimental results indicate that using PCA reconstructed datasets, instead of original images, improves the model's recall and Dice scores, particularly for model-dataset pairs where baseline performance was lowest, achieving statistically significant gains in recall (0.57 $\pm$ 0.07 vs. 0.70 $\pm$ 0.05, $p = 0.0004$) and Dice scores (0.50 $\pm$ 0.06 vs. 0.58 $\pm$ 0.06, $p = 0.03$). Our method reduced the decline in recall values due to external validation by $33\%$. These findings underscore the potential of PCA reconstruction as a safeguard to mitigate declines in segmentation performance, especially in challenging cases, with implications for enhancing external validity in real-world medical applications.

Hypergraph Tversky-Aware Domain Incremental Learning for Brain Tumor Segmentation with Missing Modalities

Existing methods for multimodal MRI segmentation with missing modalities typically assume that all MRI modalities are available during training. However, in clinical practice, some modalities may be missing due to the sequential nature of MRI acquisition, leading to performance degradation. Furthermore, retraining models to accommodate newly available modalities can be inefficient and may cause overfitting, potentially compromising previously learned knowledge. To address these challenges, we propose Replay-based Hypergraph Domain Incremental Learning (ReHyDIL) for brain tumor segmentation with missing modalities. ReHyDIL leverages Domain Incremental Learning (DIL) to enable the segmentation model to learn from newly acquired MRI modalities without forgetting previously learned information. To enhance segmentation performance across diverse patient scenarios, we introduce the Cross-Patient Hypergraph Segmentation Network (CHSNet), which utilizes hypergraphs to capture high-order associations between patients. Additionally, we incorporate Tversky-Aware Contrastive (TAC) loss to effectively mitigate information imbalance both across and within different modalities. Extensive experiments on the BraTS2019 dataset demonstrate that ReHyDIL outperforms state-of-the-art methods, achieving an improvement of over 2\% in the Dice Similarity Coefficient across various tumor regions. Our code is available at ReHyDIL.

Beyond Segmentation: Confidence-Aware and Debiased Estimation of Ratio-based Biomarkers

Ratio-based biomarkers -- such as the proportion of necrotic tissue within a tumor -- are widely used in clinical practice to support diagnosis, prognosis and treatment planning. These biomarkers are typically estimated from soft segmentation outputs by computing region-wise ratios. Despite the high-stakes nature of clinical decision making, existing methods provide only point estimates, offering no measure of uncertainty. In this work, we propose a unified \textit{confidence-aware} framework for estimating ratio-based biomarkers. We conduct a systematic analysis of error propagation in the segmentation-to-biomarker pipeline and identify model miscalibration as the dominant source of uncertainty. To mitigate this, we incorporate a lightweight, post-hoc calibration module that can be applied using internal hospital data without retraining. We leverage a tunable parameter $Q$ to control the confidence level of the derived bounds, allowing adaptation towards clinical practice. Extensive experiments show that our method produces statistically sound confidence intervals, with tunable confidence levels, enabling more trustworthy application of predictive biomarkers in clinical workflows.

TAGS: 3D Tumor-Adaptive Guidance for SAM

Foundation models (FMs) such as CLIP and SAM have recently shown great promise in image segmentation tasks, yet their adaptation to 3D medical imaging-particularly for pathology detection and segmentation-remains underexplored. A critical challenge arises from the domain gap between natural images and medical volumes: existing FMs, pre-trained on 2D data, struggle to capture 3D anatomical context, limiting their utility in clinical applications like tumor segmentation. To address this, we propose an adaptation framework called TAGS: Tumor Adaptive Guidance for SAM, which unlocks 2D FMs for 3D medical tasks through multi-prompt fusion. By preserving most of the pre-trained weights, our approach enhances SAM's spatial feature extraction using CLIP's semantic insights and anatomy-specific prompts. Extensive experiments on three open-source tumor segmentation datasets prove that our model surpasses the state-of-the-art medical image segmentation models (+46.88% over nnUNet), interactive segmentation frameworks, and other established medical FMs, including SAM-Med2D, SAM-Med3D, SegVol, Universal, 3D-Adapter, and SAM-B (at least +13% over them). This highlights the robustness and adaptability of our proposed framework across diverse medical segmentation tasks.

DC-Seg: Disentangled Contrastive Learning for Brain Tumor Segmentation with Missing Modalities

Accurate segmentation of brain images typically requires the integration of complementary information from multiple image modalities. However, clinical data for all modalities may not be available for every patient, creating a significant challenge. To address this, previous studies encode multiple modalities into a shared latent space. While somewhat effective, it remains suboptimal, as each modality contains distinct and valuable information. In this study, we propose DC-Seg (Disentangled Contrastive Learning for Segmentation), a new method that explicitly disentangles images into modality-invariant anatomical representation and modality-specific representation, by using anatomical contrastive learning and modality contrastive learning respectively. This solution improves the separation of anatomical and modality-specific features by considering the modality gaps, leading to more robust representations. Furthermore, we introduce a segmentation-based regularizer that enhances the model's robustness to missing modalities. Extensive experiments on the BraTS 2020 and a private white matter hyperintensity(WMH) segmentation dataset demonstrate that DC-Seg outperforms state-of-the-art methods in handling incomplete multimodal brain tumor segmentation tasks with varying missing modalities, while also demonstrate strong generalizability in WMH segmentation. The code is available at https://github.com/CuCl-2/DC-Seg.

CDPDNet: Integrating Text Guidance with Hybrid Vision Encoders for Medical Image Segmentation

Most publicly available medical segmentation datasets are only partially labeled, with annotations provided for a subset of anatomical structures. When multiple datasets are combined for training, this incomplete annotation poses challenges, as it limits the model's ability to learn shared anatomical representations among datasets. Furthermore, vision-only frameworks often fail to capture complex anatomical relationships and task-specific distinctions, leading to reduced segmentation accuracy and poor generalizability to unseen datasets. In this study, we proposed a novel CLIP-DINO Prompt-Driven Segmentation Network (CDPDNet), which combined a self-supervised vision transformer with CLIP-based text embedding and introduced task-specific text prompts to tackle these challenges. Specifically, the framework was constructed upon a convolutional neural network (CNN) and incorporated DINOv2 to extract both fine-grained and global visual features, which were then fused using a multi-head cross-attention module to overcome the limited long-range modeling capability of CNNs. In addition, CLIP-derived text embeddings were projected into the visual space to help model complex relationships among organs and tumors. To further address the partial label challenge and enhance inter-task discriminative capability, a Text-based Task Prompt Generation (TTPG) module that generated task-specific prompts was designed to guide the segmentation. Extensive experiments on multiple medical imaging datasets demonstrated that CDPDNet consistently outperformed existing state-of-the-art segmentation methods. Code and pretrained model are available at: https://github.com/wujiong-hub/CDPDNet.git.

PRS-Med: Position Reasoning Segmentation with Vision-Language Model in Medical Imaging

Recent advancements in prompt-based medical image segmentation have enabled clinicians to identify tumors using simple input like bounding boxes or text prompts. However, existing methods face challenges when doctors need to interact through natural language or when position reasoning is required - understanding spatial relationships between anatomical structures and pathologies. We present PRS-Med, a framework that integrates vision-language models with segmentation capabilities to generate both accurate segmentation masks and corresponding spatial reasoning outputs. Additionally, we introduce the MMRS dataset (Multimodal Medical in Positional Reasoning Segmentation), which provides diverse, spatially-grounded question-answer pairs to address the lack of position reasoning data in medical imaging. PRS-Med demonstrates superior performance across six imaging modalities (CT, MRI, X-ray, ultrasound, endoscopy, RGB), significantly outperforming state-of-the-art methods in both segmentation accuracy and position reasoning. Our approach enables intuitive doctor-system interaction through natural language, facilitating more efficient diagnoses. Our dataset pipeline, model, and codebase will be released to foster further research in spatially-aware multimodal reasoning for medical applications.