Cervical spondylosis, a complex and prevalent condition, demands precise and efficient diagnostic techniques for accurate assessment. While MRI offers detailed visualization of cervical spine anatomy, manual interpretation remains labor-intensive and prone to error. To address this, we developed an innovative AI-assisted Expert-based Diagnosis System that automates both segmentation and diagnosis of cervical spondylosis using MRI. Leveraging multi-center datasets of cervical MRI images from patients with cervical spondylosis, our system features a pathology-guided segmentation model capable of accurately segmenting key cervical anatomical structures. The segmentation is followed by an expert-based diagnostic framework that automates the calculation of critical clinical indicators. Our segmentation model achieved an impressive average Dice coefficient exceeding 0.90 across four cervical spinal anatomies and demonstrated enhanced accuracy in herniation areas. Diagnostic evaluation further showcased the system's precision, with the lowest mean average errors (MAE) for the C2-C7 Cobb angle and the Maximum Spinal Cord Compression (MSCC) coefficient. In addition, our method delivered high accuracy, precision, recall, and F1 scores in herniation localization, K-line status assessment, T2 hyperintensity detection, and Kang grading. Comparative analysis and external validation demonstrate that our system outperforms existing methods, establishing a new benchmark for segmentation and diagnostic tasks for cervical spondylosis.

Imbalanced class distributions among different organs pose significant challenges in real-world semi-supervised multi-organ segmentation. Integrating anatomical priors offers a promising research direction to mitigate these imbalances. In this paper, we explore the capabilities of Multimodal Large Language Models (MLLM) to extract robust, generic textual anatomical insights serving as prior knowledge for segmentation model. Specifically, we employ GPT-4o to generate detailed textual descriptions of anatomical priors-including both inter-organ relative positional relationships and organ shape characteristics. These priors generated only once for the whole training and testing are then seamlessly integrated into the segmentation model as parameters within the segmentation head. Furthermore, we align the textual priors with visual features using contrastive learning. The inter-organ positional priors guide the model in localizing smaller organs relative to larger ones, while the organ shape priors help ensure that the learned morphological structures are more anatomically plausible. Extensive experiments demonstrate that our method significantly outperforms some state-of-the-art approaches. The source code is available at: https://github.com/Lunn88/TAK-Semi.

Cardiovascular health is vital to human well-being, and cardiac magnetic resonance (CMR) imaging is considered the clinical reference standard for diagnosing cardiovascular disease. However, its adoption is hindered by long scan times, complex contrasts, and inconsistent quality. While deep learning methods perform well on specific CMR imaging sequences, they often fail to generalize across modalities and sampling schemes. The lack of benchmarks for high-quality, fast CMR image reconstruction further limits technology comparison and adoption. The CMRxRecon2024 challenge, attracting over 200 teams from 18 countries, addressed these issues with two tasks: generalization to unseen modalities and robustness to diverse undersampling patterns. We introduced the largest public multi-modality CMR raw dataset, an open benchmarking platform, and shared code. Analysis of the best-performing solutions revealed that prompt-based adaptation and enhanced physics-driven consistency enabled strong cross-scenario performance. These findings establish principles for generalizable reconstruction models and advance clinically translatable AI in cardiovascular imaging.

Major adverse cardiac events (MACE) pose a high life-threatening risk to patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Cardiac magnetic resonance (CMR) has been proven to reflect the risk of MACE, but two challenges remain: limited dataset size due to the rarity of ARVC and overlapping image distributions between non-MACE and MACE patients. To address these challenges by fully leveraging the dynamic and spatial information in the limited CMR dataset, a deep learning-based risk prediction model named Three-Tier Spatiotemporal Transformer (TTST) is proposed in this paper, which utilizes three transformer-based tiers to sequentially extract and fuse features from three domains: the 2D spatial domain of each slice, the temporal dimension of slice sequence and the inter-slice depth dimension. In TTST, a pericardial adipose tissue (PAT) embedding unit is proposed to incorporate the dynamic and positional information of PAT, a key biomarker for distinguishing MACE from non-MACE based on its thickening and reduced motion, as prior knowledge to reduce reliance on large-scale datasets. Additionally, a patch voting unit is introduced to pick out local features that highlight more indicative regions in the heart, guided by the PAT embedding information. Experimental results demonstrate that TTST outperforms existing classification methods in MACE prediction (internal: AUC = 0.89, ACC = 84.02%; external: AUC = 0.87, ACC = 86.21%). Clinically, TTST achieves effective risk prediction performance either independently (C-index = 0.744) or in combination with the existing 5-year risk score model (increasing C-index from 0.686 to 0.777). Code and dataset are accessible at https://github.com/DFLAG-NEU.

Test-Time Adaptation (TTA) offers a practical solution for deploying image segmentation models under domain shift without accessing source data or retraining. Among existing TTA strategies, pseudo-label-based methods have shown promising performance. However, they often rely on perturbation-ensemble heuristics (e.g., dropout sampling, test-time augmentation, Gaussian noise), which lack distributional grounding and yield unstable training signals. This can trigger error accumulation and catastrophic forgetting during adaptation. To address this, we propose A3-TTA, a TTA framework that constructs reliable pseudo-labels through anchor-guided supervision. Specifically, we identify well-predicted target domain images using a class compact density metric, under the assumption that confident predictions imply distributional proximity to the source domain. These anchors serve as stable references to guide pseudo-label generation, which is further regularized via semantic consistency and boundary-aware entropy minimization. Additionally, we introduce a self-adaptive exponential moving average strategy to mitigate label noise and stabilize model update during adaptation. Evaluated on both multi-domain medical images (heart structure and prostate segmentation) and natural images, A3-TTA significantly improves average Dice scores by 10.40 to 17.68 percentage points compared to the source model, outperforming several state-of-the-art TTA methods under different segmentation model architectures. A3-TTA also excels in continual TTA, maintaining high performance across sequential target domains with strong anti-forgetting ability. The code will be made publicly available at https://github.com/HiLab-git/A3-TTA.

Myocardial infarction (MI) is a leading cause of death worldwide. Late gadolinium enhancement (LGE) and T2-weighted cardiac magnetic resonance (CMR) imaging can respectively identify scarring and edema areas, both of which are essential for MI risk stratification and prognosis assessment. Although combining complementary information from multi-sequence CMR is useful, acquiring these sequences can be time-consuming and prohibitive, e.g., due to the administration of contrast agents. Cine CMR is a rapid and contrast-free imaging technique that can visualize both motion and structural abnormalities of the myocardium induced by acute MI. Therefore, we present a new end-to-end deep neural network, referred to as CineMyoPS, to segment myocardial pathologies, i.e., scars and edema, solely from cine CMR images. Specifically, CineMyoPS extracts both motion and anatomy features associated with MI. Given the interdependence between these features, we design a consistency loss (resembling the co-training strategy) to facilitate their joint learning. Furthermore, we propose a time-series aggregation strategy to integrate MI-related features across the cardiac cycle, thereby enhancing segmentation accuracy for myocardial pathologies. Experimental results on a multi-center dataset demonstrate that CineMyoPS achieves promising performance in myocardial pathology segmentation, motion estimation, and anatomy segmentation.

Due to the association with higher incidence of left ventricular dysfunction and complications, segmentation of left ventricle and related pathological tissues: microvascular obstruction and myocardial infarction from late gadolinium enhancement cardiac magnetic resonance images is crucially important. However, lack of datasets, diverse shapes and locations, extreme imbalanced class, severe intensity distribution overlapping are the main challenges. We first release a late gadolinium enhancement cardiac magnetic resonance benchmark dataset LGE-LVP containing 140 patients with left ventricle myocardial infarction and concomitant microvascular obstruction. Then, a progressive deep learning model LVPSegNet is proposed to segment the left ventricle and its pathologies via adaptive region of interest extraction, sample augmentation, curriculum learning, and multiple receptive field fusion in dealing with the challenges. Comprehensive comparisons with state-of-the-art models on the internal and external datasets demonstrate that the proposed model performs the best on both geometric and clinical metrics and it most closely matched the clinician's performance. Overall, the released LGE-LVP dataset alongside the LVPSegNet we proposed offer a practical solution for automated left ventricular and its pathologies segmentation by providing data support and facilitating effective segmentation. The dataset and source codes will be released via https://github.com/DFLAG-NEU/LVPSegNet.

To assess the efficacy of point cloud features, conventional image indices, and radiomics signatures from cardiovascular magnetic resonance (CMR) images, as well as their combinations in distinguishing hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) patients and normal (NOR) (healthy) subjects. A total of 452 participants (142 HCM, 157 DCM, 153 NOR) from two public datasets were analyzed. Features were extracted from the left ventricle (LV), right ventricle (RV), and myocardium (MYO) in end-diastolic (ED) and end-systolic (ES) phases, including 78 point cloud, 84 radiomics, and 20 image indices. Feature selection and SVM classification were used to create discriminative signatures. Reproducibility was assessed with a 20% training set and full test set. The combined feature model with all three types yielded the highest accuracy (92.3%, AUC 0.977), followed by point cloud and the combination of point cloud and image features (90.2% accuracy). Selected features had high repeatability (ICC ≥ 0.85), offering a detailed multi-angle view of differences among HCM, DCM, and NOR.

Accurate myocardial segmentation is crucial in the diagnosis and treatment of myocardial infarction (MI), especially in Late Gadolinium Enhancement (LGE) cardiac magnetic resonance (CMR) images, where the infarcted myocardium exhibits a greater brightness. However, segmentation annotations for LGE images are usually not available. Although knowledge gained from CMR images of other modalities with ample annotations, such as balanced-Steady State Free Precession (bSSFP), can be transferred to the LGE images, the difference in image distribution between the two modalities (i.e., domain shift) usually results in a significant degradation in model performance. To alleviate this, an end-to-end Variational autoencoder based feature Alignment Module Combining Explicit and Implicit features (VAMCEI) is proposed. We first re-derive the Kullback-Leibler (KL) divergence between the posterior distributions of the two domains as a measure of the global distribution distance. Second, we calculate the prototype contrastive loss between the two domains, bringing closer the prototypes of the same category across domains and pushing away the prototypes of different categories within or across domains. Finally, a domain discriminator is added to the output space, which indirectly aligns the feature distribution and forces the extracted features to be more favorable for segmentation. In addition, by combining CycleGAN and VAMCEI, we propose a more refined multi-stage unsupervised domain adaptation (UDA) framework for myocardial structure segmentation. We conduct extensive experiments on the MSCMRSeg 2019, MyoPS 2020 and MM-WHS 2017 datasets. The experimental results demonstrate that our framework achieves superior performances than state-of-the-art methods.

Increased pericardial adipose tissue (PEAT) is associated with a series of cardiovascular diseases (CVDs) and metabolic syndromes. Quantitative analysis of PEAT by means of image segmentation is of great significance. Although cardiovascular magnetic resonance (CMR) has been utilized as a routine method for non-invasive and non-radioactive CVD diagnosis, segmentation of PEAT in CMR images is challenging and laborious. In practice, no public CMR datasets are available for validating PEAT automatic segmentation. Therefore, we first release a benchmark CMR dataset, MRPEAT, which consists of cardiac short axis (SA) CMR images from 50 hypertrophic cardiomyopathy (HCM), 50 acute myocardial infarction (AMI), and 50 normal control (NC) subjects. We then propose a deep learning model, named as 3SUnet, to segment PEAT on MRPEAT to tackle the challenges that PEAT is relatively small and diverse and its intensities are hard to distinguish from the background. The 3SUnet is a triple-stage network, of which the backbones are all Unet. One Unet is used to extract a region of interest (ROI) for any given image with ventricles and PEAT being contained completely using a multi-task continual learning strategy. Another Unet is adopted to segment PEAT in ROI-cropped images. The third Unet is utilized to refine PEAT segmentation accuracy guided by an image adaptive probability map. The proposed model is qualitatively and quantitatively compared with the state-of-the-art models on the dataset. We obtain the PEAT segmentation results through 3SUnet, assess the robustness of 3SUnet under different pathological conditions, and identify the imaging indications of PEAT in CVDs. The dataset and all source codes are available at https://dflag-neu.github.io/member/csz/research/.