While various deep learning methods were proposed for low-dose computed tomography (CT) denoising, they often suffer from over-smoothing, blurring, and lack of explainability. To alleviate these issues, we propose a plug-and-play Language-Engaged Dual-space Alignment loss (LEDA) to optimize low-dose CT denoising models. Our idea is to leverage large language models (LLMs) to align denoised CT and normal-dose CT images in both the continuous perceptual space and discrete semantic space, which is the first LLM-based scheme for low-dose CT denoising. LEDA involves two steps: the first is to pretrain an LLM-guided CT autoencoder, which can encode a CT image into continuous high-level features and quantize them into a token space to produce semantic tokens derived from the LLM’s vocabulary; and the second is to minimize the discrepancy between the denoised CT images and normal-dose CT in terms of both encoded high-level features and quantized token embeddings derived by the LLM-guided CT autoencoder. Extensive experimental results demonstrate that our LEDA can enhance existing denoising models in terms of quantitative metrics and qualitative evaluation, and also provide explainability through language-level image understanding. The code is publicly available at https://github.com/hao1635/LEDA.

Mild cognitive impairment (MCI) is often at high risk of progression to Alzheimer's disease (AD). Existing works to identify the progressive MCI (pMCI) typically require MCI subtype labels, pMCI vs. stable MCI (sMCI), determined by whether or not an MCI patient will progress to AD after a long follow-up. However, prospectively acquiring MCI subtype data is time-consuming and resource-intensive; the resultant small datasets could lead to severe overfitting and difficulty in extracting discriminative information. Inspired by that various longitudinal biomarkers and cognitive measurements present an ordinal pathway on AD progression, we propose a novel Hybrid-granularity Ordinal PrototypE learning (HOPE) method to characterize AD ordinal progression for MCI progression prediction. First, HOPE learns an ordinal metric space that enables progression prediction by prototype comparison. Second, HOPE leverages a novel hybrid-granularity ordinal loss to learn the ordinal nature of AD via effectively integrating instance-to-instance ordinality, instance-to-class compactness, and class-to-class separation. Third, to make the prototype learning more stable, HOPE employs an exponential moving average strategy to learn the global prototypes of NC and AD dynamically. Experimental results on the internal ADNI and the external NACC datasets demonstrate the superiority of the proposed HOPE over existing state-of-the-art methods as well as its interpretability.

Medical image segmentation has been significantly advanced with the rapid development of deep learning (DL) techniques. Existing DL-based segmentation models are typically discriminative; i.e., they aim to learn a mapping from the input image to segmentation masks. However, these discriminative methods neglect the underlying data distribution and intrinsic class characteristics, suffering from unstable feature space. In this work, we propose to complement discriminative segmentation methods with the knowledge of underlying data distribution from generative models. To that end, we propose a novel hybrid diffusion framework for medical image segmentation, termed HiDiff, which can synergize the strengths of existing discriminative segmentation models and new generative diffusion models. HiDiff comprises two key components: discriminative segmentor and diffusion refiner. First, we utilize any conventional trained segmentation models as discriminative segmentor, which can provide a segmentation mask prior for diffusion refiner. Second, we propose a novel binary Bernoulli diffusion model (BBDM) as the diffusion refiner, which can effectively, efficiently, and interactively refine the segmentation mask by modeling the underlying data distribution. Third, we train the segmentor and BBDM in an alternate-collaborative manner to mutually boost each other. Extensive experimental results on abdomen organ, brain tumor, polyps, and retinal vessels segmentation datasets, covering four widely-used modalities, demonstrate the superior performance of HiDiff over existing medical segmentation algorithms, including the state-of-the-art transformer- and diffusion-based ones. In addition, HiDiff excels at segmenting small objects and generalizing to new datasets. Source codes are made available at https://github.com/takimailto/HiDiff.