Deep learning has made remarkable progress in medical image analysis, yet its black-box nature still limits interpretability and clinician trust. Concept-based modeling offers a promising direction for explainable AI by integrating human-understandable concepts. However, existing approaches typically rely on global concept annotations and infer diagnosis based solely on the presence or absence of individual concepts. This oversimplified paradigm ignores the rich relationships among concepts and their causal influence on disease outcomes. To overcome these limitations, we propose the Concept Relationship Embedding Model (CREM) for interpretable medical diagnosis. CREM mirrors coarse-to-fine clinical reasoning by first extracting fine-grained subregional concepts, then explicitly encoding their relationships as a concept interaction graph, and finally performing causal inference between concepts and diagnoses to enable reliable and transparent diagnostic predictions. We evaluate CREM on four public medical imaging benchmarks, where it achieves state-of-the-art performance on both concept recognition and disease classification tasks, while exhibiting improved robustness, label efficiency, and interpretability. Furthermore, we deploy CREM as an interactive web-based demo that allows clinicians to visualize concept activations, trace diagnostic reasoning paths, and iteratively refine concept cues, facilitating effective human-in-the-loop decision-making.

Surgical instrument segmentation under Federated Learning (FL) is a promising direction, which enables multiple surgical sites to collaboratively train the model without centralizing datasets. However, there exist very limited FL works in surgical data science, and FL methods for other modalities do not consider inherent characteristics in surgical domain: i) different scenarios show diverse anatomical backgrounds while highly similar instrument representation; ii) there exist surgical simulators which promote large-scale synthetic data generation with minimal efforts. In this paper, we propose a novel Personalized FL scheme, Spatio-Temporal Representation Decoupling and Enhancement (FedST), which wisely leverages surgical domain knowledge during both local-site and global-server training to boost segmentation. Concretely, our model embraces a Representation Separation and Cooperation (RSC) mechanism in local-site training, which decouples the query embedding layer to be trained privately, to encode respective backgrounds. Meanwhile, other parameters are optimized globally to capture the consistent representations of instruments, including the temporal layer to capture similar motion patterns. A textual-guided channel selection is further designed to highlight site-specific features, facilitating model adaptation to each site. Moreover, in global-server training, we propose Synthesis-based Explicit Representation Quantification (SERQ), which defines an explicit representation target based on synthetic data to synchronize the model convergence during fusion for improving model generalization. We construct a new PFL benchmark comprising five surgical sites from public datasets covering four types, with one out-of-federation site. FedST outperforms other state-of-the-art methods on federated sites (1.84% on IoU) and achieves a remarkable improvement on the out-of-federation site (45.29% on IoU). Our source code can be made available at: https://github.com/Meaw0415/FedST.

Federated learning (FL) for histopathology image segmentation involving multiple medical sites plays a crucial role in advancing the field of accurate disease diagnosis and treatment. However, it is still a task of great challenges due to the sample imbalance across clients and large data heterogeneity from disparate organs, variable segmentation tasks, and diverse distribution. Thus, we propose a novel FL approach for histopathology nuclei and tissue segmentation, FedSODA, via synthetic-driven cross-assessment operation (SO) and dynamic stratified-layer aggregation (DA). Our SO constructs a cross-assessment strategy to connect clients and mitigate the representation bias under sample imbalance. Our DA utilizes layer-wise interaction and dynamic aggregation to diminish heterogeneity and enhance generalization. The effectiveness of our FedSODA has been evaluated on the most extensive histopathology image segmentation dataset from 7 independent datasets. The code is available at https://github.com/yuanzhang7/FedSODA.

Accurate polyp segmentation is crucial for precise diagnosis and prevention of colorectal cancer. However, precise polyp segmentation still faces challenges, mainly due to the similarity of polyps to their surroundings in terms of color, shape, texture, and other aspects, making it difficult to learn accurate semantics. To address this issue, we propose a novel semantic enhanced perceptual network (SEPNet) for polyp segmentation, which enhances polyp semantics to guide the exploration of polyp features. Specifically, we propose the Polyp Semantic Enhancement (PSE) module, which utilizes a coarse segmentation map as a basis and selects kernels to extract semantic information from corresponding regions, thereby enhancing the discriminability of polyp features highly similar to the background. Furthermore, we design a plug-and-play semantic guidance structure for the PSE, leveraging accurate semantic information to guide scale perception and context fusion, thereby enhancing feature discriminability. Additionally, we propose a Multi-scale Adaptive Perception (MAP) module, which enhances the flexibility of receptive fields by increasing the interaction of information between neighboring receptive field branches and dynamically adjusting the size of the perception domain based on the contribution of each scale branch. Finally, we construct the Contextual Representation Calibration (CRC) module, which calibrates contextual representations by introducing an additional branch network to supplement details. Extensive experiments demonstrate that SEPNet outperforms 15 SOTA methods on five challenging datasets across six standard metrics.

The segmentation of cardiac structure in magnetic resonance images (CMR) is paramount in diagnosing and managing cardiovascular illnesses, given its 3D+Time (3D+T) sequence. The existing deep learning methods are constrained in their ability to 3D+T CMR segmentation, due to: (1) Limited motion perception. The complexity of heart beating renders the motion perception in 3D+T CMR, including the long-range and cross-slice motions. The existing methods' local perception and slice-fixed perception directly limit the performance of 3D+T CMR perception. (2) Lack of labels. Due to the expensive labeling cost of the 3D+T CMR sequence, the labels of 3D+T CMR only contain the end-diastolic and end-systolic frames. The incomplete labeling scheme causes inefficient supervision. Hence, we propose a novel spatio-temporal adaptation network with clinical prior embedding learning (STANet) to ensure efficient spatio-temporal perception and optimization on 3D+T CMR segmentation. (1) A spatio-temporal adaptive convolution (STAC) treats the 3D+T CMR sequence as a whole for perception. The long-distance motion correlation is embedded into the structural perception by learnable weight regularization to balance long-range motion perception. The structural similarity is measured by cross-attention to adaptively correlate the cross-slice motion. (2) A clinical prior embedding learning strategy (CPE) is proposed to optimize the partially labeled 3D+T CMR segmentation dynamically by embedding clinical priors into optimization. STANet achieves outstanding performance with Dice of 0.917 and 0.94 on two public datasets (ACDC and STACOM), which indicates STANet has the potential to be incorporated into computer-aided diagnosis tools for clinical application.

In this work, we address the task of few-shot medical image segmentation (MIS) with a novel proposed framework based on the learning registration to learn segmentation (LRLS) paradigm. To cope with the limitations of lack of authenticity, diversity, and robustness in the existing LRLS frameworks, we propose the better registration better segmentation (BRBS) framework with three main contributions that are experimentally shown to have substantial practical merit. First, we improve the authenticity in the registration-based generation program and propose the knowledge consistency constraint strategy that constrains the registration network to learn according to the domain knowledge. It brings the semantic-aligned and topology-preserved registration, thus allowing the generation program to output new data with great space and style authenticity. Second, we deeply studied the diversity of the generation process and propose the space-style sampling program, which introduces the modeling of the transformation path of style and space change between few atlases and numerous unlabeled images into the generation program. Therefore, the sampling on the transformation paths provides much more diverse space and style features to the generated data effectively improving the diversity. Third, we first highlight the robustness in the learning of segmentation in the LRLS paradigm and propose the mix misalignment regularization, which simulates the misalignment distortion and constrains the network to reduce the fitting degree of misaligned regions. Therefore, it builds regularization for these regions improving the robustness of segmentation learning. Without any bells and whistles, our approach achieves a new state-of-the-art performance in few-shot MIS on two challenging tasks that outperform the existing LRLS-based few-shot methods. We believe that this novel and effective framework will provide a powerful few-shot benchmark for the field of medical image and efficiently reduce the costs of medical image research. All of our code will be made publicly available online.

Accurate segmentation of topological tubular structures, such as blood vessels and roads, is crucial in various fields, ensuring accuracy and efficiency in downstream tasks. However, many factors complicate the task, including thin local structures and variable global morphologies. In this work, we note the specificity of tubular structures and use this knowledge to guide our DSCNet to simultaneously enhance perception in three stages: feature extraction, feature fusion, and loss constraint. First, we propose a dynamic snake convolution to accurately capture the features of tubular structures by adaptively focusing on slender and tortuous local structures. Subsequently, we propose a multi-view feature fusion strategy to complement the attention to features from multiple perspectives during feature fusion, ensuring the retention of important information from different global morphologies. Finally, a continuity constraint loss function, based on persistent homology, is proposed to constrain the topological continuity of the segmentation better. Experiments on 2D and 3D datasets show that our DSCNet provides better accuracy and continuity on the tubular structure segmentation task compared with several methods. Our codes are publicly available1.

The nature of thick-slice scanning causes severe inter-slice discontinuities of 3D medical images, and the vanilla 2D/3D convolutional neural networks (CNNs) fail to represent sparse inter-slice information and dense intra-slice information in a balanced way, leading to severe underfitting to inter-slice features (for vanilla 2D CNNs) and overfitting to noise from long-range slices (for vanilla 3D CNNs). In this work, a novel mesh network (MNet) is proposed to balance the spatial representation inter axes via learning. 1) Our MNet latently fuses plenty of representation processes by embedding multi-dimensional convolutions deeply into basic modules, making the selections of representation processes flexible, thus balancing representation for sparse inter-slice information and dense intra-slice information adaptively. 2) Our MNet latently fuses multi-dimensional features inside each basic module, simultaneously taking the advantages of 2D (high segmentation accuracy of the easily recognized regions in 2D view) and 3D (high smoothness of 3D organ contour) representations, thus obtaining more accurate modeling for target regions. Comprehensive experiments are performed on four public datasets (CT\&MR), the results consistently demonstrate the proposed MNet outperforms the other methods. The code and datasets are available at: https://github.com/zfdong-code/MNet

The accurate 3D left ventricular (LV) myocardium segmentation in short-axis (SAX) view of cardiac magnetic resonance (CMR) is challenged by the sparse spatial structure of CMR. The strategy of multi-view CMR fusion can provide fine-grained spatial structure for accurate segmentation. However, the large information misalignment and lack of dense 3D CMR as fusion target in multi-view CMR fusion, and the different spatial resolution between the fusion result and the ground truth in segmentation limit the strategy. In this study, we propose a multi-view spatial-aware adversarial network (MVSGAN). It studies the perception of fine-grained cardiac structure for accurate segmentation by the spatialaware multi-view CMR fusion. It consists of three modules: (1) A residual adversarial fusion (RAF) module takes inter-slices deep correlation and anatomical prior to refine the spatial structures by residual supplement and adversarial optimization. (2) A structural perception-aggregation (SPA) module establishes the spatial correlation between the dense cardiac model and sparse label for accurate CMR LV myocardium segmentation. (3) A joint training strategy utilizes the dense SAX volume as explicit and implicit goals to jointly optimize the framework. The experiments are applied on a public dataset and a clinical dataset to evaluate the performance of MVSGAN. The average Dice and Jaccard score of LV myocardium segmentation obtained by MVSGAN are highest among seven existing state-of-the-art methods, which are up to 0.92 and 0.75. It is concluded that the spatial-aware multi-view CMR fusion can provide meaningful spatial correlation for accurate LV myocardium segmentation.

Maps from the Version 2 Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS) Nighttime Lights Series were used to assess increases in the extents and spatial configurations of urban areas in the vicinity of the Yellow River in Inner Mongolia Autonomous Region, China, over the period 1992 – 2003. Lit area data were extracted and used with population and economic data to examine patterns of urban expansion at the county level. The major trends seen were a dramatic increase in urban areas, metropolization driven by economic expansion, and an important decline in urban population density that reflects increasing prosperity.