Numerous techniques excel in brain tumor segmentation using multi-modal magnetic resonance imaging (MRI) sequences, delivering exceptional results. However, the prevalent absence of modalities in clinical scenarios hampers performance. Current approaches frequently resort to zero maps as substitutes for missing modalities, inadvertently introducing feature bias and redundant computations. To address these issues, we present the Token Merging transFormer (TMFormer) for robust brain tumor segmentation with missing modalities. TMFormer tackles these challenges by extracting and merging accessible modalities into more compact token sequences. The architecture comprises two core components: the Uni-modal Token Merging Block (UMB) and the Multi-modal Token Merging Block (MMB). The UMB enhances individual modality representation by adaptively consolidating spatially redundant tokens within and outside tumor-related regions, thereby refining token sequences for augmented representational capacity. Meanwhile, the MMB mitigates multi-modal feature fusion bias, exclusively leveraging tokens from present modalities and merging them into a unified multi-modal representation to accommodate varying modality combinations. Extensive experimental results on the BraTS 2018 and 2020 datasets demonstrate the superiority and efficacy of TMFormer compared to state-of-the-art methods when dealing with missing modalities.

In diffusion-based medical segmentation models, stochastic sampling is commonly used to generate multiple masks. However, the inherent variability in diffusion models can lead to significant biases in some masks, resulting in the fused mask deviating from the true mask. In this study, we propose a novel multi-modal diffusion segmentation network (MMDSN) with controllable variability, specifically designed to address the issue of variability in diffusion models. MMDSN achieves multi-modal conditional control through medical text annotations, thereby enhancing consistency of visual semantic representation and establishing a correspondence between vision and language for diffusion models. Additionally, MMDSN constrains the uncertainty distributions of multiple timesteps within the latent Gaussian space, controlling the variability at each denoising timestep. Extensive experiments on the Qata-Covid19 and MosMed datasets demonstrate that our proposed method surpasses existing state-of-the-art diffusion networks, producing a high-quality, controllable segmentation map with just a single reverse diffusion step and one sampling.

Multi-modal Magnetic Resonance Imaging (MRI) is imperative for accurate brain tumor segmentation, offering indispensable complementary information. Nonetheless, the absence of modalities poses significant challenges in achieving precise segmentation. Recognizing the shared anatomical structures between mono-modal and multi-modal representations, it is noteworthy that mono-modal images typically exhibit limited features in specific regions and tissues. In response to this, we present Anatomical Consistency Distillation and Inconsistency Synthesis (ACDIS), a novel framework designed to transfer anatomical structures from multi-modal to mono-modal representations and synthesize modality-specific features. ACDIS consists of two main components: Anatomical Consistency Distillation (ACD) and Modality Feature Synthesis Block (MFSB). ACD incorporates the Anatomical Feature Enhancement Block (AFEB), meticulously mining anatomical information. Simultaneously, Anatomical Consistency ConsTraints (ACCT) are employed to facilitate the consistent knowledge transfer, i.e., the richness of information and the similarity in anatomical structure, ensuring precise alignment of structural features across mono-modality and multi-modality. Complementarily, MFSB produces modality-specific features to rectify anatomical inconsistencies, thereby compensating for missing information in the segmented features. Through validation on the BraTS2018 and BraTS2020 datasets, ACDIS substantiates its efficacy in the segmentation of brain tumors with missing MRI modalities.