Spatial transcriptomics (ST) enables the simultaneous measurement of gene expression and spatial localization within tissue sections, providing unprecedented opportunities to dissect tissue architecture and functional organization. As a relatively new omics technology, bioinformatics has driven much of the innovation in ST. However, within these frameworks, spatial information is often reduced to locations and relationships between molecular profiles, without fully leveraging the wealth of sub-micron morphological detail and histological knowledge available. Advances in computer vision-based artificial intelligence (AI) are opening exciting new avenues beyond conventional bioinformatics approaches by modeling complex histological patterns and linking morphology to molecular states. More excitingly, they bring fresh perspectives to potentially address key limitations of ST, including its high cost, limited clinical applicability, and reliance on 2D analysis of inherently 3D tissues. For instance, models that predict ST directly from histology images enable virtual sequencing, drastically reducing costs while integrating morphological insights from pathology with molecular biomarkers, thus accelerating clinical translation. Moreover, computer vision techniques can reconstruct pixel-aligned 3D tissue models, overcoming the technical barriers of 2D acquisition and advancing 3D spatial omics analytics. In this paper, we present the first systematic survey of computer vision AI models for ST analytics, categorizing approaches across architectures, learning paradigms, tasks, and datasets, and tracing their technological evolution. We highlight key challenges and future directions, offering a panoramic perspective on vision-driven ST and its potential to transform both basic research and clinical practice. The curated collection of vision-driven ST papers is available at https://github.com/hrlblab/computer_vision_spatial_omics.

Spatial transcriptomics (ST) is an emerging technology that enables medical computer vision scientists to automatically interpret the molecular profiles underlying morphological features. Currently, however, most deep learning-based ST analyses are limited to two-dimensional (2D) sections, which can introduce diagnostic errors due to the heterogeneity of pathological tissues across 3D sections. Expanding ST to three-dimensional (3D) volumes is challenging due to the prohibitive costs; a 2D ST acquisition already costs over 50 times more than whole slide imaging (WSI), and a full 3D volume with 10 sections can be an order of magnitude more expensive. To reduce costs, scientists have attempted to predict ST data directly from WSI without performing actual ST acquisition. However, these methods typically yield unsatisfying results. To address this, we introduce a novel problem setting: 3D ST imputation using 3D WSI histology sections combined with a single 2D ST slide. To do so, we present the Anatomy-aware Spatial Imputation Graph Network (ASIGN) for more precise, yet affordable, 3D ST modeling. The ASIGN architecture extends existing 2D spatial relationships into 3D by leveraging cross-layer overlap and similarity-based expansion. Moreover, a multi-level spatial attention graph network integrates features comprehensively across different data sources. We evaluated ASIGN on three public spatial transcriptomics datasets, with experimental results demonstrating that ASIGN achieves state-of-the-art performance on both 2D and 3D scenarios. The code for this paper is publicly available1.

Annotating medical images, particularly for organ segmentation, is laborious and time-consuming. For example, annotating an abdominal organ requires an estimated rate of 30-60 minutes per CT volume based on the expertise of an annotator and the size, visibility, and complexity of the organ. Therefore, publicly available datasets for multi-organ segmentation are often limited in data size and organ diversity. This paper proposes an active learning procedure to expedite the annotation process for organ segmentation and creates the largest multi-organ dataset (by far) with the spleen, liver, kidneys, stomach, gallbladder, pancreas, aorta, and IVC annotated in 8,448 CT volumes, equating to 3.2 million slices. The conventional annotation methods would take an experienced annotator up to 1,600 weeks (or roughly 30.8 years) to complete this task. In contrast, our annotation procedure has accomplished this task in three weeks (based on an 8-hour workday, five days a week) while maintaining a similar or even better annotation quality. This achievement is attributed to three unique properties of our method: (1) label bias reduction using multiple pre-trained segmentation models, (2) effective error detection in the model predictions, and (3) attention guidance for annotators to make corrections on the most salient errors. Furthermore, we summarize the taxonomy of common errors made by AI algorithms and annotators. This allows for continuous improvement of AI and annotations, significantly reducing the annotation costs required to create large-scale datasets for a wider variety of medical imaging tasks. Code and dataset are available at https://github.com/MrGiovanni/AbdomenAtlas