Medical image segmentation faces persistent challenges due to severe class imbalance and the frequency-specific distribution of anatomical structures. Most conventional CNN-based methods operate in the spatial domain and struggle to capture minority class signals, often affected by frequency aliasing and limited spectral selectivity. Transformer-based models, while powerful in modeling global dependencies, tend to overlook critical local details necessary for fine-grained segmentation. To overcome these limitations, we propose FreqU-FNet, a novel U-shaped segmentation architecture operating in the frequency domain. Our framework incorporates a Frequency Encoder that leverages Low-Pass Frequency Convolution and Daubechies wavelet-based downsampling to extract multi-scale spectral features. To reconstruct fine spatial details, we introduce a Spatial Learnable Decoder (SLD) equipped with an adaptive multi-branch upsampling strategy. Furthermore, we design a frequency-aware loss (FAL) function to enhance minority class learning. Extensive experiments on multiple medical segmentation benchmarks demonstrate that FreqU-FNet consistently outperforms both CNN and Transformer baselines, particularly in handling under-represented classes, by effectively exploiting discriminative frequency bands.

Intraventricular hemorrhage (IVH) is a severe neurological complication among premature infants, necessitating early and accurate detection from brain ultrasound (US) images to improve clinical outcomes. While recent deep learning methods offer promise for computer-aided diagnosis, challenges remain in capturing both local spatial details and global contextual dependencies critical for segmenting brain anatomies. In this work, we propose an enhanced Residual U-Net architecture incorporating two complementary attention mechanisms: the Convolutional Block Attention Module (CBAM) and a Sparse Attention Layer (SAL). The CBAM improves the model's ability to refine spatial and channel-wise features, while the SAL introduces a dual-branch design, sparse attention filters out low-confidence query-key pairs to suppress noise, and dense attention ensures comprehensive information propagation. Extensive experiments on the Brain US dataset demonstrate that our method achieves state-of-the-art segmentation performance, with a Dice score of 89.04% and IoU of 81.84% for ventricle region segmentation. These results highlight the effectiveness of integrating spatial refinement and attention sparsity for robust brain anatomy detection. Code is available at: https://github.com/DanYuan001/BrainImgSegment.

Lung cancer has been one of the major threats across the world with the highest mortalities. Computer-aided detection (CAD) can help in early detection and thus can help increase the survival rate. Accurate lung parenchyma segmentation (to include the juxta-pleural nodules) and lung nodule segmentation, the primary symptom of lung cancer, play a crucial role in the overall accuracy of the Lung CAD pipeline. Lung nodule segmentation is quite challenging because of the diverse nodule types and other inhibit structures present within the lung lobes. Traditional machine/deep learning methods suffer from generalization and robustness. Recent Vision Language Models/Foundation Models perform well on the anatomical level, but they suffer on fine-grained segmentation tasks, and their semi-automatic nature limits their effectiveness in real-time clinical scenarios. In this paper, we propose a novel method for accurate 3D segmentation of lung parenchyma and lung nodules. The proposed architecture is an attention-based network with residual blocks at each encoder-decoder state. Max pooling is replaced by strided convolutions at the encoder, and trilinear interpolation is replaced by transposed convolutions at the decoder to maximize the number of learnable parameters. Dilated convolutions at each encoder-decoder stage allow the model to capture the larger context without increasing computational costs. The proposed method has been evaluated extensively on one of the largest publicly available datasets, namely LUNA16, and is compared with recent notable work in the domain using standard performance metrics like Dice score, IOU, etc. It can be seen from the results that the proposed method achieves better performance than state-of-the-art methods. The source code, datasets, and pre-processed data can be accessed using the link: https://github.com/EMeRALDsNRPU/Attention-Based-3D-ResUNet.

BackgroundThis study aims to present the Segmentation-based Myocardial Advanced Refinement Tracking (SMART) system, a novel artificial intelligence (AI)-based framework for transthoracic echocardiography (TTE) that incorporates motion tracking and left ventricular (LV) myocardial segmentation for automated LV mass (LVM) and global longitudinal strain (LVGLS) assessment. MethodsThe SMART system demonstrates LV speckle tracking based on motion vector estimation, refined by structural information using endocardial and epicardial segmentation throughout the cardiac cycle. This approach enables automated measurement of LVMSMART and LVGLSSMART. The feasibility of SMART is validated in 111 hypertrophic cardiomyopathy (HCM) patients (median age: 58 years, 69% male) who underwent TTE and cardiac magnetic resonance imaging (CMR). ResultsLVGLSSMART showed a strong correlation with conventional manual LVGLS measurements (Pearsons correlation coefficient [PCC] 0.851; mean difference 0 [-2-0]). When compared to CMR as the reference standard for LVM, the conventional dimension-based TTE method overestimated LVM (PCC 0.652; mean difference: 106 [90-123]), whereas LVMSMART demonstrated excellent agreement with CMR (PCC 0.843; mean difference: 1 [-11-13]). For predicting extensive myocardial fibrosis, LVGLSSMART and LVMSMART exhibited performance comparable to conventional LVGLS and CMR (AUC: 0.72 and 0.66, respectively). Patients identified as high-risk for extensive fibrosis by LVGLSSMART and LVMSMART had significantly higher rates of adverse outcomes, including heart failure hospitalization, new-onset atrial fibrillation, and defibrillator implantation. ConclusionsThe SMART technique provides a comparable LVGLS evaluation and a more accurate LVM assessment than conventional TTE, with predictive values for myocardial fibrosis and adverse outcomes. These findings support its utility in HCM management.

Accurate and efficient segmentation of medical images plays a vital role in clinical tasks, such as diagnostic procedures and planning treatments. Traditional U-shaped encoder-decoder architectures, built on convolutional and transformer-based networks, have shown strong performance in medical image processing. However, the simple skip connections commonly used in these networks face limitations, such as insufficient nonlinear modeling capacity, weak global multiscale context modeling, and limited interpretability. To address these challenges, this study proposes the PDS-UKAN network, an innovative subdivision-based U-KAN architecture, designed to improve segmentation accuracy. The PDS-UKAN incorporates a PKAN module-comprising partial convolutions and Kolmogorov - Arnold network layers-into the encoder bottleneck, enhancing the network's nonlinear modeling and interpretability. Additionally, the proposed Dual-Branch Convolutional Boundary Enhancement Module (DBE) focuses on pixel-level boundary refinement, improving edge detail preservation in shallow skip connections. Meanwhile, the Skip Connection Channel Spatial Attention Module (SCCSA) mechanism is applied in the deeper skip connections to strengthen cross-dimensional interactions between channels and spatial features, mitigating the loss of spatial information due to downsampling. Extensive experiments across multiple medical imaging datasets demonstrate that PDS-UKAN consistently achieves superior performance compared to state-of-the-art (SOTA) methods.

Stroke is among the top three causes of death worldwide, and accurate identification of stroke lesion boundaries is critical for diagnosis and treatment. Supervised deep learning methods have emerged as the leading solution for stroke lesion segmentation but require large, diverse, and annotated datasets. The ISLES'24 challenge addresses this need by providing longitudinal stroke imaging data, including CT scans taken on arrival to the hospital and follow-up MRI taken 2-9 days from initial arrival, with annotations derived from follow-up MRI. Importantly, models submitted to the ISLES'24 challenge are evaluated using only CT inputs, requiring prediction of lesion progression that may not be visible in CT scans for segmentation. Our winning solution shows that a carefully designed preprocessing pipeline including deep-learning-based skull stripping and custom intensity windowing is beneficial for accurate segmentation. Combined with a standard large residual nnU-Net architecture for segmentation, this approach achieves a mean test Dice of 28.5 with a standard deviation of 21.27.

Background and Purpose Assessment of brain lesions on MRI is crucial for research in multiple sclerosis (MS). Manual segmentation is time consuming and inconsistent. We aimed to develop an automated MS lesion segmentation algorithm for T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI. Methods We developed FLAIR Lesion Analysis in Multiple Sclerosis (FLAMeS), a deep learning-based MS lesion segmentation algorithm based on the nnU-Net 3D full-resolution U-Net and trained on 668 FLAIR 1.5 and 3 tesla scans from persons with MS. FLAMeS was evaluated on three external datasets: MSSEG-2 (n=14), MSLesSeg (n=51), and a clinical cohort (n=10), and compared to SAMSEG, LST-LPA, and LST-AI. Performance was assessed qualitatively by two blinded experts and quantitatively by comparing automated and ground truth lesion masks using standard segmentation metrics. Results In a blinded qualitative review of 20 scans, both raters selected FLAMeS as the most accurate segmentation in 15 cases, with one rater favoring FLAMeS in two additional cases. Across all testing datasets, FLAMeS achieved a mean Dice score of 0.74, a true positive rate of 0.84, and an F1 score of 0.78, consistently outperforming the benchmark methods. For other metrics, including positive predictive value, relative volume difference, and false positive rate, FLAMeS performed similarly or better than benchmark methods. Most lesions missed by FLAMeS were smaller than 10 mm3, whereas the benchmark methods missed larger lesions in addition to smaller ones. Conclusions FLAMeS is an accurate, robust method for MS lesion segmentation that outperforms other publicly available methods.

Accurate and efficient quantification of cardiac function is essential for the estimation of prognosis of cardiovascular diseases (CVDs). One of the most commonly used metrics for evaluating cardiac pumping performance is left ventricular ejection fraction (LVEF). However, LVEF can be affected by factors such as inter-observer variability and varying pre-load and after-load conditions, which can reduce its reproducibility. Additionally, cardiac dysfunction may not always manifest as alterations in LVEF, such as in heart failure and cardiotoxicity diseases. An alternative measure that can provide a relatively load-independent quantitative assessment of myocardial contractility is myocardial strain and strain rate. By using LVEF in combination with myocardial strain, it is possible to obtain a thorough description of cardiac function. Automated estimation of LVEF and other volumetric measures from cine-MRI sequences can be achieved through segmentation models, while strain calculation requires the estimation of tissue displacement between sequential frames, which can be accomplished using registration models. These tasks are often performed separately, potentially limiting the assessment of cardiac function. To address this issue, in this study we propose an end-to-end deep learning (DL) model that jointly estimates groupwise (GW) registration and segmentation for cardiac cine-MRI images. The proposed anatomically-guided Deep GW network was trained and validated on a large dataset of 4-chamber view cine-MRI image series of 374 subjects. A quantitative comparison with conventional GW registration using elastix and two DL-based methods showed that the proposed model improved performance and substantially reduced computation time.

To address the challenge of complex pathological feature extraction in automated cardiac MRI segmentation, this study proposes an innovative dual-encoder architecture named SAMba-UNet. The framework achieves cross-modal feature collaborative learning by integrating the vision foundation model SAM2, the state-space model Mamba, and the classical UNet. To mitigate domain discrepancies between medical and natural images, a Dynamic Feature Fusion Refiner is designed, which enhances small lesion feature extraction through multi-scale pooling and a dual-path calibration mechanism across channel and spatial dimensions. Furthermore, a Heterogeneous Omni-Attention Convergence Module (HOACM) is introduced, combining global contextual attention with branch-selective emphasis mechanisms to effectively fuse SAM2's local positional semantics and Mamba's long-range dependency modeling capabilities. Experiments on the ACDC cardiac MRI dataset demonstrate that the proposed model achieves a Dice coefficient of 0.9103 and an HD95 boundary error of 1.0859 mm, significantly outperforming existing methods, particularly in boundary localization for complex pathological structures such as right ventricular anomalies. This work provides an efficient and reliable solution for automated cardiac disease diagnosis, and the code will be open-sourced.

High-quality segmentation is important for AI-driven radiological research and clinical practice, with the potential to play an even more prominent role in the future. As medical imaging advances, accurately segmenting anatomical and pathological structures is increasingly used to obtain quantitative data and valuable insights. Segmentation and volumetric analysis could enable more precise diagnosis, treatment planning, and patient monitoring. These guidelines aim to improve segmentation accuracy and consistency, allowing for better decision-making in both research and clinical environments. Practical advice on planning and organization is provided, focusing on quality, precision, and communication among clinical teams. Additionally, tips and strategies for improving segmentation practices in radiology and radiation oncology are discussed, as are potential pitfalls to avoid. KEY POINTS: As AI continues to advance, volumetry will become more integrated into clinical practice, making it essential for radiologists to stay informed about its applications in diagnosis and treatment planning. There is a significant lack of practical guidelines and resources tailored specifically for radiologists on technical topics like segmentation and volumetric analysis. Establishing clear rules and best practices for segmentation can streamline volumetric assessment in clinical settings, making it easier to manage and leading to more accurate decision-making for patient care.