ORB-SVM : An Innovative Hybrid Framework for Efficient Brain Tumor Detection from MRI Scans

Brain cancer remains one of the most significant challenges in modern medicine, where the accuracy of early stage diagnosis is a decisive factor in patient survival and treatment efficacy. Although Magnetic Resonance Imaging (MRI) is the established gold standard for visualizing neurological structures, the interpretation of these high dimensional scans is often complicated by subjective variability among practitioners and the inherent noise present in complex medical images. While contemporary approaches frequently rely on high parameter deep learning architectures, such models often involve significant computational costs and require extensive data for effective training. This study introduces a hybrid framework that utilizes the Oriented FAST and Rotated BRIEF (ORB) algorithm for precise feature extraction and a Support Vector Machine (SVM) for classification [1], [2]. The proposed approach achieves a sub- stantial data reduction of approximately 99.5%, which effectively minimizes the influence of non informative background data while preserving critical diagnostic patterns essential for tumor identification. By balancing feature sparsity with a robust kernel based classifier, this methodology addresses the limitations of over parameterized systems while maintaining high diagnostic integrity. Experimental evaluations conducted on the Br35H dataset demonstrate that the framework attains a classification accuracy of 97.5%. The findings suggest that the integration of localized feature representation and optimized classification provides a reliable and resource efficient alternative for medical image analysis, offering a structured solution that maintains per- formance without the need for extensive computational overhead.

On the Role of MRI Sequences in Cross-Dataset Generalization for Brain Tumor Segmentation

Brain tumor segmentation in magnetic resonance imaging (MRI) is a critical task for diagnosis and treatment planning. Despite the success of deep learning architectures such as U-Net and its variants, performance degradation across datasets remains a major challenge, particularly under domain shift and limited annotated data. To address this issue, this study systematically evaluates how individual MRI sequences influence model robustness across two well-known datasets. A ResUNet-based framework is employed, where each modality is trained independently to isolate its effect under a controlled cross-dataset evaluation protocol with tumor size stratification, without target-domain training, or with limited domain adaptation. Results show that the T2f/FLAIR sequence achieves the best cross-dataset performance, with Dice scores exceeding 75%. It consistently outperforms other modalities across most tumor size ranges, while multi-sequence training further improves performance. Additionally, even limited target-domain adaptation yields rapid initial gains, reducing the need for extensive annotations and costly retraining. Our source code is publicly available at https://github.com/henrique-zan/brain_tumor_segmentation/.

Medical Foundation Model Features as Perceptual Loss for Brain MRI Contrast Dose Simulation

Perceptual losses are widely used in medical image synthesis because they encourage agreement in high-level structure beyond voxel-wise intensity similarity. In practice, most perceptual losses are still computed with natural-image backbones such as VGG16 or ResNet50, even when the target domain is magnetic resonance imaging (MRI). This mismatch may weaken supervision for anatomy, contrast enhancement, and acquisition variability. We test whether medical foundation model features provide a more suitable perceptual loss for brain MRI contrast dose simulation. The study has two stages. First, we compare RadImageNet, SegVol, and BrainIAC with ImageNet-pretrained VGG16 and ResNet50 as frozen feature extractors on four public medical imaging benchmarks: thyroid ultrasound, breast ultrasound, anterior cruciate ligament knee MRI, and meniscus knee MRI. RadImageNet achieves the lowest mean rank across the Stage I representation suite and is selected as $φ^\star$. Second, we replace only the VGG16 feature extractor in an existing iterative brain MRI dose simulation framework with $φ^\star$. The generator, reconstruction loss, adversarial loss, auxiliary losses, optimization schedule, and loss weights are kept unchanged. Standard metrics change modestly, with PSNR increasing from 41.63 to 41.74, SSIM from 0.9739 to 0.9754, RMSE decreasing from 0.1384 to 0.1369, and residual-uptake CNR from 0.0085 to 0.0082. The visual results show the main effect: RadImageNet reduces residual enhancement in marked structures, follows a more faithful dose-reduction trajectory, and remains close to the acquired 10% low-dose target. These results support domain-aligned radiology features as a practical perceptual feature space for MRI dose simulation, while leaving clinical equivalence and larger-cohort validation as future work.

Enhancing MRI Brain Tumor Edge Detection: A Hybrid Preprocessing Approach Utilizing CLAHE

Accurate boundary delineation of brain tumors in Magnetic Resonance Imaging (MRI) is a critical yet formidable challenge in neuro-oncology due to inherent scanner noise, complex anatomical structures, and uneven illumination. Traditional edge detection algorithms, while computationally lightweight and mathematically interpretable, frequently fail to capture the diffuse, localized boundaries of edema when relying solely on global preprocessing and manual parameter tuning. To overcome these limitations, we propose a hybrid automated edge detection pipeline. Our approach integrates an optimally configured Contrast-Limited Adaptive Histogram Equalization (CLAHE) layer into a comprehensive morphological preprocessing framework, followed by a deterministic sequential parameter sweep to fully automate threshold selection. The proposed hybrid model demonstrated enhancement in detecting critical anatomical structures in a publicly available benchmark database from Kaggle. By intelligently amplifying localized gradients without overwhelming the image with background noise, our method achieved higher Recall (Sensitivity). Consequently, the overall F1-Score elevated, and the Structural Similarity Index (SSIM) improved, all while maintaining a highly efficient execution. This establishes our optimized pipeline as a highly practical and near real-time operational model for clinical diagnostics, offering a compelling alternative to computationally heavy deep learning approaches.

Deep Learning Segmentation of Diffusion-Weighted MRI Acute Ischaemic Stroke: A Pragmatic Evaluation Across Three Datasets

Objective: Diffusion-weighted MRI (DWI-MRI) is the gold standard for visualizing and quantifying acute ischaemic stroke (AIS). Although deep learning methods can accurately segment AIS lesions, the optimal image inputs and model architecture remain uncertain. We evaluated whether accurate AIS lesion segmentation can be achieved using a pragmatic deep learning approach with minimal preprocessing and clinically feasible inference times. Materials and Methods: Self-configured nnU-Net models were trained on 1,744 DWI cases from local, national, and open-access datasets and tested on 436 cases. Four experimental conditions were evaluated using five-fold cross-validation: with or without brain extraction and using either DWI alone or DWI plus apparent diffusion coefficient (ADC) images as inputs. Two architectures were compared: the baseline nnU-Net (base) and a residual encoder nnU-Net (ResEnc). Performance was benchmarked against the DeepISLES ensemble model from the 2022 ISLES challenge. Results: In the test set (n=436), the base model achieved a median (IQR) Dice similarity coefficient (DSC) of 0.84 (0.19). For the base model, only two of six pairwise comparisons between input configurations showed significant differences. ResEnc produced small but significant improvements in DSC compared with the base model for DWI, DWI+brain extraction, and DWI+ADC inputs (all p<0.02), but not for DWI+ADC+brain extraction (p>0.50). The base model significantly outperformed DeepISLES, particularly in patients with smaller infarct volumes (signed-rank test, p<0.01). Conclusions: A baseline nnU-Net trained on DWI alone, without preprocessing, enabled fast and accurate AIS lesion segmentation. This streamlined approach may facilitate clinical research and support acute stroke imaging workflows

Native-Space 3D CarveMix for Multi-Site T1w Stroke Segmentation

Segmenting ischemic stroke lesions on T1-weighted (T1w) MRI acquired across different scanners and protocols without intensity standardization is difficult because lesions are subtle and share intensity characteristics with cerebrospinal fluid. Standard deep learning architectures trained across multiple centers plateau around Dice 0.66, with acute lesions ($\le 7$ days post-stroke) performing substantially worse due to severe sample scarcity. We combine a MedNeXt-L ($k=5$) backbone with on-the-fly 3D CarveMix augmentation that pastes real lesion patches into healthy brain regions during training. By generating synthetic lesion placements dynamically within each fold with subject-level split isolation, the model sees more diverse lesion patterns without requiring pre-generated copies on disk. We evaluate on 1,453 native T1w scans from 55 clinical centers in the ISLES 2026 challenge. Our method achieves a mean 5-fold cross-validation Dice of 0.648 at 500 epochs, a +0.018 improvement over the MedNeXt-L backbone at a matched training budget (0.630)

Multi-Stage Prompt-Guided Feature Modulation for Generalizable Brain Tumor Segmentation

Accurate brain tumor segmentation from magnetic resonance imaging (MRI) is essential for diagnosis, treatment planning, surgical guidance, and disease monitoring. However, developing automated segmentation models that generalize across diverse tumor characteristics, imaging protocols, acquisition sites, and patient populations remains challenging. Variations in tumor morphology and imaging distributions can substantially degrade performance outside the training domain. Consequently, improving the robustness and generalization of deep learning-based segmentation models has become a key objective in medical image analysis. To improve segmentation robustness, we propose Multi-Stage Dynamic Prompt nnU-Net, a prompt-conditioned extension of nnU-Net. Three independent dynamic prompt modules are inserted into the deepest encoder stages. Each module contains a learnable bank of ten 256-dimensional prompt vectors and uses globally pooled encoder features to generate image-specific prompt representations. These representations are projected into feature-wise scaling $(γ)$ and shifting $(β)$ parameters that modulate encoder feature maps through Feature-wise Linear Modulation (FiLM), enabling adaptive feature conditioning at multiple semantic levels. Evaluation on the BraTS GOAT validation dataset demonstrated that the proposed Multi-Stage Dynamic Prompt nnU-Net outperformed the baseline nnU Net across the majority of evaluated metrics and tumor subregions. The proposed model achieved average lesion-wise Dice scores of 76.16% (ET), 80.04% (TC), and 86.42% (WT), compared with 74.38%, 78.14% and 84.01% for the baseline model. The results demonstrate that multi-stage dynamic prompt conditioning improves segmentation accuracy and boundary delineation for brain tumor segmentation.

A Few Cases Are All You Need: An Empirical Study of Annotation-Efficient LoRA Fine-Tuning of MedSAM3

Medical image segmentation is essential for clinical workflows such as treatment planning and disease assessment. While specialist tools like TotalSegmentator and MRSegmentator achieve strong performance, they require large annotated datasets for training. Medical foundation models offer a promising alternative through large-scale pretraining that reduces the annotation burden for new tasks, but zero-shot performance remains limited. Parameter-efficient adaptation via Low-Rank Adaptation (LoRA) enables efficient specialization with few trainable parameters, but a key question remains: how many expert-annotated cases are needed to achieve clinically useful segmentation performance? We address this by adapting MedSAM3 with LoRA for five abdominal organs (liver, kidneys, spleen, gallbladder, and pancreas) in CT and MRI using only 1, 2, 5, and 10 annotated cases, evaluating on AMOS22 dataset. With just 10 cases, models achieve performance competitive with specialist systems trained on orders of magnitude more data. Notably, this includes reliable gallbladder segmentation (Dice 0.68 CT, 0.59 MRI) where existing tools fail almost completely (Dice 0.0004), while remaining within 5--10% of MRSegmentator for liver, kidneys, and spleen using over 100 times fewer annotations. Furthermore, external validation on the Whole Heart Segmentation dataset shows that the approach extends to cardiac segmentation, a use case beyond the scope of TotalSegmentator (MRI) and MRSegmentator, achieving competitive left ventricle (LV) performance with only 10 annotated cases. Training requires only3--5,hours per organ on a single GPU, approximately 2--3 times faster than nnU-Net. These findings suggest that ten annotated cases are sufficient for clinically useful segmentation, effectively reducing bottlenecks for both image annotation and training time.

BrainNorm: A Foundation Model that knows Normal via Semantic Atlas Pretraining

We introduce BrainNorm, a normative foundation model, trained and tested on ~66,000 T1-weighted structural MRI (T1w sMRI) scans. By leveraging language-image style contrastive pretraining on healthy cohorts across ages, BrainNorm learns a Semantic Atlas Latent space (SAL), where each scan is represented as a set of atlas-parcel embeddings. This yields parcel-specific healthy aging template trajectories that support age-consistent template matching and localized deviation scoring relative to a subject's chronological age. Across 6 downstream cohorts, BrainNorm demonstrates generalization evaluated across 25 task-setting combinations spanning age estimation, brain-age gap estimation, parcel identification, and single- & multi-disease classification tasks under direct inference, zero-shot, few-shot & full-data linear-probe settings. The resulting deviation patterns in SAL space enable zero-shot tasks for disease prediction using parcel-wise abnormalities. Fine-tuning on healthy-only cohorts of downstream datasets further improves the performance of various tasks. Across all classification tasks, linear probing on BrainNorm's frozen embeddings outperforms 9 baselines finetuned under end-to-end supervision. Furthermore, the localized deviations identified by BrainNorm across various neurodegenerative disorders closely align with established neurodegeneration pathology in clinical literature.

Cross-Modal Ultrasound-MRI Learning for Fetal Brain Ventricular Volumetry and Abnormality Screening

Assessment of ventriculomegaly (VM) on fetal brain ultrasound relies primarily on measuring lateral ventricular atrial width on standard planes, which is operator-dependent and may not fully reflect the overall ventricular enlargement. Fetal brain MRI provides more reliable volumetric information but is costly and less accessible for routine use. To address these limitations, we propose VIFBA, an ultrasound video-based framework for fetal brain assessment that predicts MRI-derived lateral ventricular volume, classifies VM severity, and identifies potential non-VM fetal brain abnormalities. Our contribution is three-fold. First, we introduce a joint-embedding predictive architecture (JEPA)-inspired tube latent prediction objective that leverages spatio-temporal coherence in ultrasound videos to enhance representation learning. Second, we develop a contrastive cross-modal alignment strategy that transfers structural information from MRI to ultrasound during training, while requiring ultrasound alone at inference. Third, we augment VIFBA with a training-free vision-language model and retrieval augmentation to verify uncertain predictions and identify potential non-VM fetal brain abnormalities. We validated VIFBA on a large dataset comprising 857 cases (3,196 videos) with paired fetal brain ultrasound and MRI examinations. On held-out test data, VIFBA achieved an MAE of 0.5909 mL and Pearson correlation coefficient of 0.9907 for ventricular volume regression, 0.9400 accuracy for VM severity classification, and an F1 score of 0.7764 for multi-abnormality classification, substantially outperforming single-task baselines, video-based strong competitors, and state-of-the-art foundation models. By enabling MRI-informed volumetric assessment from routine ultrasound alone, VIFBA offers a practical and potentially broadly deployable pathway toward accurate and affordable prenatal brain screening.

How Good are Foundation Models in Longitudinal MRI Disease Progression Reasoning?

Magnetic Resonance Imaging (MRI) interpretation is fundamental to clinical decision-making, requiring radiologists to integrate multi-view anatomical planes across sequential timepoints while precisely localizing interval changes. However, existing vision-language benchmarks remain confined to single-timepoint, single-view interpretation, failing to capture the temporal-spatial reasoning essential to radiologic practice. We introduce the Time-Aware Multi-View MRI Benchmark, an evaluation framework unifying multi-view anatomical input, temporal reasoning across longitudinal scans, and structured localization guidance. The benchmark comprises 3,920 expert-verified question-answer pairs derived from 890 patients across over 3,200 longitudinal MRI timepoints, drawn from seven clinical cohorts covering glioblastoma, neurodegeneration, vestibular schwannoma, and brain metastases, in open-ended, multiple-choice, and binary formats, requiring models to identify anatomical regions of maximal change, characterize progression across sequences and views, and provide structured guidance specifying boundaries, imaging features, and confounders. Experiments across 16 vision-language models reveal moderate temporal alignment but systematic failure on change direction recognition and volumetric quantification, while multi-view inputs improve spatial localization yet degrade temporal reasoning in compact architectures. Our benchmark provides a systematic framework for evaluating progression tracking, interval change localization, and temporal ordering, which are essential for clinical deployment. Code, evaluation splits, and the dataset are available at: https://github.com/wafaAlghallabi/Time-Aware-MRI.

Emergence of Transfer Learning towards Specific Identification of Alzheimer's Disease A Prospective Approach

Worldwide, millions of senior citizens are suffering from Alzheimer disease abbreviated as AD, a well- versed form of dementia. AD is featured by amnesia, intellectual disability, and difficulty with consciousness. DL and ML models are undoubtedly explored to identify AD related patterns on large dimensional neuroimaging data but they need global optimization and are suffering from overfitting issue that might yield dissatisfactory result in testing data set. DL overcomes the issue by convolution of input image with kernel but any sudden change in the MRI image or human manipulation, limited pre- processing of the images can mislead CNN in achieving highly accurate detection. Transfer Learning (TL) has proved itself in AD diagnosis by utilizing pre-trained models on large data sets to guide novice model in a new neuroimaging dataset. This review provides an inclusive glimpse of TL implication in classification, identification including the conversion of AD. Keeping in view, we have assessed the strengths and limitations of TL in improvising diagnostic accuracy even with limited data. The uniqueness of the present review is the incorporation of explainable AI in TL based AD diagnosis system. Finally, it can be claimed that the review will guide the new re-searchers in the area of TL induced neurodegenerative disease detection.

Curia-MAE: Multi-Modal Multi-Anatomy MAE Pre-Training for 3D Medical Image Segmentation

Radiology foundation models learn transferable representations that can be adapted to new tasks by training only small layers on top of a frozen encoder. Dense prediction tasks such as 3D segmentation are, however, underrepresented in their evaluation, and, with the encoder kept frozen, pre-trained models still fall short of nnU-Net, the state-of-the-art reference trained from scratch. To close this gap we extend convolutional MAE pre-training with a robust reconstruction objective, a feature regularizer, and a local-global similarity objective. Using this method, we propose Curia-MAE, a multi-modal, multi-anatomy MAE model pre-trained on 300,000 CT and MRI images covering a large number of anatomical sites. On eight anatomy- and lesion-focused segmentation benchmarks, Curia-MAE improves frozen-encoder performance over a strong MAE baseline, while remaining competitive under full finetuning and superior on lesion tasks, where labeled data is scarce. These results indicate that a single frozen encoder can be reused across diverse segmentation tasks, reducing the cost of adapting and deploying such models in clinical workflows. We will make our pre-trained model weights publicly available.

Segmentation Pre-training for Label-Efficient Lumbar Spine Degeneration Grading

Automated assessment of degenerative pathology in the lumbar spine on magnetic resonance imaging (MRI) requires access to large-scale datasets of expert-annotated radiological gradings. In contrast, segmentation pseudo-labels can be generated by automated tools at negligible radiologist cost. We examine whether pre-training on segmentation can effectively replace a fraction of the manual grading annotations required for downstream supervision. We pre-train a 3D ResNet encoder to segment the vertebrae, intervertebral discs (IVDs), and the spinal canal, then fine-tune lightweight task-specific grading heads using different proportions of the available training data, ranging from $10\%$ to $100\%$. On a multicentre dataset of ${\sim}2{,}000$ subjects across 11 pathologies, segmentation pre-training, achieving a Dice score of $0.94$ against pseudo-labels, improved the task-averaged (macro) one-vs-rest ROC-AUC at all proportions. With only 20\% of grading labels after pre-training, the method achieved near full-supervision performance, with the largest gains observed for either low-prevalence or spatially grounded pathologies.

Unsupervised Adversarial Domain Adaptation for Uterine layer Segmentation: From Labeled Cine to Unlabeled Dynamic EPI MRI

Uterine peristalsis is a key physiological phenomenon responsible for various functions across the menstrual cycle, intimately linked to uterine wall microstructure. Alterations in uterine motion and tissue properties are implicated in the etiology of gynecological diseases, yet these processes have been studied in isolation. We introduce a dynamic multi-echo gradient echo EPI framework for simultaneous characterization and correlation of uterine peristaltic activity and time-resolved T2* changes at 0.55T. Inherent susceptibility artifacts, reduced resolution, and burden of manual uterine layer annotation are addressed by an unsupervised adversarial domain adaptation framework, transferring segmentation knowledge from labeled cine MRI to unlabeled dynamic EPI. We implemented Unet-LSTM with multi-scale domain discriminators that exploits temporal layer dynamics. A Dice score of 0.88 and Jaccard index of 0.80 was achieved. Mean T2* values were 108ms, 76ms, and 124ms for the myometrium, junctional zone, and endometrium. A negative correlation between junctional zone area and T2* was observed in 14/39 cases, providing first insights into oxygenation patterns associated with junctional zone contraction and motion, demonstrating feasibility of assessing the interplay between contractility and dynamic T2* changes.

Predictive Enhancement Calibration for Latent Breast MRI Virtual Contrast Enhancement

Virtual contrast enhancement (VCE) synthesizes enhanced breast MR images from pre-contrast acquisitions. Modern latent generators offer strong image priors, but their bounded natural-image autoencoders conflict with the non-canonical intensity scale of MRI. We show that the upper bound can alter radiomic fidelity before generation, while scaling source and target independently creates a coordinate inconsistency. We propose Predictive Enhancement Calibration (PEC), which represents each pair in a shared, case-adaptive coordinate during training and predicts its unavailable upper endpoint from the pre-contrast image at inference. We integrate PEC with a pretrained FLUX latent flow transformer via parameter-efficient reference conditioning. Target round trips first isolate representation loss before generation; near-matched conditional models then compare PEC with fixed-wide and separate coordinates under comparable training budgets and backbone settings. On the fixed internal MAMA100 development cohort, PEC improves all eight point estimates in this source-only VCE setting, with paired evidence strongest for MSE and LPIPS.\noindent\textbf{Code:} https://github.com/tanlei0/pec-breast-mri-vce

Implicit Neural Representations for Multimodal Longitudinal Image Imputation and Interpolation

Longitudinal multiparametric MRI is central to follow-up imaging in oncology, yet real-world clinical data are characterised by missing sequences, heterogeneous acquisition protocols, and varying spatial resolutions across time points. We propose a patient-specific conditional implicit neural representation (INR) that models multimodal longitudinal MRI as a continuous function of world coordinates, time, and modality conditioning. The model is trained with stochastic modality dropout to handle incomplete data, and its continuous coordinate-space formulation enables both spatial and temporal interpolation without resampling to a fixed voxel grid. A self-consistency-based confidence estimator is derived from cross-modal reconstruction performance at inference time. We evaluate the framework on longitudinal MRI from paediatric brain tumour patients, demonstrating statistically significant improvements over linear interpolation for T1CE and FLAIR (p < 0.05), with mean MS-SSIM of 0.95 $\pm$ 0.02 for T1CE. Predicted confidence correlates strongly with true reconstruction quality (Pearson r up to 0.996), suggesting reliable deployment potential in heterogeneous clinical settings.

The K-Space Signature: Frequency-Domain Representation Learning for Medical Deepfake Detection

In medical imaging, generative models are increasingly deployed to synthesize realistic data and augment limited datasets. Unfortunately, while beneficial for privacy-preserving data sharing, these synthesized images can be repurposed for malicious intents, threatening public health through the creation of Medical Deepfakes. To address this threat, we introduce the K-Space Signature (KSS), a novel forensic framework that isolates hardware and generative traces within the spectral domain. By shifting analysis to the frequency domain, the KSS suppresses macroscopic anatomical variance by subtracting an empirical global anatomical prior computed in the Logarithmic Power Spectral Density (Log-PSD) space. To effectively process these globally distributed spectral artifacts without the local spatial bias inherent to Convolutional Neural Networks, we pair the KSS representation with a novel 3D MLP-Mixer architecture equipped with an ArcFace metric-learning head. Extensive experiments on multi-center 3D MRI datasets demonstrate that this combined approach achieves exceptional detection performance, exceeding 0.99 Accuracy and ROC-AUC on multi-generator synthetic datasets. Furthermore, the framework exhibits robust zero-shot generalization, maintaining strong discriminative power (up to 0.93 Accuracy) on independent datasets acquired from entirely unseen scanners. To ensure full reproducibility, the complete source code and pre-trained models will be made publicly available upon acceptance.

A Unified Benchmark of Deep Learning Models for Multi-task 3D Brain Tumor Segmentation from Magnetic Resonance Imaging

Automatic brain tumor segmentation from magnetic resonance imaging (MRI) has become a fundamental task in computer-assisted diagnosis, treatment planning, and disease monitoring. Although numerous deep learning architectures have recently been proposed, objective comparisons remain challenging because published studies often employ different datasets, preprocessing strategies, training protocols, and evaluation procedures. This work presents a unified experimental benchmark for comparing representative convolutional neural networks (CNNs), Transformer-based models, and recent State Space Model (SSM) architectures under homogeneous experimental conditions. Five state-of-the-art three-dimensional segmentation models, including 3D U-Net, SegResNet, Swin UNETR, SegMamba, and SegMambaV2, are evaluated on two brain tumor segmentation datasets representing distinct clinical scenarios: intracranial meningioma segmentation (BraTS 2023) and post-treatment glioma segmentation (BraTS 2024). All architectures are trained using identical preprocessing, data augmentation, optimization strategies, and evaluation protocols to ensure a fair comparison. Performance is assessed using segmentation accuracy metrics together with computational cost indicators, including inference time and the size of each model. The results provide practical insights into the trade-offs between segmentation accuracy and computational efficiency, highlighting the suitability of different architectural paradigms for challenging three-dimensional brain tumor segmentation tasks.

Panda: Unsupervised Pelvic Anomaly Detection for Real-Time MR Imaging

Female pelvic diseases remain an under researched area characterized by often delayed diagnosis. While pelvic MRI offers superior soft-tissue contrast for diagnosis and image-guided procedures, real-time anomaly detection remains challenging due to physiological motion, tissue deformation, and instrument artifacts. Existing supervised approaches are impractical, as adverse events are rare, heterogeneous, and difficult to annotate. We present a Dinomaly-based unsupervised anomaly detection framework adapted for pelvic MRI that learns normative representations from healthy cases and flags deviations without requiring labels. Our approach leverages a frozen DINOv3 Vision Transformer encoder combined with a noisy MLP bottleneck and Linear Attention decoder to prevent identity mapping while maintaining computational efficiency. Anomalies are localized via per-token cosine distance between encoder and decoder representations, yielding spatial anomaly maps that provide immediate feedback at the scanner to support radiologist decision-making and adaptive protocol adjustment. Evaluated on a curated subset of the Uterine Myoma Dataset, the framework achieves a pixel-level AUROC of 88.06% and high specificity (95.45%) at frame level at 40.5 slices/s, meeting real-time clinical deployment requirements. The spatial anomaly maps and frame-level scores provide immediate, localized feedback at the scanner to support radiologist decision-making and adaptive protocol adjustment during active procedures.

Segmentation Robustness and Predictive Utility in Glioblastoma Radiomics: Evidence for a Trade-off in Survival Modelling

Radiomic biomarkers derived from magnetic resonance imaging (MRI) have been widely investigated as non-invasive tools for tumor characterization and prognostic modeling in glioblastoma (GBM). However, their clinical translation remains limited, in part due to sensitivity to tumor segmentation variability. In this study, we systematically investigate the relationship between feature robustness and predictive utility in GBM survival modeling using the University of Pennsylvania Glioblastoma Imaging, Genomics, and Radiomics (UPENN-GBM) cohort. A total of 4,752 radiomic features were obtained from multiparametric MRI across three tumor subregions: enhancing tumor (ET), peritumoral edema (ED), and necrotic core (NC). Feature robustness was quantified using the intraclass correlation coefficient (ICC) based on the automatic and expert-refined segmentation versions. Among features with valid ICC estimates, 48.1% were classified as robust. Survival prediction was evaluated using cross-validation with Coxnet, Random Survival Forest, and Gradient Boosting Survival Analysis models. In this cohort, radiomic feature inclusion showed no consistent improvement over the clinical baseline, and robustness filtering produced no detectable performance gain. Model-selected features were less robust than the overall feature pool, indicating a lack of enrichment for robustness. These findings suggest that robustness alone is not a reliable criterion for feature selection in radiomics-based survival modelling.

CrossSpine: Multi-scale Cross-sequence Attention with Anatomical Priors for Automated Pfirrmann Grading

Automated grading of Lumbar Disc Degeneration is essential for the objective quantification of structural changes associated with low back pain. Observing that baseline models underperformed on our data, we propose a framework designed to overcome these limitations. First, we present the Cross-sequence Attention Spine (CrossSpine) framework, a novel architecture that employs a cross-sequence attention mechanism to adaptively fuse features from different MRI sequences at multiple spa- tial scales. Second, we contribute a meticulously curated dataset aimed at automated Pfirrmann grading. Finally, we introduce an IVD-aware classification technique that integrates anatomical disc-level information, enabling the model to learn level-specific degeneration priors. Our experi- ments demonstrate the superiority of this approach: CrossSpine achieved a relative improvement exceeding 125% in the Macro F1 score, while boosting the Mean AUPRC by 99% and the Mean AUROC by 36% com- pared to the baseline.

PhenSPINE: A Standardized Benchmark for Spine Pathology Diagnosis

The accurate diagnosis of spinal pathologies depends heavily on radiological interpretation, yet automated systems are hindered by the lack of diverse, high-quality benchmarks. In this study, we present PhenSPINE, a Magnetic Resonance Imaging dataset comprising 16,813 images from 250 patients, curated to facilitate advanced deep learning research. We propose a robust diagnostic benchmark that integrates state-of-theart convolutional backbones with a Positional Encoding mechanism to explicitly model the anatomical context of intervertebral discs. Evaluating across four standard MRI sequences, our experiments demonstrate that the Sagittal T2-weighted sequence offers the most robust diagnostic value, achieving a superior Macro F1-score of 50.31%. We find that multisequence fusion strategies yield inferior performance compared to this single-sequence baseline, as the images across sequences in our dataset are significantly compromised by noise interference from surrounding anatomical regions. This work establishes a robust baseline and offers critical insights into sequence selection for spine analysis.

MIRAGE: Multi-scale Lesion-Informed Representation with Auxiliary Guidance for MRI Contrast Enhancement

Inferring contrast enhancement from one pre-contrast breast MRI slice is underdetermined: post-contrast appearance contains physiological information that is not uniquely encoded in baseline anatomy. Optimizing only paired pixel fidelity can suppress uncertain lesion enhancement, whereas adversarial or stochastic generative objectives can favor realistic post-contrast appearance without guaranteeing patient-specific lesion fidelity. We introduce MIRAGE, a residual 2D U-Net that combines global reconstruction and perceptual losses with three forms of lesion-aware supervision available only during training: an asymmetric penalty for missed tumor enhancement, multi-scale auxiliary tumor segmentation, and guidance through a frozen post-contrast tumor segmentation nnU-Net. We evaluate the method on 301 cases from the multi-centre MAMA-SYNTH data using eight complementary image-, region-, radiomics-, and segmentation-based metrics. MIRAGE ranks first on six metrics and markedly improves downstream lesion localization over tuned pix2pix, conditional diffusion, and latent bridge-matching baselines. The generative alternatives retain advantages in LPIPS or contrast classification, revealing a clear fidelity-utility trade-off. Leave-one-in and leave-one-out ablations show that the losses are partly redundant for lesion localization but exert distinct effects on appearance, radiomics, and boundary accuracy. These results support task-aware synthesis while also showing that its apparent optimality is conditional on the downstream models and metrics used to define utility.

Causal-Adversarial Probing of Clinical Covariates for Prostate MRI Grading

Deep learning models for prostate MRI-based cancer grading may encode clinical covariates that either reflect useful disease-related signal or non-generalising shortcut information, but their role is usually assumed. We propose a causal-reasoning framework for probing covariate dependence in MRI-based International Society of Urological Pathology (ISUP) Grade Group prediction. Rather than treating mpMRI as a direct cause of grade, we model MRI appearance and ISUP grade as observations of latent tumour pathology, and test whether candidate clinical variables act as nuisance correlates, disease-related proxies, or irrelevant covariates in the learned representation. We implement this using an adversarial framework that suppresses the decodability of individual clinical covariate at a time while preserving MRI-based grade prediction. The approach is developed and evaluated on 2,903 prostate MRI examinations, with external validation on 576 patients. We report a set of interesting and previously under-explored imaging-to-clinical-variable interactions in the context of deep learning generalisation. For examples, in binary ISUP Grade Group $\geq2$ classification, suppressing age, BMI, and alcohol use improved AUC by 1.23%, 0.84%, and 1.42%, respectively (all p < 0.05), suggesting reduced non-generalising covariate information; In contrast, suppressing PSA and prostate volume degraded AUC by 1.91% and 7.61% (all p < 0.001), indicating that these variables carried task-relevant signal. These findings show that adversarial covariate suppression can provide a practical representation-level analysis for distinguishing potentially harmful dependence from informative signal in prostate MRI grading models.

Efficient Computing for Medical Image Acquisition and Reconstruction

Medical imaging systems such as CT, MRI, PET, and SPECT do not directly acquire images. Instead, they measure physical signals that encode anatomical or physiological information, and image reconstruction recovers the underlying image by solving an inverse problem. Although these imaging modalities are governed by different imaging physics, they share a common computational framework that naturally connects medical physics, linear algebra, probability, numerical optimization, and efficient computing. As medical imaging systems acquire increasingly large and higher-dimensional datasets, image reconstruction has become one of the primary computational bottlenecks in modern medical imaging. Advanced reconstruction methods, including analytical reconstruction, iterative optimization, and statistical model-based reconstruction, substantially improve image quality while reducing radiation dose or scan time, but at significantly increased computational cost. Efficient computing has therefore become essential for achieving clinically practical reconstruction times. This chapter presents a unified computational perspective on medical image acquisition and reconstruction across CT, MRI, PET, and SPECT. It first reviews the imaging physics and data acquisition process for each modality and derives a generalized mathematical framework for image reconstruction. Building on this framework, the chapter discusses analytical, iterative, and statistical reconstruction methods together with their computational characteristics. Finally, it examines efficient computing considerations, including optimization algorithms, physics-aware forward operators, memory-efficient implementations, and parallel computing strategies. Together, these topics demonstrate how the integration of imaging physics, mathematical modeling, and efficient computing enables accurate and scalable medical image reconstruction.

Lesion Segmentation in Moderate to Severe Traumatic Brain Injury: An nnU-Net Based Approach with Adaptive Normalization in the AIMS-TBI 2025 Challenge

The segmentation of lesions in Moderate to Severe Traumatic Brain Injury (msTBI) from T1-weighted MRI presents a significant clinical challenge due to the profound heterogeneity of lesion characteristics in terms of size, shape, and location. To address this, the AIMS-TBI 2025 Challenge was organized to promote the development of robust and accurate segmentation algorithms. In this paper, we present our deep learning-based solution. Our methodology employs the nnU-Net framework with an adaptive intensity normalization strategy confined to the brain parenchyma, effectively reducing inter-subject variability and mitigating artifacts from non-brain structures. Upon final evaluation on the held-out test set, our method demonstrated highly competitive performance on the official leaderboard, achieving an Overall Dice Coefficient of 0.6305. The model obtained a Dice score of 0.4805 for lesion segmentation and 0.9324 for non-lesion tissue. While the lesion Dice reflects the difficulty of detecting highly heterogeneous lesions, the high non-lesion Dice primarily indicates the model's strong ability to correctly identify non-lesion voxels, demonstrating good specificity in differentiating lesion from non-lesion regions. These results demonstrate that incorporating anatomically constrained normalization within the nnU-Net pipeline is a powerful and effective strategy for tackling the complexities of msTBI lesion segmentation.

Physically Aware Radiomics Without Interpolation: Disentangling Voxel Geometry and Signal Modification in CT and MRI

Objective: Radiomic texture features are usually computed in voxel-index neighborhoods, implicitly assuming isotropic spatial relationships. In anisotropic images, this can confound voxel geometry with interpolation-induced signal changes. We developed a voxel-spacing-aware radiomic framework that incorporates physical geometry into texture computation without resampling. Approach: We modified PyRadiomics to account for voxel spacing while preserving the native image signal. Four configurations were compared: native non-resampled extraction (NR), isotropic resampling (RS), voxel-spacing-aware extraction (VS), and fake-isotropic preprocessing (FK), in which spacing metadata were overwritten without altering the image array. Experiments included 685 LIDC-IDRI pulmonary nodules and 209 I-SPY2 breast MRI cases, with 196 radiomic descriptors. Robustness was assessed using ICC, within-subject variability, Friedman testing, feature selection, machine learning, a multilayer perceptron, and external validation. Main results: VS showed near-native agreement with NR: median ICC(A,1) was 0.9976 in CT and 0.9984 in MRI. RS produced lower agreement and larger deviations, while FK showed intermediate behavior, confirming that spacing metadata alone can affect radiomic features. Gradient-derived and neighborhood-sensitive descriptors were most affected by preprocessing. VS preserved predictive performance comparable to NR in external CT validation, whereas MRI showed greater variability across preprocessing strategies and classifiers. Significance: Voxel-spacing-aware extraction separates geometric modeling from interpolation-induced signal modification while preserving the native image signal, offering a coherent alternative to isotropic resampling for radiomic analysis of anisotropic CT and MRI.

Anatomy-Privileged Distillation with Token Routing for MRI-Based Prediction of Perineural Invasion

Perineural invasion (PNI) is associated with poor postoperative outcomes in intrahepatic cholangiocarcinoma, but it is confirmed by surgical pathology. Existing preoperative imaging models often rely on radiologist-defined variables, contrast-enhanced imaging, or manual annotations. We propose an anatomy-privileged teacher--student framework for patient-level PNI prediction from T2-weighted MRI. During training, the teacher uses MRI with tumor and liver masks to learn dense token routing, and the student distills this guidance to retain and aggregate informative tokens under a fixed budget. Anatomical supervision is restricted to training, and the deployed model does not require masks at inference. In 155 patients, the proposed method achieved the highest mean AUROC of 0.750 among matched MRI-only baselines evaluated under the same protocol, with 1.43 GFLOPs and 8.02 ms per case on a Jetson Orin Nano Super Developer Kit.

Metadata Supervised MRI Representations for Modelling and Controlling Acquisition Variability

Magnetic resonance imaging exhibits substantial acquisition variability, where identical anatomy can appear markedly different across scanners and imaging protocols. Consequently, learned representations entangle biological structure with acquisition-dependent appearance, limiting interpretability, generalisation, and clinical deployment. We show that these sources of variation can be separated by jointly modelling MRI images and DICOM metadata. Using large-scale clinical brain MRI data, we learn representations that separate anatomical structure from contrast-dependent appearance. Resulting contrast representations organise heterogeneous acquisitions, support sequence understanding, and detect image--metadata inconsistencies, whereas anatomical representations suppress acquisition-specific variation while preserving biologically relevant information. Building on these disentangled representations, we introduce a unified anatomy-preserving harmonisation model for cross-modality and cross-site adaptation, conditioned on image or acquisition metadata. Our findings suggest that acquisition variability is a structured component of the imaging process that can be modelled, audited, and controlled, providing a foundation for acquisition-aware representation learning in large-scale medical imaging.