We explore the feasibility and potential of building a ground-truth-free evaluation model to assess the quality of segmentations generated by the Segment Anything Model (SAM) and its variants in medical imaging. This evaluation model estimates segmentation quality scores by analyzing the coherence and consistency between the input images and their corresponding segmentation predictions. Based on prior research, we frame the task of training this model as a regression problem within a supervised learning framework, using Dice scores (and optionally other metrics) along with mean squared error to compute the training loss. The model is trained utilizing a large collection of public datasets of medical images with segmentation predictions from SAM and its variants. We name this model EvanySeg (Evaluation of Any Segmentation in Medical Images). Our exploration of convolution-based models (e.g., ResNet) and transformer-based models (e.g., ViT) suggested that ViT yields better performance for this task. EvanySeg can be employed for various tasks, including: (1) identifying poorly segmented samples by detecting low-percentile segmentation quality scores; (2) benchmarking segmentation models without ground truth by averaging quality scores across test samples; (3) alerting human experts to poor-quality segmentation predictions during human-AI collaboration by applying a threshold within the score space; and (4) selecting the best segmentation prediction for each test sample at test time when multiple segmentation models are available, by choosing the prediction with the highest quality score. Models and code will be made available at https://github.com/ahjolsenbics/EvanySeg.

The segmentation foundation model, e.g., Segment Anything Model (SAM), has attracted increasing interest in the medical image community. Early pioneering studies primarily concentrated on assessing and improving SAM's performance from the perspectives of overall accuracy and efficiency, yet little attention was given to the fairness considerations. This oversight raises questions about the potential for performance biases that could mirror those found in task-specific deep learning models like nnU-Net. In this paper, we explored the fairness dilemma concerning large segmentation foundation models. We prospectively curate a benchmark dataset of 3D MRI and CT scans of the organs including liver, kidney, spleen, lung and aorta from a total of 1056 healthy subjects with expert segmentations. Crucially, we document demographic details such as gender, age, and body mass index (BMI) for each subject to facilitate a nuanced fairness analysis. We test state-of-the-art foundation models for medical image segmentation, including the original SAM, medical SAM and SAT models, to evaluate segmentation efficacy across different demographic groups and identify disparities. Our comprehensive analysis, which accounts for various confounding factors, reveals significant fairness concerns within these foundational models. Moreover, our findings highlight not only disparities in overall segmentation metrics, such as the Dice Similarity Coefficient but also significant variations in the spatial distribution of segmentation errors, offering empirical evidence of the nuanced challenges in ensuring fairness in medical image segmentation.

In cardiac Magnetic Resonance Imaging (MRI) analysis, simultaneous myocardial segmentation and T2 quantification are crucial for assessing myocardial pathologies. Existing methods often address these tasks separately, limiting their synergistic potential. To address this, we propose SQNet, a dual-task network integrating Transformer and Convolutional Neural Network (CNN) components. SQNet features a T2-refine fusion decoder for quantitative analysis, leveraging global features from the Transformer, and a segmentation decoder with multiple local region supervision for enhanced accuracy. A tight coupling module aligns and fuses CNN and Transformer branch features, enabling SQNet to focus on myocardium regions. Evaluation on healthy controls (HC) and acute myocardial infarction patients (AMI) demonstrates superior segmentation dice scores (89.3/89.2) compared to state-of-the-art methods (87.7/87.9). T2 quantification yields strong linear correlations (Pearson coefficients: 0.84/0.93) with label values for HC/AMI, indicating accurate mapping. Radiologist evaluations confirm SQNet's superior image quality scores (4.60/4.58 for segmentation, 4.32/4.42 for T2 quantification) over state-of-the-art methods (4.50/4.44 for segmentation, 3.59/4.37 for T2 quantification). SQNet thus offers accurate simultaneous segmentation and quantification, enhancing cardiac disease diagnosis, such as AMI.

Dynamic magnetic resonance imaging (MRI) plays an indispensable role in cardiac diagnosis. To enable fast imaging, the k-space data can be undersampled but the image reconstruction poses a great challenge of high-dimensional processing. This challenge leads to necessitate extensive training data in many deep learning reconstruction methods. This work proposes a novel and efficient approach, leveraging a dimension-reduced separable learning scheme that excels even with highly limited training data. We further integrate it with spatiotemporal priors to develop a Deep Separable Spatiotemporal Learning network (DeepSSL), which unrolls an iteration process of a reconstruction model with both temporal low-rankness and spatial sparsity. Intermediate outputs are visualized to provide insights into the network's behavior and enhance its interpretability. Extensive results on cardiac cine datasets show that the proposed DeepSSL is superior to the state-of-the-art methods visually and quantitatively, while reducing the demand for training cases by up to 75%. And its preliminary adaptability to cardiac patients has been verified through experienced radiologists' and cardiologists' blind reader study. Additionally, DeepSSL also benefits for achieving the downstream task of cardiac segmentation with higher accuracy and shows robustness in prospective real-time cardiac MRI.

Magnetic resonance imaging (MRI) is a principal radiological modality that provides radiation-free, abundant, and diverse information about the whole human body for medical diagnosis, but suffers from prolonged scan time. The scan time can be significantly reduced through k-space undersampling but the introduced artifacts need to be removed in image reconstruction. Although deep learning (DL) has emerged as a powerful tool for image reconstruction in fast MRI, its potential in multiple imaging scenarios remains largely untapped. This is because not only collecting large-scale and diverse realistic training data is generally costly and privacy-restricted, but also existing DL methods are hard to handle the practically inevitable mismatch between training and target data. Here, we present a Physics-Informed Synthetic data learning framework for Fast MRI, called PISF, which is the first to enable generalizable DL for multi-scenario MRI reconstruction using solely one trained model. For a 2D image, the reconstruction is separated into many 1D basic problems and starts with the 1D data synthesis, to facilitate generalization. We demonstrate that training DL models on synthetic data, integrated with enhanced learning techniques, can achieve comparable or even better in vivo MRI reconstruction compared to models trained on a matched realistic dataset, reducing the demand for real-world MRI data by up to 96%. Moreover, our PISF shows impressive generalizability in multi-vendor multi-center imaging. Its excellent adaptability to patients has been verified through 10 experienced doctors' evaluations. PISF provides a feasible and cost-effective way to markedly boost the widespread usage of DL in various fast MRI applications, while freeing from the intractable ethical and practical considerations of in vivo human data acquisitions.