Deep neural networks (DNNs) frequently fail to generalize to out-of-distribution (OOD) medical images because of variations in scanners and acquisition protocols. Retraining DNN models to address these distribution shifts is often impractical due to the high cost of acquiring and annotating new medical datasets. To address this, we introduce VarDeepPCA, a novel lightweight variational DNN framework designed to restore/refine degraded segmentation maps by leveraging intrinsic geometric priors. Unlike existing approaches that require target-domain data or extensive pre-training, our VarDeepPCA explicitly learns a distribution of valid anatomical geometries using only small in-distribution (ID) datasets. Theoretically, our novel variational learning framework leverages a reinterpretation of the softmax mapping to implicitly perform exact distribution modeling, thereby enabling computationally efficient, sampling-free learning and inference. This also enables VarDeepPCA to provide uncertainty estimates associated with its restored segmentation maps. We empirically validate our framework across 4 distinct clinical applications, using 14 publicly available datasets, involving segmentation of the myocardium, neuroretinal rim, prostate, and fetal head. Comparisons against 15 existing methods demonstrate that VarDeepPCA consistently restores segmentation maps produced by the existing methods on OOD data to (i) significantly improve anatomical plausibility of geometries and clinical utility of the segmentations, and (ii) significantly reduce errors, without needing any more training data than that used by existing methods.

The scarcity of annotated medical imaging data has driven significant progress in semi-supervised learning to alleviate reliance on expensive expert labeling. While foundational vision models such as the Segment Anything Model (SAM) exhibit robust generalization in generic segmentation tasks, their direct application to medical images often results in suboptimal performance. To address this challenge, in this work, we propose a novel fully SAM-based semi-supervised medical image segmentation framework and develop the corresponding knowledge distillationbased learning strategy. Specifically, we first employ an efficient SAM variant as the backbone network of the semi-supervised framework and update the default prompt embedding of SAM to unleash its full potential. Then, we utilize an original SAM, which is rich in prior knowledge, as the teacher to optimize our efficient student SAM backbone through hierarchical knowledge distillation and a dynamic loss weighting strategy. Extensive experiments on various medical datasets demonstrate that our method outperforms state-of-the-art semi-supervised segmentation approaches. Especially, our model requires less than 10% of the parameter size of the original SAM, enabling substantially lower deployment and storage overhead in real-world clinical settings.

Effective multiscale medical image segmentation requires simultaneously preserving smooth spatial continuity and accurately delineating high-frequency boundaries, yet pixel-wise decoders often fail to maintain this balance consistently across varying resolutions. We introduce GauSAM, which seamlessly integrates contour-guided 2DGaussian probability fields into the Segment Anything Model to address these challenges. In our framework, segmentation masks are parameterized as continuous probability fields of learnable 2DGaussian primitives, enforcing spatially smooth and structurally consistent. Contourlet transforms extract rich multidirectional frequency information, notably edges and fine textures, which dynamically guide the spatial distribution of Gaussian primitives to substantially improve boundary fidelity in complex structures.

Retinal vessel segmentation is critical for medical diagnosis, yet existing models often struggle to generalize across domains due to appearance variability, limited annotations, and complex vascular morphology. We propose GraphSeg, a variational Bayesian framework that integrates anatomical graph priors with structure-aware image decomposition to enhance cross-domain segmentation.

In semi-supervised segmentation, capturing meaningful semantic structures from unlabeled data is essential. This is particularly challenging in histopathology image analysis, where objects are densely distributed. To address this issue, we propose a semi-supervised segmentation framework designed to robustly identify and preserve relevant topological features. Our method leverages multiple perturbed predictions obtained through stochastic dropouts and temporal training snapshots, enforcing topological consistency across these varied outputs. This consistency mechanism helps distinguish biologically meaningful structures from transient and noisy artifacts. A key challenge in this process is to accurately match the corresponding topological features across the predictions in the absence of ground truth. To overcome this, we introduce a novel matching strategy that integrates spatial overlap with global structural alignment, minimizing discrepancies among predictions. Extensive experiments demonstrate that our approach effectively reduces topological errors, resulting in more robust and accurate segmentations essential for reliable downstream analysis. Code is available at https://github.com/MelonXu/MATCH.

In recent years, artificial intelligence has significantly advanced medical image segmentation. Nonetheless, challenges remain, including efficient 3D medical image processing across diverse modalities and handling data variability. In this work, we introduce Hierarchical Soft Mixture-of-Experts (HoME), a two-level token-routing layer for efficient long-context modeling, specifically designed for 3D medical image segmentation. Built on the Mamba Selective State-Space Model (SSM) backbone, HoME enhances sequential modeling through adaptive expert routing.

Yet, training still treats these logits in isolation--either supervising only the final, highest-resolution logits or applying deep supervision with identical loss weights at every scale--without exploring mixed-scale combinations. Consequently, the decoder output misses the complementary cues that arise only when coarse and fine predictions are fused. To address this issue, we introduce LoMix (Logits Mixing), a Neural Architecture Search (NAS)-inspired, differentiable plug-and-play module that generates new mixed-scale outputs and learns how exactly each of them should guide the training process. More precisely, LoMix mixes the multi-scale decoder logits with four lightweight fusion operators: addition, multiplication, concatenation, and attentionbased weighted fusion, yielding a rich set of synthetic "mutant" maps. Every original or mutant map is given a softplus loss weight that is co-optimized with network parameters, mimicking a one-step architecture search that automatically discovers the most useful scales, mixtures, and operators. Plugging LoMix into recent U-shaped architectures (i.e., PVT-V2-B2 backbone with EMCAD decoder) on Synapse 8-organ dataset improves DICE by +4.2% over single-output supervision, +2.2% over deep supervision, and +1.5% over equally weighted additive fusion, all with zero inference overhead. When training data are scarce (e.g., one or two labeled scans, 5% of the trainset), the advantage grows to +9.23%, underscoring LoMix's data efficiency. Across four benchmarks and diverse U-shaped networks, LoMiX improves DICE by up to +13.5% over single-output supervision, confirming that learnable weighted mixed-scale fusion generalizes broadly while remaining data efficient, fully interpretable, and overhead-free at inference. Our implementation is available at https://github.com/SLDGroup/LoMix.

Medical image segmentation based on neural networks is pivotal in promoting digital health equity. The attention mechanism increasingly serves as a key component in modern neural networks, as it enables the network to focus on regions of interest, thus improving the segmentation accuracy in medical images. However, current attention mechanisms confront an accuracy-complexity trade-off paradox: accuracy gains demand higher computational costs, while reducing complexity sacrifices model accuracy. Such a contradiction inherently restricts the real-world deployment of attention mechanisms in resource-limited settings, thus exacerbating healthcare disparities. To overcome this dilemma, we propose a parameter-free Neighborhood Self-Dissimilarity Attention (NSDA), inspired by radiologists' diagnostic patterns of prioritizing regions exhibiting substantial differences during clinical image interpretation.

Breast cancer remains a leading cause of death among women, with early de(NCCT) tection significantly scans of the impro chest, ving routinely prognosis.

Consistency learning with feature perturbation is a widely used strategy in semisupervised medical image segmentation. However, many existing perturbation methods rely on dropout, and thus require a careful manual tuning of the dropout rate, which is a sensitive hyperparameter and often difficult to optimize and may lead to suboptimal regularization. To overcome this limitation, we propose VQ-Seg, the first approach to employ vector quantization (VQ) to discretize the feature space and introduce a novel and controllable Quantized Perturbation Module (QPM) that replaces dropout.