Segmentation of retinal vessels on fundus images plays a critical role in the diagnosis of micro-vascular and ophthalmological diseases. Although being extensively studied, this task remains challenging due to many factors including the highly variable vessel width and poor vessel-background contrast. In this paper, we propose a multiscale feature interaction network (MFI-Net) for retinal vessel segmentation, which is a U-shaped convolutional neural network equipped with the pyramid squeeze-and-excitation (PSE) module, coarse-to-fine (C2F) module, deep supervision, and feature fusion. We extend the SE operator to multiscale features, resulting in the PSE module, which uses the channel attention learned at multiple scales to enhance multiscale features and enables the network to handle the vessels with variable width. We further design the C2F module to generate and re-process the residual feature maps, aiming to preserve more vessel details during the decoding process. The proposed MFI-Net has been evaluated against several public models on the DRIVE, STARE, CHASE_DB1, and HRF datasets. Our results suggest that both PSE and C2F modules are effective in improving the accuracy of MFI-Net, and also indicate that our model has superior segmentation performance and generalization ability over existing models on four public datasets.

Self-supervised learning (SSL) has long had great success in advancing the field of annotation-efficient learning. However, when applied to CT volume segmentation, most SSL methods suffer from two limitations, including rarely using the information acquired by different imaging modalities and providing supervision only to the bottleneck encoder layer. To address both limitations, we design a pretext task to align the information in each 3D CT volume and the corresponding 2D generated X-ray image and extend self-distillation to deep self-distillation. Thus, we propose a self-supervised learner based on Cross-modal Alignment and Deep Self-distillation (CADS) to improve the encoder’s ability to characterize CT volumes. The cross-modal alignment is a more challenging pretext task that forces the encoder to learn better image representation ability. Deep self-distillation provides supervision to not only the bottleneck layer but also shallow layers, thus boosting the abilities of both. Comparative experiments show that, during pre-training, our CADS has lower computational complexity and GPU memory cost than competing SSL methods. Based on the pre-trained encoder, we construct PVT-UNet for 3D CT volume segmentation. Our results on seven downstream tasks indicate that PVT-UNet outperforms state-of-the-art SSL methods like MOCOv3 and DiRA, as well as prevalent medical image segmentation methods like nnUNet and CoTr. Code and pre-trained weight will be available at https://github.com/yeerwen/CADS.

Cross-domain joint segmentation of optic disc and optic cup on fundus images is essential, yet challenging, for effective glaucoma screening. Although many unsupervised domain adaptation (UDA) methods have been proposed, these methods can hardly achieve complete domain alignment, leading to suboptimal performance. In this paper, we propose a triple-level alignment (TriLA) model to address this issue by aligning the source and target domains at the input level, feature level, and output level simultaneously. At the input level, a learnable Fourier domain adaptation (LFDA) module is developed to learn the cut-off frequency adaptively for frequency-domain translation. At the feature level, we disentangle the style and content features and align them in the corresponding feature spaces using consistency constraints. At the output level, we design a segmentation consistency constraint to emphasize the segmentation consistency across domains. The proposed model is trained on the RIGA+ dataset and widely evaluated on six different UDA scenarios. Our comprehensive results not only demonstrate that the proposed TriLA substantially outperforms other state-of-the-art UDA methods in joint segmentation of optic disc and optic cup, but also suggest the effectiveness of the triple-level alignment strategy.

Although recent years have witnessed significant advancements in medical image segmentation, the pervasive issue of domain shift among medical images from diverse centres hinders the effective deployment of pre-trained models. Many Test-time Adaptation (TTA) methods have been proposed to address this issue by fine-tuning pre-trained models with test data during inference. These methods, however, often suffer from less-satisfactory optimization due to suboptimal optimization direction (dictated by the gradient) and fixed step-size (predicated on the learning rate). In this paper, we propose the Gradient alignment-based Test-time adaptation (GraTa) method to improve both the gradient direction and learning rate in the optimization procedure. Unlike conventional TTA methods, which primarily optimize the pseudo gradient derived from a self-supervised objective, our method incorporates an auxiliary gradient with the pseudo one to facilitate gradient alignment. Such gradient alignment enables the model to excavate the similarities between different gradients and correct the gradient direction to approximate the empirical gradient related to the current segmentation task. Additionally, we design a dynamic learning rate based on the cosine similarity between the pseudo and auxiliary gradients, thereby empowering the adaptive fine-tuning of pre-trained models on diverse test data. Extensive experiments establish the effectiveness of the proposed gradient alignment and dynamic learning rate and substantiate the superiority of our GraTa method over other state-of-the-art TTA methods on a benchmark medical image segmentation task.