Multi-modal MR imaging is routinely used in clinical practice to diagnose and investigate brain tumors by providing rich complementary information. Previous multi-modal MRI segmentation methods usually perform modal fusion by concatenating multi-modal MRIs at an early/middle stage of the network, which hardly explores non-linear dependencies between modalities. In this work, we propose a novel Nested Modality-Aware Transformer (NestedFormer) to explicitly explore the intra-modality and inter-modality relationships of multi-modal MRIs for brain tumor segmentation. Built on the transformer-based multi-encoder and single-decoder structure, we perform nested multi-modal fusion for high-level representations of different modalities and apply modalitysensitive gating (MSG) at lower scales for more effective skip connections. Specifically, the multi-modal fusion is conducted in our proposed Nested Modality-aware Feature Aggregation (NMaFA) module, which enhances long-term dependencies within individual modalities via a triorientated spatial-attention transformer, and further complements key contextual information among modalities via a cross-modality attention transformer. Extensive experiments on BraTS2020 benchmark and a private meningiomas segmentation (MeniSeg) dataset show that the Nest-edFormer clearly outperforms the state-of-the-arts. The code is available at https://github.com/920232796/NestedFormer.

In recent years, Denoising Diffusion Models have demonstrated remarkable success in generating semantically valuable pixel-wise representations for image generative modeling. In this study, we propose a novel end-to-end framework, called Diff-UNet, for medical volumetric segmentation. Our approach integrates the diffusion model into a standard U-shaped architecture to extract semantic information from the input volume effectively, resulting in excellent pixel-level representations for medical volumetric segmentation. To enhance the robustness of the diffusion model's prediction results, we also introduce a Step-Uncertainty based Fusion (SUF) module during inference to combine the outputs of the diffusion models at each step. We evaluate our method on three datasets, including multimodal brain tumors in MRI, liver tumors, and multi-organ CT volumes, and demonstrate that Diff-UNet outperforms other state-of-the-art methods significantly. Our experimental results also indicate the universality and effectiveness of the proposed model. The proposed framework has the potential to facilitate the accurate diagnosis and treatment of medical conditions by enabling more precise segmentation of anatomical structures. The codes of Diff-UNet are available at https://github.com/ge-xing/Diff-UNet.

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Masked image modeling (MIM) with transformer backbones has recently been exploited as a powerful self-supervised pre-training technique. The existing MIM methods adopt the strategy to mask random patches of the image and reconstruct the missing pixels, which only considers semantic information at a lower level, and causes a long pre-training time. This paper presents Hy-bridMIM, a novel hybrid self-supervised learning method based on masked image modeling for 3D medical image segmentation. Specifically, we design a two-level masking hierarchy to specify which and how patches in sub-volumes are masked, effectively providing the constraints of higher level semantic information. Then we learn the semantic information of medical images at three levels, including: 1) partial region prediction to reconstruct key contents of the 3D image, which largely reduces the pre-training time burden (pixel-level); 2) patch-masking perception to learn the spatial relationship between the patches in each subvolume (region-level). and 3) drop-out-based contrastive learning between samples within a mini-batch, which further improves the generalization ability of the framework (sample-level). The proposed framework is versatile to support both CNN and transformer as encoder backbones, and also enables to pre-train decoders for image segmentation. We conduct comprehensive experiments on four widelyused public medical image segmentation datasets, including BraTS2020, BTCV, MSD Liver, and MSD Spleen. The experimental results show the clear superiority of Hybrid-MIM against competing supervised methods, masked pretraining approaches, and other self-supervised methods, in terms of quantitative metrics, timing performance and qualitative observations. The codes of HybridMIM are available at https://github.com/ge-xing/HybridMIM.