arXiv subjects

James S. Duncan

Publications and source records attributed to James S. Duncan.

At least 19 recordsLinked to original sources

arXiv2026

MRI2Rep: Autoregressive Structured Report Generation for 3D Liver MRI

Manual reporting of 3D MRI studies is time-consuming, yet end-to-end structured report generation for 3D liver MRI remains underexplored due to volumetric complexity and scarce paired data. We propose MRI2Rep, an autoregressive framework for liver MRI report generation. From 3,929 real-world MRI-report pairs acquired over a 10-year single-institution cohort, a Report-to-Label Canonicalization (RLC) module converts free-text reports into structured, closed-vocabulary diagnostic sequences without lesion-level annotations. On a held-out test set, MRI2Rep achieves 76.0% case-level sensitivity, 29.4% lesion-level F1, compared with no more than 8.3% for adapted medical vision-language baselines, and 82.4% liver-level accuracy. In a blinded reader study, two radiologists rated 75% and 70% of AI-generated reports as clinically acceptable, compared with 95% and 100% for original reports. Our automated LLM-based judge, LLM-Eval, rated 61.8% of AI-generated reports as acceptable, applying a stricter standard and supporting its use as a conservative proxy. To our knowledge, this is the first end-to-end LI-RADS-structured reporting system for 3D liver MRI.

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arXiv2026

FM-fMRI: Event Conditioned Flow Matching for Rest-to-Task fMRI Time-Series Synthesis

Task-based fMRI provides a direct readout of task-evoked neural dynamics, but it is expensive and difficult to acquire at scale, motivating rest-to-task synthesis from widely available resting-state fMRI (rsfMRI). We propose FM-fMRI, an event-conditioned flow-matching model that learns a continuous-time conditional vector field to generate task ROI time series from a subject's rsfMRI and the task event information. The formulation enables fast ODE-based sampling and flexible conditioning over heterogeneous event schedules. Rather than optimizing for pointwise reconstruction, we evaluated generated signals using complementary criteria that probe temporal and spectral structure, subject and group-level connectome consistency, and distributional alignment. On the public Human Connectome Project and internal BioPoint autism cohort, FM-fMRI achieves the strongest spectral and connectivity agreement and improved distribution-level matching over conditional diffusion, generative adversarial networks (GANs), and variational autoencoders (VAEs) baselines. Furthermore, we augment the BioPoint cohort by synthesizing task-fMRI ROI time series with our method, improving downstream autism classification and demonstrating practical utility in data-limited clinical settings. The code will be available on GitHub.

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arXiv2026

PPDM: Pixel Puzzling Diffusion Model for Speed and Memory Efficient Volumetric Medical Image Translation

Diffusion models have demonstrated superior fidelity for medical image-to-image translation, but their extension to high-resolution 3D volumes is severely constrained by prohibitive computational cost and GPU memory requirements. Existing memory-efficient strategies often compromise global volumetric consistency or fine anatomical detail. In this work, we propose the Pixel Puzzling Diffusion Model (PPDM), a simple and effective framework for memory- and speed-efficient 3D medical image translation. PPDM introduces a reversible pixel puzzle-unpuzzle operator that trades spatial resolution for channel dimensionality, substantially reducing activation memory while preserving global context. To further improve efficiency and stability, we adopt a direct bridge diffusion formulation that starts from the conditional input rather than pure noise, enabling the model to focus on task-relevant residuals. In addition, a puzzle-gradient loss is incorporated to enforce spatial coherence and suppress grid-like artifacts introduced by spatial rearrangement. We evaluate PPDM on multiple challenging 3D medical image translation tasks, including low-count PET denoising, joint PET denoising and attenuation correction, and cross-modal MRI translation. Across all tasks, PPDM consistently matches or outperforms full 3D diffusion models while reducing training GPU memory usage by up to an order of magnitude and significantly accelerating inference, and it outperforms existing memory-efficient diffusion approaches based on latent compression or frequency decomposition. These results demonstrate that PPDM provides a practical and scalable solution for high-fidelity 3D diffusion-based medical image translation under limited computational resources.

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arXiv2026

Learning Robust and Task-Invariant Functional Representation from fMRI through Siamese Self-Supervised Learning

Functional magnetic resonance imaging (fMRI) is a powerful tool for investigating human brain function. However, the high cost of data acquisition and the inherent subjectivity of psychiatric rating scales often lead to datasets with small sample sizes and variable label quality, especially when targeting a specific neurological condition. Combined with the inherently high dimensionality of fMRI data, these limitations substantially increase the risk of model overfitting. Recent years have seen growing interest in developing fMRI foundation models by combining multiple datasets; however, the computational resources needed for pretraining and fine-tuning are often prohibitive. We show that a lightweight self-supervised framework yields representations that generalize across diverse downstream tasks, outperforming fully supervised baselines and approaching the performance of large-scale models. We introduce BrainSimSiam, a data-efficient self-supervised representation learning framework that leverages positive-only data pairs to learn robust and generalizable features. We demonstrate that the learned representations achieve strong performance across multiple downstream classification and regression tasks, highlighting the potential of BrainSimSiam for data-limited neuroimaging applications.

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arXiv2026

BioFact-MoE: Biologically Factorized Mixture of Experts for Vision-Language Prognostic Modeling in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is biologically heterogeneous, shaped by the interplay between hepatic functional reserve and tumor-related oncologic factors; thus, similar survival outcomes may reflect fundamentally different underlying biological processes. Prognostic modeling in HCC is informed by rich multimodal information from multiparametric MRI and radiology reports from routine clinical practice. Existing prognostic vision-language models (VLMs) learn a single entangled latent representation that blends hepatic and tumor-related factors, limiting both accuracy and biological interpretability. We present BioFact-MoE, a biologically factorized Mixture of Experts (MoE) framework that explicitly decomposes liver and tumor factors via biologically supervised experts within a residual MoE survival architecture. On a HCC cohort of N=588 patients (pretrained on 4,582 3D MRI image-report pairs), BioFact-MoE consistently improves survival prediction over all baselines across time horizons, achieving 12-, 18-, and 24-month AUCs of 75.33%, 75.85%, and 73.96%. Beyond scalar risk prediction, gated expert weights enable phenotype-aware risk stratification. Pathway-informed gating uncovers clinically meaningful treatment-associated survival heterogeneity. In held-out validation, hepatic and tumor embeddings show selective associations with liver function and tumor burden markers, respectively (p<0.05), without supervision. The code is available at https://github.com/jy-639/BioFact-MoE.

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arXiv2026

AGA3DNet: Anatomy-Guided Gaussian Priors with Multi-view xLSTM for 3D Brain MRI Subtype Classification

Accurate 3D brain MRI subtype classification benefits from both localized anatomical cues and long-range contextual reasoning. We present AGA3DNet, a report-grounded framework that incorporates brief anatomical phrases extracted from radiology reports as a soft anatomical prior channel and fuses it with a lightweight 3D CNN and multi-view xLSTM aggregation. Specifically, extracted anatomical phrases are mapped to atlas-defined regions and converted into smooth spatial priors using a signed-distance transform followed by Gaussian weighting, providing interpretable, anatomy-grounded guidance without requiring dense voxel annotations. We evaluate AGA3DNet on a retrospective institutional brain MRI cohort for abnormal subtype discrimination and compare against reproducible 3D classification baselines. AGA3DNet achieves improved overall balance across performance metrics and supports clinically interpretable localization through the prior channel. We discuss limitations related to single-cohort evaluation and the lack of large-scale public brain MRI datasets paired with radiology reports under broadly usable terms.

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arXiv2026

Does DINOv3 Set a New Medical Vision Standard? Benchmarking 2D and 3D Classification, Segmentation, and Registration

The advent of large-scale vision foundation models, pre-trained on diverse natural images, has marked a paradigm shift in computer vision. However, how the frontier vision foundation models' efficacies transfer to specialised domains such as medical imaging remains an open question. This report investigates whether DINOv3, a state-of-the-art self-supervised vision transformer (ViT) pre-trained on natural images, can directly serve as a powerful, unified encoder for medical vision tasks without domain-specific fine-tuning. To answer this, we benchmark DINOv3 across common medical vision tasks, including 2D and 3D classification, segmentation, and registration on a wide range of medical imaging modalities. We systematically analyse its scalability by varying model sizes and input image resolutions. Our findings reveal that DINOv3 shows impressive performance and establishes a formidable new baseline. Remarkably, it can even outperform medical-specific foundation models like BiomedCLIP and CT-Net on several tasks, despite being trained solely on natural images. However, we identify clear limitations: The model's features degrade in scenarios requiring deep domain specialisation, such as in whole-slide images (WSIs), electron microscopy (EM), and positron emission tomography (PET). Furthermore, we observe that DINOv3 does not consistently follow the scaling law in the medical domain. Its performance does not reliably increase with larger models or finer feature resolutions, showing diverse scaling behaviours across tasks. Overall, our work establishes DINOv3 as a strong baseline, whose powerful visual features can serve as a robust prior for multiple medical tasks. This opens promising future directions, such as leveraging its features to enforce multiview consistency in 3D reconstruction.

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arXiv2026

Assessment of Clonal Hematopoiesis of Indeterminate Potential and Future Cardiomyopathy from Cardiac Magnetic Resonance Imaging using Deep Learning in a Cardio-oncology Population

We propose a novel deep learning framework to identify clonal hematopoiesis of indeterminate potential (CHIP), a somatic mutation condition associated with adverse cardiovascular outcomes, using routine cardiac magnetic resonance (CMR) imaging. Utilizing 152 multi-view late gadolinium enhancement (LGE) scans from 136 cardio-oncology patients, we developed a convolutional neural network to (1) detect CHIP status and (2) stratify the risk of future cardiomyopathy specifically within the CHIP-positive cohort. To ensure robustness, we performed rigorous feature importance analysis to rule out reliance on demographic confounders such as age and immune checkpoint inhibitor usage. The model achieved an AUC of 0.71 for CHIP detection and, notably, an AUC of 0.87 for predicting future cardiomyopathy in CHIP-positive patients, significantly outperforming demographic-only baselines. These results demonstrate the feasibility of using LGE-CMR signatures as a non-invasive "radiogenomic" screening tool, potentially enabling accessible risk stratification and precision medicine for high-risk cardiovascular populations.

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arXiv2025

PET Head Motion Estimation Using Supervised Deep Learning with Attention

Head movement poses a significant challenge in brain positron emission tomography (PET) imaging, resulting in image artifacts and tracer uptake quantification inaccuracies. Effective head motion estimation and correction are crucial for precise quantitative image analysis and accurate diagnosis of neurological disorders. Hardware-based motion tracking (HMT) has limited applicability in real-world clinical practice. To overcome this limitation, we propose a deep-learning head motion correction approach with cross-attention (DL-HMC++) to predict rigid head motion from one-second 3D PET raw data. DL-HMC++ is trained in a supervised manner by leveraging existing dynamic PET scans with gold-standard motion measurements from external HMT. We evaluate DL-HMC++ on two PET scanners (HRRT and mCT) and four radiotracers (18F-FDG, 18F-FPEB, 11C-UCB-J, and 11C-LSN3172176) to demonstrate the effectiveness and generalization of the approach in large cohort PET studies. Quantitative and qualitative results demonstrate that DL-HMC++ consistently outperforms state-of-the-art data-driven motion estimation methods, producing motion-free images with clear delineation of brain structures and reduced motion artifacts that are indistinguishable from gold-standard HMT. Brain region of interest standard uptake value analysis exhibits average difference ratios between DL-HMC++ and gold-standard HMT to be 1.2 plus-minus 0.5% for HRRT and 0.5 plus-minus 0.2% for mCT. DL-HMC++ demonstrates the potential for data-driven PET head motion correction to remove the burden of HMT, making motion correction accessible to clinical populations beyond research settings. The code is available at https://github.com/maxxxxxxcai/DL-HMC-TMI.

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arXiv2025

ETA: Energy-based Test-time Adaptation for Depth Completion

We propose a method for test-time adaptation of pretrained depth completion models. Depth completion models, trained on some ``source'' data, often predict erroneous outputs when transferred to ``target'' data captured in novel environmental conditions due to a covariate shift. The crux of our method lies in quantifying the likelihood of depth predictions belonging to the source data distribution. The challenge is in the lack of access to out-of-distribution (target) data prior to deployment. Hence, rather than making assumptions regarding the target distribution, we utilize adversarial perturbations as a mechanism to explore the data space. This enables us to train an energy model that scores local regions of depth predictions as in- or out-of-distribution. We update the parameters of pretrained depth completion models at test time to minimize energy, effectively aligning test-time predictions to those of the source distribution. We call our method ``Energy-based Test-time Adaptation'', or ETA for short. We evaluate our method across three indoor and three outdoor datasets, where ETA improve over the previous state-of-the-art method by an average of 6.94% for outdoors and 10.23% for indoors. Project Page: https://fuzzythecat.github.io/eta.

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arXiv2025

Snap-and-tune: combining deep learning and test-time optimization for high-fidelity cardiovascular volumetric meshing

High-quality volumetric meshing from medical images is a key bottleneck for physics-based simulations in personalized medicine. For volumetric meshing of complex medical structures, recent studies have often utilized deep learning (DL)-based template deformation approaches to enable fast test-time generation with high spatial accuracy. However, these approaches still exhibit limitations, such as limited flexibility at high-curvature areas and unrealistic inter-part distances. In this study, we introduce a simple yet effective snap-and-tune strategy that sequentially applies DL and test-time optimization, which combines fast initial shape fitting with more detailed sample-specific mesh corrections. Our method provides significant improvements in both spatial accuracy and mesh quality, while being fully automated and requiring no additional training labels. Finally, we demonstrate the versatility and usefulness of our newly generated meshes via solid mechanics simulations in two different software platforms. Our code is available at https://github.com/danpak94/Deep-Cardiac-Volumetric-Mesh.

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arXiv2025

Fréchet Radiomic Distance (FRD): A Versatile Metric for Comparing Medical Imaging Datasets

Determining whether two sets of images belong to the same or different distributions or domains is a crucial task in modern medical image analysis and deep learning; for example, to evaluate the output quality of image generative models. Currently, metrics used for this task either rely on the (potentially biased) choice of some downstream task, such as segmentation, or adopt task-independent perceptual metrics (e.g., Fréchet Inception Distance/FID) from natural imaging, which we show insufficiently capture anatomical features. To this end, we introduce a new perceptual metric tailored for medical images, FRD (Fréchet Radiomic Distance), which utilizes standardized, clinically meaningful, and interpretable image features. We show that FRD is superior to other image distribution metrics for a range of medical imaging applications, including out-of-domain (OOD) detection, the evaluation of image-to-image translation (by correlating more with downstream task performance as well as anatomical consistency and realism), and the evaluation of unconditional image generation. Moreover, FRD offers additional benefits such as stability and computational efficiency at low sample sizes, sensitivity to image corruptions and adversarial attacks, feature interpretability, and correlation with radiologist-perceived image quality. Additionally, we address key gaps in the literature by presenting an extensive framework for the multifaceted evaluation of image similarity metrics in medical imaging -- including the first large-scale comparative study of generative models for medical image translation -- and release an accessible codebase to facilitate future research. Our results are supported by thorough experiments spanning a variety of datasets, modalities, and downstream tasks, highlighting the broad potential of FRD for medical image analysis.

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arXiv2025

Uncovering Memorization Effect in the Presence of Spurious Correlations

Machine learning models often rely on simple spurious features -- patterns in training data that correlate with targets but are not causally related to them, like image backgrounds in foreground classification. This reliance typically leads to imbalanced test performance across minority and majority groups. In this work, we take a closer look at the fundamental cause of such imbalanced performance through the lens of memorization, which refers to the ability to predict accurately on atypical examples (minority groups) in the training set but failing in achieving the same accuracy in the testing set. This paper systematically shows the ubiquitous existence of spurious features in a small set of neurons within the network, providing the first-ever evidence that memorization may contribute to imbalanced group performance. Through three experimental sources of converging empirical evidence, we find the property of a small subset of neurons or channels in memorizing minority group information. Inspired by these findings, we hypothesize that spurious memorization, concentrated within a small subset of neurons, plays a key role in driving imbalanced group performance. To further substantiate this hypothesis, we show that eliminating these unnecessary spurious memorization patterns via a novel framework during training can significantly affect the model performance on minority groups. Our experimental results across various architectures and benchmarks offer new insights on how neural networks encode core and spurious knowledge, laying the groundwork for future research in demystifying robustness to spurious correlation.

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arXiv2025

Using Foundation Models as Pseudo-Label Generators for Pre-Clinical 4D Cardiac CT Segmentation

Cardiac image segmentation is an important step in many cardiac image analysis and modeling tasks such as motion tracking or simulations of cardiac mechanics. While deep learning has greatly advanced segmentation in clinical settings, there is limited work on pre-clinical imaging, notably in porcine models, which are often used due to their anatomical and physiological similarity to humans. However, differences between species create a domain shift that complicates direct model transfer from human to pig data. Recently, foundation models trained on large human datasets have shown promise for robust medical image segmentation; yet their applicability to porcine data remains largely unexplored. In this work, we investigate whether foundation models can generate sufficiently accurate pseudo-labels for pig cardiac CT and propose a simple self-training approach to iteratively refine these labels. Our method requires no manually annotated pig data, relying instead on iterative updates to improve segmentation quality. We demonstrate that this self-training process not only enhances segmentation accuracy but also smooths out temporal inconsistencies across consecutive frames. Although our results are encouraging, there remains room for improvement, for example by incorporating more sophisticated self-training strategies and by exploring additional foundation models and other cardiac imaging technologies.

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arXiv2025

STNAGNN: Data-driven Spatio-temporal Brain Connectivity beyond FC

In recent years, graph neural networks (GNNs) have been widely applied in the analysis of brain fMRI, yet defining the connectivity between ROIs remains a challenge in noisy fMRI data. Among all approaches, Functional Connectome (FC) is the most popular method. Computed by the correlation coefficients between ROI time series, FC is a powerful and computationally efficient way to estimate ROI connectivity. However, it is well known for neglecting structural connections and causality in ROI interactions. Also, FC becomes much more noisy in the short spatio-temporal sliding-window subsequences of fMRI. Effective Connectome (EC) is proposed as a directional alternative, but is difficult to accurately estimate. Furthermore, for optimal GNN performance, usually only a small percentage of the strongest connections are selected as sparse edges, resulting in oversimplification of complex brain connections. To tackle these challenges, we propose the Spatio-Temporal Node Attention Graph Neural Network (STNAGNN) as a data-driven alternative that combines sparse predefined FC with dense data-driven spatio-temporal connections, allowing for flexible and spatio-temporal learning of ROI interaction patterns.

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arXiv2025

Adapting Vision Foundation Models for Real-time Ultrasound Image Segmentation

We propose a novel approach that adapts hierarchical vision foundation models for real-time ultrasound image segmentation. Existing ultrasound segmentation methods often struggle with adaptability to new tasks, relying on costly manual annotations, while real-time approaches generally fail to match state-of-the-art performance. To overcome these limitations, we introduce an adaptive framework that leverages the vision foundation model Hiera to extract multi-scale features, interleaved with DINOv2 representations to enhance visual expressiveness. These enriched features are then decoded to produce precise and robust segmentation. We conduct extensive evaluations on six public datasets and one in-house dataset, covering both cardiac and thyroid ultrasound segmentation. Experiments show that our approach outperforms state-of-the-art methods across multiple datasets and excels with limited supervision, surpassing nnUNet by over 20\% on average in the 1\% and 10\% data settings. Our method achieves $\sim$77 FPS inference speed with TensorRT on a single GPU, enabling real-time clinical applications.

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arXiv2025

Progressive Test Time Energy Adaptation for Medical Image Segmentation

We propose a model-agnostic, progressive test-time energy adaptation approach for medical image segmentation. Maintaining model performance across diverse medical datasets is challenging, as distribution shifts arise from inconsistent imaging protocols and patient variations. Unlike domain adaptation methods that require multiple passes through target data - impractical in clinical settings - our approach adapts pretrained models progressively as they process test data. Our method leverages a shape energy model trained on source data, which assigns an energy score at the patch level to segmentation maps: low energy represents in-distribution (accurate) shapes, while high energy signals out-of-distribution (erroneous) predictions. By minimizing this energy score at test time, we refine the segmentation model to align with the target distribution. To validate the effectiveness and adaptability, we evaluated our framework on eight public MRI (bSSFP, T1- and T2-weighted) and X-ray datasets spanning cardiac, spinal cord, and lung segmentation. We consistently outperform baselines both quantitatively and qualitatively.

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arXiv2025

Causal Modeling of fMRI Time-series for Interpretable Autism Spectrum Disorder Classification

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects social and communicative behaviors. It emerges in early life and is generally associated with lifelong disabilities. Thus, accurate and early diagnosis could facilitate treatment outcomes for those with ASD. Functional magnetic resonance imaging (fMRI) is a useful tool that measures changes in brain signaling to facilitate our understanding of ASD. Much effort is being made to identify ASD biomarkers using various connectome-based machine learning and deep learning classifiers. However, correlation-based models cannot capture the non-linear interactions between brain regions. To solve this problem, we introduce a causality-inspired deep learning model that uses time-series information from fMRI and captures causality among ROIs useful for ASD classification. The model is compared with other baseline and state-of-the-art models with 5-fold cross-validation on the ABIDE dataset. We filtered the dataset by choosing all the images with mean FD less than 15mm to ensure data quality. Our proposed model achieved the highest average classification accuracy of 71.9% and an average AUC of 75.8%. Moreover, the inter-ROI causality interpretation of the model suggests that the left precuneus, right precuneus, and cerebellum are placed in the top 10 ROIs in inter-ROI causality among the ASD population. In contrast, these ROIs are not ranked in the top 10 in the control population. We have validated our findings with the literature and found that abnormalities in these ROIs are often associated with ASD.

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